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Payment Matters
July 14, 2011
Calendar Year 2012 Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Proposed Rules Released by CMS
By: Mark A. Stanley
CMS recently released its Calendar Year (CY) 2012 Proposed Rule for outpatient services furnished in hospitals and ASCs. Among the highlights in the proposed rule are an exception process for expansion of physician-owned hospitals, which is otherwise strictly limited by the Affordable Care Act (ACA), and modifications to the Hospital Value-Based Purchasing program. The proposed rule may be viewed here [PDF]. Comments on the Proposed Rule must be received by CMS no later than 5 PM EDT on August 30, 2011.
Click to continue...CMS Releases its Calendar Year 2012 Physician Fee Schedule Proposed Rule
By: Mark A. Stanley
CMS has released its Calendar Year (CY) 2012 Proposed Rule for practitioners who are paid under the Physician Fee Schedule (PFS). The proposed rule would impact a variety of methodologies used to calculate physician payment, including the adjustment for geographic differences in practice expenses and the payment rates for the professional component of multiple advanced diagnostic imaging procedures. The proposed rule may be viewed here [PDF].
Click to continue...CMS Proposes Rule on Signature on Laboratory Requisitions – A Trip Back to the Future
By: Robert E. Mazer
In a previous Payment Matters article, we reported that CMS had instructed its Medicare contractors not to enforce the requirement that it had included in the Medicare Physician Fee Schedule Rule (MPFS) for calendar year 2011, requiring a physician or qualified non-physician practitioner (NPP) to sign the requisition for a clinical diagnostic laboratory test. "CMS Sign-Off - No Enforcement of Physician Signature Requirement on Lab Requisitions" (April 28, 2011). We indicated that rescission of the requirement might, however, require the agency to comply with Administrative Procedure Act (APA) notice and comment requirements. That has turned out to be the case.
Click to continue...Proposed Changes to the eRx Incentive Program – Too Little, Too Late?
By: Sarah E. Swank and Joshua J. Freemire
Providers frustrated with the apparent disconnects between the Electronic Prescribing (eRx) and Electronic Health Record (EHR) programs may receive relief under a new proposed eRx incentive program rule [PDF] (the NPRM). The NPRM promises to: (1) modify the eRx program’s functional definition of a “qualified” eRx system to permit the use of “certified” EHR technology under the EHR program, (2) provide additional significant hardship exemption categories for eligible professionals or group practices requesting exemptions from 2012 payment adjustments and (3) extend the deadline for submitting requests for consideration for certain significant hardship exemption categories for the 2012 eRx payment adjustments. Comments on the proposed changes to the eRx incentive program are due on July 25, 2011, and providers must request hardship exemptions under the new proposed extended deadline, of October 1, 2011.
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