REIMBURSEMENT INFORMATION

Updated: December 18th, 2002 URGENT UPDATE INFORMATION FROM CMS! MEDICARE: The 2003 Medicare Physician Fee Schedule is expected to be released by Dec. 17 or 18, said Thomas Scully, Centers for Medicare and Medicaid Services Administrator at both the Physician Open Door Forum and Practicing Physician Advisory Council held Dec. 16. The fee schedule is not in today’s Federal Register, therefore barring any more glitches, it should be released tomorrow. The fee schedule is supposed to take effect 60 days after publication, which now means mid February, however Scully said CMS would try to seek an extension to March 1. Scully said he is not happy with the 4.4% pay reduction physicians will face when the fee schedule does go into effect. Scully said we have a “disaster” on our hands with the fee schedule. Scully worries that there will be a big drop off in physician participation and patients will lose access to physicians. He hopes Congress will fix the problem before March 1. He believes the problem will be fixed and the administration is 100% behind the fix. The issue may be raised in the President’s budget. With a correction to the payment update, doctors would see a 1.6% increase. (Information provided by the AOA) MEDICAID: The 2003 Medicaid fee schedules will NOT be effective January 1, 2003 . The Centers for Medicare and Medicaid Services (CMS) have delayed the release of the 2003 relative value units (RVUs) which assist in the calculation of the 2003 procedure code reimbursement for practitioners and other fees associated with HCPCS procedure codes. It is anticipated the 2003 Medicaid fee schedule will be effective February 1, 2003. Should that date be postponed, for reasons beyond our control, you will be notified. (Information provided by Florida's Agency for Health Care Administration, http://www.fdhc.state.fl.us . via the Florida Osteopathic Medical Association.) INTRODUCTION This page is designed to provide you with information on reimbursement issues. Read the entire article and check the relevent FAQ sections and you will find the answer to your questions most of the time. If it is not there or you need clarification, then please contact us. It is updated on a regular basis as new information becomes available, and as legislative changes are made, or as needed with changes by other regulatory agencies. If this issue is vital to you please keep checking back with us for updates as they are posted. Don't forget to hit the refresh button to enable you to load the latest updated page. You will need Adobe Acrobat Reader to view some of these documents. If you do not have it installed on your computer, click this link to obtain it free. Please contact us if you would like to suggest additional information to include on this page, or if you have a question that is not addressed in the information furnished below or in one of the links. Reimbursement Problems? FAPA Wants To Know FAPA is building a database of problems that PAs in Florida are having in getting reimbursed for their services. Click on the link below to report these problems to us. Report of Reimbursement Issues Information From The AAPA The American Academy of Physician Assistants has some excellent information on its' website in regards to reimbursement issues. Click on the link below to go view their information. The topics included in this site are: AAPA Reimbursement Seminars Third-Party Reimbursement for Physician Assistants Balanced Budget Act of 1997 - PAs and Medicare Expanded Coverage for Medical Services Provided by PAs Under Medicare Medicare Billing for Medical Services Provided by PAs in Hospitals & Hospital Emergency Departments Medicare Billing for Teaching Physicians PAs as Medicaid Managed Care Providers The State Children's Health Insurance Program Rural Health Clinics PAs and Innovative Solutions for Rural Hospitals Antitrust Issues: Antitrust Implications of Negotiating with Third-Party Payers Antitrust Issues: Coverage and Payment for Services Private Insurance Companies AAPA Reimbursement Information. Back To The Top Centers for Medicare and Medicaid Services (CMS) Introducing CMS As of July 1, 2001, the Health Care Financing Administration (HCFA) is now the Centers for Medicare & Medicaid Services (CMS). It's more than just a new name - it's an increased emphasis on responsiveness to beneficiaries and providers, and quality improvement. Health and Human Services Secretary Tommy G. Thompson made the announcement on June 14, 2001. "We're making quality service the number one priority in this agency," Thompson said. "These sweeping reforms will strengthen our programs and enable our dedicated employees to better serve Medicare and Medicaid beneficiaries, as well as health care providers. We're going to encourage innovation, better educate consumers about their options, and be more responsive to the health care needs of Americans." Three new business centers are being established as a part of the reform: the Center for Beneficiary Choices, the Center for Medicare Management, and the Center for Medicaid and State Operations. The new CMS will launch a national media campaign this Fall to educate seniors and other Medicare beneficiaries about their options, allowing them to make better decisions. Beginning October 1, 2001, the Medicare 800 number (1-800-633-4227) is being enhanced to provide service to beneficiaries 24 hours a day, seven days a week. "More changes are on the way," Secretary Thompson stated. "We're going to keep fine-tuning this department so Americans are receiving the highest quality health care possible." Here is a link to the CMS website where you can get the information you need on Medicare and Medicaid. They have a new service now that provides you online updates on changes in rules and procedures and you can sign up to receive email notification also. CMS Homepage On the Web And here is a link direct to the Updates from CMS. CMS Update On the Web New AAPA Medicare Coverage and Billing Web Presentation The AAPA Website presents a new audio and slide show on Medicare coverage and billing requirements for PAs. Ron Nelson, Past President of the AAPA, reviews the major changes that have occurred in Medicare's coverage policies and the detailed rules and requirements in order to bill appropriately. To view this presentation, click here. (From the AAPA E-News 4/5/02) New AAPA Medicare & Billing Web Presentation To obtain a Medicare Provider application, please log on to: Obtain Medicare Enrollment Forms To obtain a Florida Medicaid Provider Application, please call 1.800.377.8216. From the AAPA's Reimbursement Watch Reimbursement Watch is a bi-monthly newsletter written by Michael Powe, AAPA Director of Health Systems and Reimbursement Policy. They will be placed available on the FAPA website. Just click on the issue you wish to review. This is the latest information on Medicare rules, Medicaid regulations, and managed care issues affecting PAs. AAPA Reimbursement Watch 12 April 2002 AAPA Reimbursement Watch 9 August 2002 AAPA Reimbursement Watch 4 October 2002 AAPA Reimbursement Watch 7 December 2002 AAPA Reimbursement Watch 7 February 2003 Back To The Top Each organization was asked to review procedure codes applicable to their specialty and determine whether the operation requires the use of a physician as an assistant at surgery: (1) almost always (2) almost never (3) some of the time The report, Physicians as Assistants at Surgery: 2002 Study, is widely used by third-party payers to determine which procedures require the use of a physician assistant. This is the fourth edition of the study, which was first conducted in 1994. For a downloadable copy of the 2002 document, go to Physicians as Assistants at Surgery: 2002 Study A hard copy of the document can be requested by contacting customerservice@facs.org or by calling 312.202.5474. This information furnished from the PA Forum Online by: Robert M. Blumm, MA, RPA-C Chairman, Surgical Congress AAPA Home- 631.598.1081 Office-516.484.8886 2001 Florida Statutes Re Insurance Rates and Contracts Here is a link to the Florida Statute on insurance rates and contracts. Note Florida Statute 627.419 (6) that deals with first assisting. FS 627.419 Back To The Top Medicaid Reimbursement Information on FAPA Frequently Asked Questions Section Click on the link below to view the questions and answers in the FAPA Online Frequently Asked Questions (FAQ's) that relate to reimbursement and professional practice. FAPA FAQ's Workers Compensation Information Review the article in the Current News section on Workers Compensation,Workers Compensation Update. You can learn about the latest information on the work comp rules re PAs as certified health care providers. Reimbursement in Long Term Care Facilities Federal regulations regarding the billing of services by a PA in the SNF mandate that the attending (supervising) physician perform the initial evaluation and management of a new patient. The physician is required to bill for this service. The final rule regarding physician services in a nursing facility is as described in the HCFA (Department of Health and Human Services) Final Rule on Medicare and Medicaid; Requirements for Long Term Care Facilities; 42 CFR Parts 442, 447, 483, 488, 489, and 498 (56 FR 48826; 56 FR 48880, Sept. 26, 1991): · The resident must be seen by a physician at least once every thirty days for the first 90 days after admission (except as provided below), and at least once every 60 days thereafter. · A physician visit is considered timely if it occurs not later than 10 days after the date the visit was required. · All required physician visits must be made by the physician personally, except as provided below: At the option of the physician, required visits in the SNF after the initial visit may alternate between personal visits by the physician and visits by a PA when certain requirements are met - - the PA meets the applicable definition in Chapter 491.2 - the PA must act within the scope of practice as defined by State law - the PA must be under the supervision of a physician In other words, the initial visit must be made by the physician; thereafter, visits can alternate between the physician and the PA. · Medicare will pay for additional visits (over and above the required visits) to nursing home patients if these visits are warranted by a change in the patient's medical condition. Visits in excess of the required visits can be performed exclusively by the PA. There is no Medicare requirement that these additional visits be alternated between the physician and the PA. · In general, when using the physician/PA alternating "team approach" for the required visits, Medicare will cover up to 18 visits per year (including the required visits). In certain cases, Medicare may cover more than 18 visits per year. These special cases normally require a high degree of documentation. This information can be found at the following website by searching under the term "42CFR483": Code of Federal Regulations Back To The Top Miscellaneous Information The below document is a compilation of documents collected by the FAPA Reimbursement Committee which contains letters, reports, and info from various newsletters dealing with reimbursement issues. Take time to browse each page of the document to see if any of the information is useful to you in answering your questions. Miscellaneous Documents Please contact us if you would like to suggest additional information to include in our Reimbursement Information page.