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AAPC Jan. 16, 2008
Edge Blast Header Issue #93
Top Stories

Big Changes to MPFS Payment Rates

Error Delays Anti-markup Provisions

OIG Reviews Prescription Reimbursement

Test Yourself - Earn 0.5 CEUs

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Michelle Dick
EdgeBlast Editor

Top News

Big Changes to MPFS Payment Rates

There are new payment rates in 2008 for services paid under the Medicare Physician Fee Schedule (MPFS).  With the payment rate changes comes an extension of the participation and a lot of questions from providers.

The Medicare, Medicaid and State Children’s Health Insurance Program (SCHIP) Extension Act of 2007 made several changes affecting payments to physicians. Instead of the (negative) -10.1 percent change that was originally scheduled to take place between the dates of service beginning Jan. 1 through June 30, 2008, the effective changes are a 0.5 percent increase to the physician fee schedule conversion factor for those dates. The (negative) -10.1 percent update to the physician fee schedule will go into effect for service dates rendered on and after July 1, 2008.

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Error Delays Anti-markup Provisions

On Dec. 28, 2007, CMS noted a typographical error in the final rule delaying the application of the revised anti-markup provisions for certain services provided in certain locations at 42 C.F.R. § 414.50 until Jan. 1, 2009. Inadvertently, the word "except" was omitted from Section III of the final rule CMS-1385-F2 and displayed at the Office of the Federal Register on Dec. 28, 2007. The final rule was effective as of January 1, 2008, and was published in the Federal Register on Jan. 3, 2008.

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OIG Reviews Prescription Reimbursement

On Jan. 10, 2008, The Office of Inspector General (OIG) posted on its website a review issued on Jan. 3, 2008 requested by 33 Senators. The review revealed that Medicare Part D payments to local, community pharmacies exceeded pharmacies’ drug acquisition costs by an estimated 18.1 percent when wholesaler rebates were included. The findings also showed that Medicare Part D payments exceeded drug acquisition costs by an estimated 17.3 percent when rebates were excluded. The difference between Part D payments and drug acquisition costs was estimated at $9.13 per prescription including rebates and $8.78 excluding rebates.

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Test Yourself - Earn 0.5 CEUs

By answering the following questions, you can earn 0.5 continuing education units to apply toward your annual AAPC CEU renewal every two years. Simply answer the questions and list this as one of your itemized CEUs on your CEU form. If you are chosen for verification, we will then ask you to send in a copy of your work.  Please put the number of each EdgeBlast included in your submission. The number is available at the top of the page.

Answers to the questions are not always found directly (word for word) in the EdgeBlast in which they appear. While often related to the EdgeBlast content, they require additional resources such as your ICD-9-CM, CPT® and HCPCS Level II manuals.

Index # EB01022008A

1. What is the percent increase to the MPFS for physician services rendered between Jan. 1, 2008 through June 30, 2008?

Answer:

2. When does the (negative) -10.1 percent for physician's services rendered go into effect?

Answer:

3. Medicare Part D dispensing fee at about $2.27 per prescription was approximately how much less than the average Medicaid dispensing fee?

Answer:

4. What section of the final rule CMS-1385-F2 was the word "except" omitted from?

Answer:

5. When are the applicability of the provisions of 414.50, as revised at 72 FR 66222, with certain exceptions, delayed until?

Answer:

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