Medicare Conferees Consider Regulatory Reform
House and Senate conferees began reconciling differences between the
two Medicare Reform bills (HR 1 and S1) in early August but House
Ways and Means Committee Chair William Thomas (R-CA) said the
conferees' wouldn't complete the final product until September.
However, congressional aides have reported that the final Medicare
Reform bill would most likely come in early October. Both bills passed
their respective chambers earlier this year, but must now be combined
to created a final bill for approval of both chambers and the President.
Payment
CMS released the 2004 proposed Medicare Physician Fee Schedule for
comment on August 15. It includes a proposed 4.2% cut in physician
Medicare reimbursements. Since the release of the proposed rule, AMDA
has been working with CMS to address our concerns with the particularly
steep cuts in the reimbursement rates for the nursing home non-facility
E&M codes. In the proposed rule, the non-facility E&M codes
99301 to 99313 appear to be reduced to match the facility (SNF) rates
for the same codes, signaling to AMDA staff that CMS either made a
mistake in the data spread sheets or they decided to remove the site of
service of differential between nursing facilities and skilled nursing
facilities.
The best hope for averting the pay cuts this year, is to maintain
the payment update provisions of the House bill. These provisions would
replace projected cuts in Medicare physician reimbursement for each of
the next two years with updates of at least 1.5 percent. While the
outlook for inclusion of the 1.5 percent update in the final bill
remains positive, without other changes to the formula used to
calculate physician updates, the additional spending in 2004 and 2005
would result in deeper cuts in 2006 and 2007.
AMDA will send comments on the rule to CMS in early September. In
order to shore up support for maintaining the physician payment updates
contained in HR 1, AMDA is asking all state chapters to activate their
grassroots networks in an effort to put pressure on the Medicare
Conferees to keep the House payment provision in the final bill.
Members should go to AMDA's Web site to obtain a model letter and e-mail addresses for each of the conferees.
Regulatory Reform
Conferees allegedly ironed out differences in the regulatory relief
provisions of the two bills last month. The final provisions will
likely include, but not be limited to, the following: ensure that
any new documentation guidelines for evaluation and management codes
are thoroughly pilot tested before they can be implemented as national
policy; require carriers to provide physicians with clear, concise, and
accurate answers to their billing questions; and establish a Medicare
Provider Ombudsmen office to assist providers.
AMDA will continue to send e-mail updates to the membership on this issue. You may go to www.amda.com/federalaffairs to view updates on Medicare payment and other priority issues.
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