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Payment Matters
November 18, 2010
CMS's Outpatient Supervision Rules – A Moving Target
By: Thomas W. Coons
The Centers for Medicare and Medicaid Services (CMS) has long taken the position that, in order for outpatient hospital services to be covered by Medicare, the services must be supervised by a physician or, in some instances, by a non-physician practitioner. The extent to which that supervision must be demonstrated, however, has been a moving target. In the 2000 Outpatient PPS Rule — that is, the original provider-based rule — CMS said that supervision was presumed to be present if the outpatient service was furnished in the hospital or in a provider-based department located on the hospital's main campus. Thus, most people fairly assumed that the supervision requirement did not pose a significant issue, at least for outpatient services furnished in a hospital or in an on-campus, provider-based location of the hospital. That changed, however, in 2008 when CMS did an about face and began requiring, as a condition of coverage, that hospitals be able to demonstrate physician supervision of outpatient services. No longer was it presumed that hospital outpatient services were supervised even when those services were furnished on the campus of the hospital. CMS's 2008 position created considerable consternation, and since that time CMS has adjusted its position regarding supervision with each OPPS update. These changes are most recently reflected in FFY 2011 Final Outpatient PPS Rule, which went on display November 2, 2010, and will be published in the Federal Register on November 24, 2010.
Click to continue...Therapy Changes, Face-to-Face Encounter Provisions and Enrollment Changes are Highlights of CY 2011 Home Health PPS Final Rule
By: Carel T. Hedlund
Home Health Agencies (HHAs) have many challenges ahead as they deal with the requirements of the CY 2011 Final Rule for the Home Health Prospective Payment System (PPS) [PDF]. Among other things, this Rule implements the requirement of the health reform legislation that certifying physicians have face-to-face encounters with patients in order to certify the need for home health services. It also revises assessment and documentation requirements for therapy services, and enrollment requirements for HHAs.
The Final Rule includes the following changes, among others:
Physician Face-to-Face Encounter As Condition of Payment (42 C.F.R. §424.22)
- Finalizes statutory requirement for physician face-to-face encounter with patient before physician certifies that patient is homebound and needs skilled care.
Deficit Reduction Commission Recommends Cuts to Federal Health Care Costs
By: Susan A. Turner
On November 10, 2010, the National Commission on Fiscal Responsibility and Reform, a bipartisan commission created by President Obama to address the fiscal challenges facing this country, issued a draft co-chairs' proposal [PDF] intended to reduce the federal deficit to sustainable levels by 2015, and to balance the budget by 2037.
The co-chairs of the Commission explained that they were recommending that "ALL excess spending" be cut, even if that spending is in traditional entitlement programs, and they specifically identified the "reduction in long-term growth in health care costs" as a goal of the proposal. The draft includes a Five Part Plan, with the control of health care costs playing a front-and-center role as a mandatory linchpin of the proposal.
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