7/7/2010
New CMS Director Appointed

Today, Wed. July 27 President Obama appointed Dr. Donald Berwick Director of CMS. Dr. Berwick will serve as Director through 2011 at which time he must then be sanctioned by the Senate.

7/2/2010
Latest Updates

2011 PROPOSED PHYSICIAN FEE SCHEDULE CLARIFIES IN-OFFICE IMAGING REGULATION

Section 6003 of the PPACA adds a new provision to the in-office ancillary services exception in the Stark statute requiring practices that provide magnetic resonance imaging (MRI), computed tomography (CT) or positron emission tomography (PET) in their offices under the in-office ancillary services exception to notify the patient, in writing at the time of the referral, of the following:

• The patient’s right to receive the service from a person other than the referring physician, a physician who is a member of the same group practice as the referring physician, or an individual directly supervised by the physician or by another physician in the group practice, and
• A list of alternative practices or imaging facilities near the patient’s residence.

In the 2011 Physician Fee Schedule Proposed Rule CMS clarifies and amends the provision. In the Proposed Rule CMS says that the effective date of the regulation will not be retroactive to January 1, 2010 as stated in the PPACA proposing instead an effective date of January 1, 2011. 

The Proposed Rule also includes the following patient disclosure proposals:

• The written notice, provided to the patient at the time of referral, is to include a list of 10 other suppliers within a 25-mile radius of the referring physician’s office. If there are fewer than 10 alternate suppliers the list should include all suppliers within the 25-mile radius.
• “Suppliers” are defined as a physician or other practitioner, a facility, or other entity (other than a provider of services) that furnishes items or services under this title. The list is not to include hospitals and critical access hospitals, among other facilities.
• The disclosure notification must be signed by the patient and maintained as an element of the patient’s medical record.

NEW PRIT ISSUE ON LOCUM TENENS POSTED

The Physician Regulatory Issues Team (PRIT) posted guidance on the use of a Locum Tenens to replace a physician who has left a practice.  The Kansas City Medical Association contacted the PRIT in response to educational material posted on the WPS Medicare Contractor’s website which states that CMS prohibits the use of locum tenens to cover a vacancy created when a physician leaves a medical practice. On June 9, 2010 the PRIT responded by posting the following statement, “In fact CMS does permit the use of a locum tenens physician to cover a departed physician’s patients. WPS is being contacted to update their educational material.”

FTC CALLS ON CONGRESS TO EXEMPT PHYSICIAN OFFICES FROM RED FLAGS RULE

Under the Fair and Accurate Credit Transactions Act of 2003 (FACTA) the Federal Trade Commission (FTC) is required to enact rules requiring creditors  to develop and implement written identity theft prevention programs to protect consumers from identity theft. Under the “Red Flags Rule” legislation most physician practices would be considered a covered entity and have to comply with the Rule. The FTC recently called on Congress to exempt physician offices from the Red Flags Rule, and on May 31, the FTC announced they would delay enforcement of the Rule through December 31, 2010 while Congress considers legislation exempting physician, attorney and accounting offices with fewer than 20 employees from having to comply with the rule. On June 25, in response to a lawsuit filed by the AMA and two other medical societies, the FTC announced they will delay enforcement of the Rule until after the U.S. Court of Appeals in Washington reviews a trial court decision in which the American Bar Association was successful in exempting legal offices from the Rule. This is the fifth delay in implementation of the Rule.

Watch your mailboxes for the upcoming issue of Oplinc's Best Practices Review sponsored by Lilly Oncology for an in-depth look at the Patient Protection and Affordable Care Act.

5/3/2010
CMS Drops LCA Policies for Part B Drugs

least costly alternative changes