In this issue’s View From Washington, Dr. Robert Betz looks at recent developments regarding the implementation of key provisions of the Patient Protection and Affordable Care Act (PPACA). The following looks at other implementation information, as well as proposed MD fee schedule rule.
Other Health Reform-Related Implementation Information
Provision: Additional Requirements for Tax-Exempt Hospitals.
Impacted Entities: 501(c) (3) hospitals.
Summary: In IRS notice 2010-39, the IRS is requesting comments regarding the application of new requirements for tax-exempt 501(c) (3) hospitals. These new requirements include: (1) conducting a community health needs assessment ever three years and adopting an implementation strategy to meet the health needs of the community; (2) establishing a written financial assistance policy and a written policy relating to the provision of emergency care to individuals eligible for financial assistance; (3) limiting amounts charged for emergency care that is provided to individuals eligible for assistance under the organization’s financial assistance policy to no more than amounts generally billed to insured patients; and (4) foregoing extraordinary collection actions against an individual before the hospital has made reasonable efforts to determine whether the individual is eligible for financial assistance. Comments must be submitted to the IRS by July 22, 2010.
CMS Releases Proposed MD Fee Schedule Rule
CMS just released the 2011 Medicare physician fee schedule proposed rule. This rule, in addition to containing the standard annual revisions to the fee schedule, implements several provisions from the Affordable Care Act. The following are some of the key Affordable Care Act provisions affecting Medicare payment to physicians included in this proposed rule:
- The sustainable growth rate formula (SGR) will be reduced 6.1%. By Congressional action, physicians will receive a 2.2% update from June 1 through November 30, 2010.
- Medicare will cover an annual wellness visit between a physician and Medicare beneficiary. This annual wellness visit includes the creation of a personalized prevention plan.
- The Part B deductible and 20% cost-sharing requirement are eliminated for preventive services receiving a grade of A or B from the U.S. Preventive Services Task Force, the annual wellness visit, and the initial “Welcome to Medicare” preventive physical examination.
- A 10% incentive payment will be paid for certain primary care services and for general surgeons operating in Health Professional Shortage Areas (HPSAs).
- The in-office ancillary services exception to the self-referral law, as applied to MRI, CT scans, and PET scans, is modified to require the physician to disclose to the patient at the time of the referral that there are other suppliers of these imaging services. CMS is proposing that the referring physician provide a list of ten alternative suppliers to the patient.
- The equipment utilization rate assumption for expensive diagnostic imaging equipment used in CT and MRI services is increased to 75%.
- Beginning July 1, 2010, the reduction for the technical component of certain imaging services to contiguous areas of the body is increased from 25% to 50% for the second and subsequent imaging procedures when performed in the same session.
- The maximum period for submission of Medicare claims is reduced to not more than 12 months, effective for services furnished on or after January 1, 2010. However, CMS is proposing that claims for services furnished during the last three months of 2009 must be filed no later than December 31, 2010.