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Current Health Policy Issues Updated March, 2015
NAMDRC continues to work on various legislative and regulatory issues impacting pulmonary medicine.
Legislative: S. 488, introduced by Senators Schumer and Crapo, would permit non physician practitioners to supervise pulmonary rehabilitation programs. Under current policy, CMS interprets the Medicare statute to preclude such supervisory options to hospitals, requiring a physician to supervise these programs. Physician supervision is distinctly different from the medical director responsibilities even though the same person might fulfill both regulatory requirements.
Regulatory Issues: It is difficult to list all of the issues of importance to NAMDRC members as the interests are varied.
Here is an abbreviated list, and if you are unable to locate specific regulations that may be of interest to you, contact the NAMDRC Executive Office at 703-752-4359 or Execoffice@namdrc.org
Medicare Manuals (claims processing, benefit policies, NCDs, etc)
RADs Policy Article, effective 10/1/2015
The complexity of our nation’s health care system in general, and Medicare in particular, create a true challenge for physicians and their office staffs. One of NAMDRC’s key strengths is to offer assistance on a myriad of coding, coverage and payment issues.
NAMDRC has won praise with its track record with government agencies, most notably the Centers for Medicare and Medicaid Services (CMS). The majority of NAMDRC members agree that NAMDRC’s voice before regulatory agencies and legislators has been the #1 reason for belonging to and continuing membership.
That effective voice is translated into providing members with timely information, identifying important Federal Register announcements, pertinent statements and notices by the Centers for Medicare and Medicaid Services, the Durable Medical Equipment Regional Carriers, and local medical review policies.
NAMDRC has been a successful advocate on these issues:
- Obtaining a change in the Medicare physician update, resulting in an increase, rather than a decrease, in the conversion factor used to determine payments to physicians
- Securing new CPT codes for placement of tracheal and bronchial stents, placement of additional stents in another main bronchus, endobroncial ultrasound, and high altitude simulation testing (HAST) and HAST with oxygen titration
- Increasing the work valve for Transbronchial Needle Aspiration biopsies
- Working to secure Medicare coverage of smoking cessation counseling
- Collaborating to assist CMS in better defining critical care services and teaching physicians’ documentation of these services.
NAMDRC’s advocacy focuses on issues of immediate importance to you and your patients. NAMDRC continues to:
- Monitor changes in the Medicare Physician Fee Schedule and the current five (5) year review of selected pulmonary related codes
- Monitor development of pay-for-performance models
- Advocate the adoption of a national coverage policy for pulmonary rehabilitation
- Advocate a change in Medicare policy to ensure that home oxygen patients receive the delivery system most appropriate for the patient’s needs
In response to NAMDRC pressure, the final rule published by the Department of Transportation that permits oxygen users to bring their own portable oxygen concentrators on board can be viewed here.