Health Law Monitor

CMS Announces Cut in Physician Reimbursement Rates and Changes to Supervision Requirements for Outpatient Services

CMS issued the 2011 Medicare Physician Fee Schedule final rule, which cuts physician reimbursement by 24.9% between November 2010 and January 2011. Additionally, CMS recently released its 2011 Outpatient Prospective Payment System final rule setting forth several changes to physician supervision requirements for hospital outpatient services to take effect on January 1, 2011.

Important Changes to Medicare Secondary Payer Electronic Reporting Rules

The Centers for Medicare and Medicare Services ("CMS") announced that it is extending the date for electronic reporting under the Medicare Secondary Payer rules for all Non-Group Health Plans from April 1, 2010 to January 1, 2011.

CMS CLARIFIES SUPERVISION REQUIREMENTS FOR OUTPATIENT SERVICES

CMS recently released its 2010 Outpatient Prospective Payment System (“OPPS”) rule clarifying the requirements for supervision of certain hospital outpatient services. The rule makes clear that if direct physician supervision is required for the performance of an outpatient service, this level of supervision may not be assumed to exist in a hospital setting. Rather, a hospital must establish a plan or policy to ensure that the direct supervision required by the Centers for Medicare and Medicaid Services (“CMS”) for a particular outpatient service is available. Read More.

Medicare Revs Up Secondary Payer Enforcement

 

 “Medicare Secondary Payer” is the term used when the Medicare program does not have primary payment responsibility for medical claims (that is, another entity has the responsibility for paying a medical claim before Medicare). Current law makes Medicare the secondary payer to group health plan coverage in certain situations, and the secondary payer to all forms of liability insurance (including self-insurance), no-fault insurance, and workers’ compensation.