Keep an eye out for early legislative developments that could put you at risk.
Congress can't agree on much this year, but legislators do seem to want to move forward on a fix for physicians' Medicare payment rates--and that could put your own Medicare reimbursement at risk.
In December, Congress passed and President Bush signed into law a Medicare package that averted docs' 10 percent pay cut under Medicare. Home care providers pulled out a victory by avoiding cuts to their own 2008 rates, despite heavy consideration of such reductions by lawmakers.
But the current legislation staves off the cut only until July 1. That means lawmakers will have to put together another Medicare package before then to avoid the cut again. And they will be looking for likely sources of funding for the fix--especially home health agencies and durable medical equipment suppliers. The Medicare Payment Advisory Commission's forthcoming recommendation to freeze Medicare rates in 2009 won't help agencies' case.
Some observers predict that Congress will hold off on a Medicare package until after the November elections. Getting anything passed in an election year is a big challenge, they note. Such a post-election package would include retroactive pay increases for physicians to make up for the months of reduced Medicare rates, they say.
But others think there is enough political momentum to pass a physician fix--and thus other provider payment provisions--before the July 1 cut takes effect.
Watch for: President Bush is expected to unveil his proposal for a broader physician formula fix in his State of the Union address Jan. 28. And the Administration will include the measure in next month's 2009 budget proposal. • If you're having trouble getting your referring physicians' National Provider Identifier (NPI) numbers, don't despair. The Centers for Medicare & Medicaid Services has relented and given providers a work-around when they just can't obtain NPIs from their referring docs, according to Jan. 18 Transmittal No. 235 (CR 5890).
"After several attempts to obtain the NPI" from the ordering/referring provider, providers "can report their own name and NPI in the ordering/referring ... provider fields of the claims," CMS says in the memo.
"Contractors shall accept the supplier's own name and NPI in the ordering/referring ... provider fields, effective for claims with dates of receipt on or after May 23, 2008," CMS states. But home health agencies, hospices and durable medical equipment suppliers will have to do the substituting themselves--Medicare contractors won't automatically fill the field with the primary provider's NPI, the memo instructs.
And CMS still expects providers to make every effort to obtain NPIs, it makes clear in a related MLN Matters article.
The memo is at
www.cms.hhs.gov/transmittals/downloads/R235PI.pdf. The MLN Matters article is at
www.cms.hhs.gov/MLNMattersArticles/downloads/MM5890.pdf. • The feds' latest count [...]
