July 15th, 2008

Congress overrides veto; Medicare payment bill becomes law
 
The Senate has voted 70 to 26 to override the president’s veto of the Medicare Improvement Act for Patients and Providers (H.R. 6331). This action follows a successful override vote earlier today by the House of Representatives.
 
Success was only achieved due to an extraordinary grassroots effort by Medical Group Management Association (MGMA) members, the American Medical Association, medical specialties, senior citizens and military families. The bill achieves two of MGMA’s top advocacy objectives for 2008.
 
First, it reverses the 10.6 percent payment cut that went into effect on July 1 and halts the 5.4 percent cut scheduled for Jan 1, 2009.
 
Second, Congress addressed a severe operational deficiency in the Medicare Advantage (MA) program.  Currently, Medicare Advantage private fee-for-service (PFFS) plans are not required to establish traditional provider networks. This has created tremendous beneficiary confusion and provider distrust. H.R. 6331 makes significant improvements to the program by eliminating the ability of PFFS plans to “deem” physicians where there are two or more MA plans in an area beginning in 2011. This change in the law is the direct result of MGMA’s two-year grassroots campaign to revise unfair MA contracting policies.
 
MGMA is working with Congress and the Centers for Medicare & Medicaid Services to address the administrative difficulties caused by the delay in passage of this legislation.

June 2nd, 2008
 
CMS rescinds changes to incident-to billing rules
 
On May 30, the Centers for Medicare & Medicaid Services (CMS) announced its decision to rescind a recent transmittal on incident-to billing guidance. This action is a direct result of advocacy efforts led jointly by the Medical Group Management Association (MGMA) and the American Medical Association. This effort, supported by 30 other physician organizations, prompted CMS to consider the issue more thoroughly. In addition to rescinding the transmittal, the agency announced its intention to release a new transmittal at a future date.
 
Despite CMS’ contention that Transmittal 87 served only to clarify the agency’s incident-to billing rules, it would have, in fact, changed them significantly. The policy, originally released with little notice and education for providers, included:
 
*    Increased reliance on the discretion of Medicare contractors to determine whether a service by a nonphysician provider can be billed incident to a physician’s care;
*    A narrow definition of “clinic,” which appears to limit the provision of incident-to services in clinics other than those that are physician-owned and operated; and
*    Administratively burdensome documentation requirements, such as explicit documentation in patient medical records of credentials of clinical personnel performing incident-to services.
 

CMS intends to examine its incident-to billing guidance and has not ruled out changes to these rules. MGMA will continue to work with CMS and the physician community to ensure that any changes to incident-to billing rules make sense and that the agency will provide adequate notice and education before the new policy takes effect.

Read the physician community’s letter to CMS. http://www.mgma.com/article.aspx?id=19074