Join MGMA's nationwide campaign to reform Medicare Advantage
As beneficiary enrollment in Medicare Advantage plans has steadily increased, statutory loopholes, coupled with a lack of oversight by the Centers for Medicare & Medicaid Services, has caused serious problems for Medicare Advantage patients and medical practices that care for them.
MGMA is initiating a nationwide, grassroots effort to encourage Congress to strengthen the Medicare Advantage program and reduce beneficiaries' confusion and the administrative burden on group practices. Let your lawmakers know they can improve Medicare Advantage by passing legislation to:
* Standardizing patient identification cards;
* Removing the unfair deeming and "all products" provisions; and
* Enforcing prompt-payment provisions for Medicare Advantage payments.
Send your senators and representatives a letter today.
Read the full recommendation.
Remember: Urge your members of Congress to support the Save Medicare Act of 2008 (S. 2785) which would halt Medicare physician payment cuts
Sen. Debbie Stabenow, D-Mich., introduced the Save Medicare Act of 2008 (S. 2785). If enacted into law, the bill would halt scheduled Medicare cuts, provide 18 months of positive Medicare physician payments, continue the physician scarcity-area bonus payments and fund the Physician Quality Reporting Initiative for 2009.
It is critical that you contact your senators to urge them to co-sponsor this bill and demonstrate their commitment to stopping cuts to Medicare physician payments. The House of Representatives will ultimately negotiate with the Senate based on the positive update provisions included in last year's Children's Health and Medicare Protection (CHAMP) act.
Contact your senators today through the MGMA Advocacy Center. Urge them to co-sponsor S. 2785 and remind them that positive updates are necessary to cover increasing practice costs and stabilize an uncertain financial environment that threatens Medicare beneficiaries' access to care.
CMS issues two decision memoranda
The Centers for Medicare & Medicaid Services (CMS) recently issued two coverage determinations, one affecting cardiac computed tomographic angiography (CCTA) and one affecting continuous positive airway pressure (CPAP) devices.
CMS chose not to finalize a national coverage decision for CCTA. Local Medicare contractors now determine Medicare coverage for this procedure. CMS had proposed a national coverage policy that would have limited use of the procedure to only two indications. However, after reviewing available data and comments to its proposal, CMS decided to leave coverage decisions about the procedure with local contractors.
Read CMS's decision memo on CCTA.
CMS also released a final coverage policy expanding coverage for CPAP devices, used to treat patients with sleep apnea. CMS currently covers the use of these devices when a Medicare beneficiary is diagnosed with sleep apnea in a sleep laboratory setting. Under the new policy, CMS will now cover use of CPAP devices for patients diagnosed with sleep apnea through an in-home sleep test.
Read CMS's press release and decision memo.
Note that payment for use of a CPAP device in the home would fall under the durable medical equipment benefit, which makes the device a designated health service under the physician self-referral ("Stark") law. Physicians who order these devices for in-home use should ensure they do so in compliance with the Stark law.
Deadline looms for Medicaid tamper-resistant prescription pads
Remember, as of April 1, Medicaid outpatient drugs must be written on tamper-resistant prescription pads. The pads initially must have one or more security features, and by Oct. 1 they must have at least three security features. Examples of security features include serial/sequential numbering, VOID pantograph paper, quantity check-off boxes and safety paper with uniform background color.
The provision applies to all written prescriptions provided in settings other than nursing facilities, intermediate care facilities for the mentally retarded, and other specified institutional and clinical settings. It will not apply to prescriptions transmitted to pharmacies electronically, orally or via facsimile, nor will it apply to emergency fills of prescriptions when an oral, faxed, electronic or compliant-written prescription is sent within 72 hours of the date on which the prescription was filled.
The Centers for Medicare & Medicaid Services has issued broad guidance on the requirement, but state Medicaid directors must issue regulations that define requirements for their particular states.
In February, the Medical Group Management Association and a coalition of organizations that represent providers, pharmacists and other stakeholders sent a letter to state Medicaid directors asking that they publish the guidance as quickly as possible.
This requirement, and the uncertainty of each state's policies, will most likely cause order backlogs and confusion among pharmacists, physicians and the nation's 55 million Medicaid beneficiaries. Check your state Medicaid Web site for further guidance, and order your compliant prescription pads as soon as possible. Some Medicaid directors and the National Association of State Medicaid Directors have posted lists of manufacturers of compliant pads. In addition, the National Council for Prescription Drug Programs (NCPDP) has issued guidelines for determining whether a prescription form is compliant.
Read more about this topic and get a list of approved vendors and guidelines.
Review the related CMS FAQs.
If your state Medicaid Web site offers no specific guidance, please let MGMA know.
"Reprinted with permission from the Medical Group Management Association, 104 Inverness Terrace East, Englewood, CO 80112-5306; 303.799.1111. www.mgma.com. Copyright 2008"
