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January 25, 2018


Four Tests Added to List of CLIA Waived Tests

In early January, the Centers for Medicare and Medicaid Services (CMS) announced new waived tests... Learn More


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OIG Recommends Measures for Curbing Opioid Misuse and Fraud

Office of Inspector General testimony before the House Committee on Ways and Means in January ... Learn More


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Medical Coding News Archives

Proposed Reduction to Medicare Physician Fee Schedule for 2009

 
July 8, 2008:
Once again, providers face a possible reduction in rates, according to the proposed revisions to the 2009 Medicare physician fee schedule (MPFS) released on June 30th. The Centers for Medicare & Medicaid Services (CMS) is proposing a reduction of 5.4 percent in physician fee schedule payment.

Another portion of the rule that could dramatically affect physician practices is a proposal by the agency to improve the quality of diagnostic testing performed by physicians and nonphysician practitioners in their offices. This would require them to enroll as suppliers of these services and to meet certain quality and performance standards, including applicable federal and state licensure and health and safety requirements that currently apply to independent diagnostic testing facilities (IDTFs). The agency maintains that the requirement is necessary to ensure that patients are receiving the quality of care that can be administered only by appropriately licensed or credentialed nonphysician personnel.

According to the proposal, the quality and performance standards would become effective January 1, 2009, for newly enrolling suppliers but allow existing suppliers until September 30, 2009, to come into compliance. Failure to enroll as an IDTF and meet the provisions could result in claim denials for the diagnostic test or a revocation of the provider’s billing privileges. The proposal specifically seeks public comment about whether these standards should apply to [bold]all[end bold] diagnostic services or to a subset of services such as those that require more costly testing and equipment, all imaging services, or only advanced imaging techniques.

CMS will accept comments on the proposed rule until August 29, 2008, and will respond to those comments in a final rule to be issued by November 1, 2008. The revised policies and payment rates become effective January 1, 2009.

Deborah C. Hall
Clinical/Technical Editor

 

 
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