The following is a draft update for SVT - AIUM newsletters ...
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Regulation Corner
Franklin W. West
1996 Medicare Fee Schedule Update
Using the default formula for determining the Medicare Conversion Factor,
payment for primary care services could decrease by 2.2%, while surgical
services would receive a 3.9% increase and non-surgical services would receive a
0.6% increase. The default formula will apply if congress does not intervene.
The decrease for primary care services is secondary to growth in these
procedures at a rate of 14.9% in 1994, far exceeding the projected rate of
10.5%.
The Physician Payment Review Commission (PPRC) has provided an alternate
proposal of a single increase of 1.1% that would apply to all services. The
Department of Health and Human Services (DHHS) supports the PPRCs 1.1% overall
increase, and further recommends volume performance standards of -1.8% for
surgery, 6.5% for primary care, and 2.0% for non-surgical services. The PPRC is
supporting a single standard of 2.0% and has requested congress alter
legislation to require a single conversion factor and volume performance
standard for all services.
Editors comment: So, what does this mean to the practice of ultrasound /
vascular technology? The good news is that, in all likelihood, well see an
increase in payment. The bad news: the raise, in all likelihood, will not keep
pace with the cost of living.
HCFA Proposal Regarding Emergency Room Services
As published in the Federal Register (July 26, 1995), HCFA believes that, in the
case of emergency room services, specialist interpretation of ultrasound
procedures often does not occur until a significant period of time after the
patient has been diagnosed, treated, and discharged. Consequently, HCFA is
proposing several policies including those listed below:
.. Payment for only one interpretation and report of emergency room services.
.. Distinguishing between an "interpretation and report," and a "review" of a
procedure, with the review not meeting requirements for payment.
.. In the case of multiple bills: (1) an end to the practice of considering
physician specialty as a prime consideration in deciding which to pay, (2)
payment only for the interpretation and report that directly contributed to
diagnosis and treatment, and (3) payment to the specialist if the interpretation
was performed contemporaneously with the diagnosis and treatment.
.. Minimizing the carriers decision making role by: (1) encouraging hospitals to
exercise their authority over the medical staff to ensure only one claim is
submitted, (2) advising hospitals that Medicare will not pay two claims, (3)
advising hospitals that "official interpretations" may be for quality control
and liability purposes rather than a service to a beneficiary, and (4) advising
hospitals that Medicare considers costs incurred for quality control activities
in determining payments to hospitals.
A variety of other issues are discussed under the proposed rules, and comments
will be accepted by HCFA until September 25, 1995. Credit card orders for the
Federal Register can be placed by calling the order desk at (202) 512-1800 or by
faxing to (202) 512-2250. The cost for each copy is $8.00 and you will need to
specify the publication date.
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Franklin W. West
writing at 11:10 AM,
on Friday, August 18, 1995
Pacific Vascular, Inc.
18702 North Creek Parkway, Suite 212
Bothell, WA 98011
Office: (206) 486-6014
Fax: (206) 486-8976
E-Mail: [log in to unmask]
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