The National Association for Medical Direction of Respiratory Care

The Washington Watchline

Increased Scrutiny of Hospital Acquired Physician Offices

The January issue of NAMDRC’s Washington Watchline usually deals with areas of our practice that will be under scrutiny by the Health and Human Services Office of Inspector General (HHS OIG) for the coming year. The recently released HHS OIG 2015 Workplan proposes no new projects for 2015. However, one high profile project worth commenting on is the ongoing review of provider-based billing for services delivered in physician offices and the new billing requirements mandated by the Centers for Medicare and Medicaid Services (CMS) in the 2015 Physicians Fee Schedule.

Will the 2015 Changes to the Medicare Physicians Fee Schedule Improve Medical Care?

CMS released the 2015 calendar year Physician Fee Schedule (PFS) final rule on Halloween, October 31st . Following the publication of the proposed rule last summer, detailed comments were submitted to the Centers for Medicare and Medicaid Services (CMS) by the Medicare Payment Advisory Commission, The American Medical Association, The American College of Physicians, The American College of Cardiology, The Society of Thoracic Surgeons, The Association of American Medical Colleges, The American Hospital Association and the Medical Group Management Association among others.

The Physician Payment Sunshine Act/Open Payments Program

In 2007, following several high profile investigations by federal agents into financial relationships between physicians and industry resulting in criminal charges and convictions, Senators Charles Grassley and Herbert Kohl introduced The Physician Payment Sunshine Act .

CMS Methodology for Measuring Physician Costs

Over the last three years, CMS has been developing the value-based payment modifier (VBPM) for the Medicare Physician Fee Schedule. The Affordable Care Act requires the VBPM to be phased in beginning in 2015 and be complete in 2017, when it would apply to all physicians.

The Impact of Comparative Effectiveness Research

With passage of The American Recovery and Reinvestment Act of 2009 (ARRA 2009) Congress authorized the Administration to spend $1.1 billion to develop a federally directed Comparative Effectiveness Research (CER) program. The majority of the initial expenditures were directed toward improving the capacity to conduct comparative effectiveness research through the establishment of a nationwide research architecture.

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