Medicare Compliance & Reimbursement

Find out what's wrapped up in the extra $2.2 billion package coming in January.

 The 1.5-percent pay hike for docs is arriving as promised in the 2005 physician fee schedule. And according to the Centers for Medicare & Medicaid Services, physicians have a few other ways to boost their bottom line.
     
Here's a roundup of what you'll see in the upcoming final rule.
     
  "Welcome to Medicare" physical. You can now get paid separately for a screening electrocardiogram in addition to physicals. Also: CMS has given the green light for you to bill for a more extensive office visit provided at the same time as the physical, as long as you can show medical necessity.
     
  Vaccinations and injections. Expect increased reimbursement and coverage - even when the injections are performed on the same day as other Medicare-covered services.

Expanded access. Services provided by psychologists, non-physician professionals and hospice physicians will see new types of coverage.

  Pay restrictions removed. New funding will target low osmolar contrast mediums and clinical costs in certain studies of life-saving investigational devices.

In-office drug administration. You'll be reimbursed at rates more than 120 percent higher than in 2003, and new codes will allow more chances to bill for these services. "For the first time, we're going to pay accurately for the drugs and for their administration, " claims CMS Administrator Mark McClellan.

Part B drugs. New payment rates will be set at 106 percent of the average sales price based on the most recent quarterly data from manufacturers.

Physician "scarcity" areas. You could see a 5-percent quarterly incentive payment if your area is listed on the CMS Web site at www.cms.hhs.gov/providers/bonuspayment.
     
The final rule will be published in the Nov. 15, 2004 Federal Register.
     
Lesson Learned: Doctors can rely on new benefits and a boost in pay this January.