Payment Matters

November 8, 2007

CMS Unveils 2008 Physician Fee Schedule

By: Laurence B. Russell, Paul W. Kim, and Donna J. Senft

On November 1, 2007, the Centers for Medicare and Medicaid Services ("CMS") posted on its website the 2008 Medicare physician fee schedule ("MPFS") final rule. These regulations will be published in the Federal Register on November 27, 2007, and become effective January 1, 2008. Overall, most physicians generally will encounter an average of 10.1 percent reduction in reimbursement next year. However, most anesthesiologists generally will notice an increase in payments for their work by an average of 32 percent. Likewise, most physicians who make house calls generally will benefit from the increase in their work relative value units ("RVUs").

CMS Puts Clinical Trial Policy On Hold Again

By: Christine M. Morse

CMS has now twice proposed to reconsider the clinical trial policy, and twice it has been unable to issue a new Final National Coverage Determination. CMS issued a Proposed Decision Memorandum for Second Reconsideration of the Clinical Trial Policy ("Proposed Second Reconsideration Memorandum") on July 19, 2007. The Final National Coverage Determination on the Proposed Second Reconsideration Memorandum was to be made by October 17, 2007, but review of public comments and new federal legislation caused CMS to issue a new Decision Memo for Clinical Trial Policy (CAG-00071R2) on October 17, 2007 ("October 17 Decision Memo").

Requests for Approval for All Hospital Transplant Programs Due by December 26

By: Leslie Demaree Goldsmith

CMS published final regulations on March 30, 2007, authorizing the survey and certification of hospital organ transplant programs. Under the new regulations addressing conditions of participation, all hospital transplant programs that wish to participate with Medicare must submit a request to CMS for approval no later than December 26, 2007. The necessity to submit such a request applies not only to new programs, but to all existing programs approved for Medicare participation as of June 28, 2007 (either under the ESRD Conditions for Coverage or the National Coverage Decisions).