Medicare Compliance & Reimbursement

Physicians can catch their breath; CMS presses on toward preventive care.

What's on tap for physician reimbursement in 2005?

A more "modern Medicare," according to the Centers for Medicare & Medicaid Services. That translates to new coverage of preventive treatments and an across-the-board, 1.5-percent increase in physician payment rates.
     
Total Medicare spending for physicians and other health care professionals will increase by more than 4 percent from $52.7 billion in 2004 to a projected $55.0 billion in 2005, a July 27 release said.
     
Here's a sneak peek at the impending proposed fee schedule:
 
  Five percent "incentive payments" to doctors practicing in physician scarcity areas with the lowest physician to beneficiary ratios;
 
  telehealth billing which reimburses physicians who make monthly visits to beneficiaries on dialysis via telecommunications equipment;
     
  expanded coverage of a broader array of health care professionals, such as psychologists who administer and supervise diagnostic psychological tests;
     
  home health care payments for non-physician professionals (nurse practitioners, physician assistants, clinical nurse specialists) who provide care plan oversight;
     
coverage of a one-time evaluation and counseling from a hospice physician for end-of-life services; and
     
eliminated restrictions on payment for higher-cost treatments including low osmolar contrast materials and routine clinical costs in studies of life-saving investigational devices.
 
The proposed rule would also reverse CMS's "backwards" stance on preventive medicine, says Health and Human Services Secretary Tommy Thompson. Up to now Medicare has spent only 1 percent of its resources on disease prevention and management.
     
"Medicare will have the most comprehensive array of preventive benefits ever, including coverage of a Welcome to Medicare exam and screening for heart disease, diabetes, weak bones, and cancers of the colon, breast, cervix and prostate, as well as vaccinations for influenza, pneumonia and hepatitis B," said CMS Administrator Mark McClellan.
 
CMS will also reimburse cardiovascular and diabetes screening blood tests. The proposed rule was published in the August 5, 2004 Federal Register, with comments accepted until September 24.

 Lesson Learned: Providers can expect fees to hold steady and CMS to slant coverage in favor of preventive treatments.