The National Association for Medical Direction of Respiratory Care

The Washington Watchline

Pulmonary Rehabilitation and Site Neutral Payment

The controversy continues over a government proposal to no longer pay for services provided through hospital outpatient departments at a higher rate than physicians’ offices. Physicians and hospitals continue to line up on opposite sides of the fence. The Alliance for Site Neutral Payment Reform, which includes the American Academy of Family Physicians, American College of Physicians and the U.S. Oncology Network, has released statements supporting the Centers for Medicare & Medicaid Services (CMS) new policy.

The OIG Report on Medicare Claims for Home Ventilators

The Office of Inspector General of the Department of Health and Human Services (HHS OIG) has just released its study of Medicare billing trends for home ventilators from 2009 to 2015. This report was requested by one or more of the Durable Medical Equipment Medicare Administrative Carrier (DME MAC) medical directors as part of an aggressive campaign to curb errors and fraud in the Durable Medical Equipment (DME) program.

Political Party Health Platforms

The Centers for Medicare and Medicaid (CMS) has recently released a projection of health expenditures over the next decade. According to the report from the Centers for Medicare & Medicaid Services’ Office of the Actuary, total health care spending growth is expected to average 5.8 percent annually over the next decade. While the projected cost of healthcare will not be rising as fast as it was in the last several decades it is still projected to rise faster than the cost of other goods and services.

Medicare’s Proposed Fee Schedules for 2017

The proposed Hospital Outpatient Prospective Payment for 2017 (HOPPS) and the proposed Physician Fee Schedule for 2017 (MPFS) were published by the Centers for Medicare and Medicaid (CMS) in the Federal Register on July 14 and July 15 respectively. The proposed rules and regulations address issues which we have discussed in previous editions of the Washington Watchline. One of the principle issues addressed in the HOPPS is the issue of Provider Based Billing. 

The New World of Alternate Payment Models

As noted in last month’s Washington Watchline, and often repeated in notices from the Centers for Medicare and Medicaid Services (CMS), it is the intent of the Administration to shift Medicare physician compensation out of fee for service and into Alternate Payment Models (APMs). The goal is to have this completed by 2025. The process begins in 2017 with the implementation of the financial levers established by the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA).

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