Notice: This CMS-approved document has been submitted - Philips ...

More documents

Recommendations

Info

CMS-1403-FC the diagnostic tests have been ordered by physicians outside the laboratory. A second commenter representing pathologists also suggested an exception for pathology practices (which it would define as any entity for which at least 75 percent of all CPT codes billed by the entity are pathology and laboratory codes). The commenter also cited the exclusion from the definition of “referral” in the physician self-referral rules for services ordered by pathologists pursuant to a consultation, and asserted that there should not be a self-referral or mark-up concern when pathology groups order special stains or other tests. A third commenter stated that the “rapid rise” in special stains in the last eight years is not a result of in-office pathology services or TC/PC arrangements, but rather is a result of the failure of national, regional, and hospital- based pathology laboratories to follow standard protocol for tissue biopsies. The commenter contended that overutilization of anatomic pathology testing can be managed by imposing tighter controls on such laboratory-based pathologists with respect to what stains they order and the reasons for ordering them. Response: We are not establishing an exception that would be applicable to pathology practices or independent laboratories, to the anti-markup provisions. We note that 514
CMS-1403-FC we did not propose such an exception and, thus, question whether we would have the authority to provide for such an exception in this final rule. Moreover, we are not convinced of the need for or wisdom of such an exception. We believe that the same potential that exists for the overutilization of diagnostic tests ordered by single- specialty physician groups and other suppliers, due to the profit motive, also exists for the ordering of special stains or other tests by pathology groups or independent laboratories. Comment: An association that represents physician group practices suggested that we establish a multi- specialty medical group “carve out” for “merit,” that is, an exemption from the anti-markup provisions based on delivery of high-quality health care services in the multi- specialty/organized system of care model. According to the commenter, the potential and risk for inappropriate actions is outweighed by the attributes and meritorious actions of multi-specialty groups. The commenter noted that, in section 131 of MIPPA, the Congress recognized the coordinated approach to patient care that multi-specialty medical groups provide. A different commenter requested that multi-specialty group practices not be permitted to use the employment or 515
Page 1 and 2:
Notice: This CMS-approved document
Page 3 and 4:
CMS-1403-FC 3 1. Electronically. Yo
Page 5 and 6:
CMS-1403-FC 5 FOR FURTHER INFORMATI
Page 7 and 8:
CMS-1403-FC 7 Trisha Brooks, (410)7
Page 9 and 10:
CMS-1403-FC 9 ● The physician sel
Page 11 and 12:
CMS-1403-FC 11 Schedule C. Malpract
Page 13 and 14:
CMS-1403-FC 13 3. Beneficiary Signa
Page 15 and 16:
CMS-1403-FC 15 A. Summary of Issues
Page 17 and 18:
CMS-1403-FC 17 XIII. Waiver of Prop
Page 19 and 20:
CMS-1403-FC 19 BBRA [Medicare, Medi
Page 21 and 22:
CMS-1403-FC 21 E/M Evaluation and m
Page 23 and 24:
CMS-1403-FC 23 MA-PD Medicare Advan
Page 25 and 26:
CMS-1403-FC 25 OSCAR Online Survey
Page 27 and 28:
CMS-1403-FC 27 WAMP Widely availabl
Page 29 and 30:
CMS-1403-FC 29 2. Practice Expense
Page 31 and 32:
CMS-1403-FC 31 extent practicable a
Page 33 and 34:
CMS-1403-FC 33 AMA's Current Proced
Page 35 and 36:
CMS-1403-FC 35 Payment = [(RVU work
Page 37 and 38:
CMS-1403-FC 37 legislation, the PFS
Page 39 and 40:
CMS-1403-FC that time, PE RVUs were
Page 41 and 42:
CMS-1403-FC utilize a “bottom-up
Page 43 and 44:
CMS-1403-FC ● All other expenses,
Page 45 and 46:
CMS-1403-FC b. Allocation of PE to
Page 47 and 48:
CMS-1403-FC combined survey data fr
Page 49 and 50:
CMS-1403-FC for the global componen
Page 51 and 52:
CMS-1403-FC equipment cost per minu
Page 53 and 54:
CMS-1403-FC components), then the i
Page 55 and 56:
CMS-1403-FC indirect PE for all PFS
Page 57 and 58:
CMS-1403-FC • Physical therapy ut
Page 59 and 60:
CMS-1403-FC TABLE 1: Calculation of
Page 61 and 62:
CMS-1403-FC 2. PE Proposals for CY
Page 63 and 64:
CMS-1403-FC The formula for estimat
Page 65 and 66:
CMS-1403-FC arbitrary method for ch
Page 67 and 68:
CMS-1403-FC We received no comments
Page 69 and 70:
CMS-1403-FC (iv) Contractor Pricing
Page 71 and 72:
CMS-1403-FC Response: We will ask t
Page 73 and 74:
Code CMS-1403-FC 2008/9 Description
Page 75 and 76:
CMS-1403-FC TABLE 4: Practice Expen
Page 77 and 78:
CMS-1403-FC B. Geographic Practice
Page 79 and 80:
CMS-1403-FC services, and are adjus
Page 81 and 82:
CMS-1403-FC by at least 5 percent,
Page 83 and 84:
CMS-1403-FC we decided not to proce
Page 85 and 86:
CMS-1403-FC so as part of the CY 20
Page 87 and 88:
CMS-1403-FC In the CY 2008 PFS fina
Page 89 and 90:
CMS-1403-FC are available, we would
Page 91 and 92:
CMS-1403-FC is no duplication of co
Page 93 and 94:
CMS-1403-FC practitioner) at the di
Page 95 and 96:
CMS-1403-FC PFS final rule with com
Page 97 and 98:
CMS-1403-FC individual MNT (or any
Page 99 and 100:
CMS-1403-FC Group DSMT (which compr
Page 101 and 102:
CMS-1403-FC The acuity of a critica
Page 103 and 104:
CMS-1403-FC needed regarding a crit
Page 105 and 106:
CMS-1403-FC errors; enhanced patien
Page 107 and 108:
CMS-1403-FC 99233). For CY 2006, we
Page 109 and 110:
CMS-1403-FC follow-up inpatient con
Page 111 and 112:
CMS-1403-FC As noted previously, CP
Page 113 and 114:
CMS-1403-FC face-to-face encounter
Page 115 and 116:
CMS-1403-FC visits requested by the
Page 117 and 118:
CMS-1403-FC Follow-up inpatient tel
Page 119 and 120:
CMS-1403-FC that were appropriate t
Page 121 and 122:
CMS-1403-FC HCPCS codes 96150 throu
Page 123 and 124:
CMS-1403-FC G0332). The Medicare pa
Page 125 and 126:
CMS-1403-FC code G0332. For CY 2009
Page 127 and 128:
CMS-1403-FC Response: The separate
Page 129 and 130:
CMS-1403-FC preadministration-relat
Page 131 and 132:
CMS-1403-FC pricing of IVIG and Med
Page 133 and 134:
CMS-1403-FC CPT Code Short Descript
Page 135 and 136:
CMS-1403-FC percent for the subsequ
Page 137 and 138:
CMS-1403-FC in the same session, on
Page 139 and 140:
CMS-1403-FC jeopardizes beneficiary
Page 141 and 142:
CMS-1403-FC As discussed in the pro
Page 143 and 144:
CMS-1403-FC Note: Under the PFS, CP
Page 145 and 146:
CMS-1403-FC The methodology for dev
Page 147 and 148:
CMS-1403-FC drugs furnished through
Page 149 and 150:
CMS-1403-FC Response: We disagree w
Page 151 and 152:
CMS-1403-FC available to support a
Page 153 and 154:
CMS-1403-FC that there are complica
Page 155 and 156:
CMS-1403-FC administered to a benef
Page 157 and 158:
CMS-1403-FC as we assess potential
Page 159 and 160:
CMS-1403-FC add a modifier to their
Page 161 and 162:
CMS-1403-FC application of the AQ m
Page 163 and 164:
CMS-1403-FC 0.7000. ● A reduction
Page 165 and 166:
CMS-1403-FC so the CY 2009 base com
Page 167 and 168:
CMS-1403-FC patient utilization gro
Page 169 and 170:
CMS-1403-FC make those estimates. A
Page 171 and 172:
CMS-1403-FC After removing the enro
Page 173 and 174:
CMS-1403-FC For CY 2009, we propose
Page 175 and 176:
CMS-1403-FC plain language over pol
Page 177 and 178:
CMS-1403-FC four quarters of ASP pr
Page 179 and 180:
CMS-1403-FC composite rates. The wa
Page 181 and 182:
CMS-1403-FC from the figure in the
Page 183 and 184:
CMS-1403-FC that our goal is the ev
Page 185 and 186:
CMS-1403-FC the average wage index
Page 187 and 188:
CMS-1403-FC Labor Statistics, to de
Page 189 and 190:
CMS-1403-FC been previously deemed
Page 191 and 192:
CMS-1403-FC CBSA where the campuses
Page 193 and 194:
CMS-1403-FC composite rates during
Page 195 and 196:
CMS-1403-FC target amount of compos
Page 197 and 198:
CMS-1403-FC admission. That is, the
Page 199 and 200:
CMS-1403-FC that CMS consider issue
Page 201 and 202:
CMS-1403-FC hold the provider in wh
Page 203 and 204:
CMS-1403-FC Comment: Commenters rai
Page 205 and 206:
CMS-1403-FC who have enrolled in th
Page 207 and 208:
CMS-1403-FC ● Posting IDTF standa
Page 209 and 210:
CMS-1403-FC other diagnostic testin
Page 211 and 212:
CMS-1403-FC entities furnishing mob
Page 213 and 214:
CMS-1403-FC state Radioactive Mater
Page 215 and 216:
CMS-1403-FC equipment and provide t
Page 217 and 218:
CMS-1403-FC Response: We understand
Page 219 and 220:
CMS-1403-FC believe that requiring
Page 221 and 222:
CMS-1403-FC these claims will ensur
Page 223 and 224:
CMS-1403-FC and NPP organizations,
Page 225 and 226:
CMS-1403-FC prior to their enrollin
Page 227 and 228:
CMS-1403-FC The date of approval is
Page 229 and 230:
CMS-1403-FC organizations, and indi
Page 231 and 232:
CMS-1403-FC To assist physician and
Page 233 and 234:
CMS-1403-FC Comment: Several commen
Page 235 and 236:
CMS-1403-FC date of filing and circ
Page 237 and 238:
CMS-1403-FC services are complying
Page 239 and 240:
CMS-1403-FC days when a Presidentia
Page 241 and 242:
CMS-1403-FC effective date under ap
Page 243 and 244:
CMS-1403-FC Comment: The suggestion
Page 245 and 246:
CMS-1403-FC Response: We thank the
Page 247 and 248:
CMS-1403-FC provider enrollment giv
Page 249 and 250:
CMS-1403-FC instead, it will force
Page 251 and 252:
CMS-1403-FC Response: As stated abo
Page 253 and 254:
CMS-1403-FC Comment: One commenter
Page 255 and 256:
CMS-1403-FC In an attempt to ensure
Page 257 and 258:
CMS-1403-FC rule, rather than limit
Page 259 and 260:
CMS-1403-FC changes have occurred,
Page 261 and 262:
CMS-1403-FC Response: While we moni
Page 263 and 264:
CMS-1403-FC records faster and more
Page 265 and 266:
CMS-1403-FC In §424.521(a)(1), we
Page 267 and 268:
CMS-1403-FC practitioners with the
Page 269 and 270:
CMS-1403-FC In June 2002 and Novemb
Page 271 and 272:
CMS-1403-FC full implementation sch
Page 273 and 274:
CMS-1403-FC with billing agents, cl
Page 275 and 276:
CMS-1403-FC 2. Medicare Billing Pri
Page 277 and 278:
CMS-1403-FC The FPLP is a collectio
Page 279 and 280:
CMS-1403-FC continued enrollment to
Page 281 and 282:
CMS-1403-FC Federal Payment Levy Pr
Page 283 and 284:
CMS-1403-FC Consistent with existin
Page 285 and 286:
CMS-1403-FC facilitate the enrollme
Page 287 and 288:
CMS-1403-FC determination. Specific
Page 289 and 290:
CMS-1403-FC individual practitioner
Page 291 and 292:
CMS-1403-FC determines in February
Page 293 and 294:
CMS-1403-FC Management Manual (IOM
Page 295 and 296:
CMS-1403-FC Response: Based on thes
Page 297 and 298:
CMS-1403-FC or continues to meet th
Page 299 and 300:
CMS-1403-FC to identify and discipl
Page 301 and 302:
Page 303 and 304:
CMS-1403-FC save our severe penalti
Page 305 and 306:
Page 307 and 308:
CMS-1403-FC affords the supplier ap
Page 309 and 310:
CMS-1403-FC privileges and assess a
Page 311 and 312:
CMS-1403-FC §424.535(a)(10) that w
Page 313 and 314:
CMS-1403-FC documentation for 7 yea
Page 315 and 316:
CMS-1403-FC pharmacies to follow re
Page 317 and 318:
Page 319 and 320:
CMS-1403-FC practitioners, includin
Page 321 and 322:
CMS-1403-FC that require a revoked
Page 323 and 324:
CMS-1403-FC provider and supplier e
Page 325 and 326:
CMS-1403-FC K. Amendment to the Exe
Page 327 and 328:
CMS-1403-FC Prescription Fill Statu
Page 329 and 330:
CMS-1403-FC dispensers to move towa
Page 331 and 332:
CMS-1403-FC Following the publicati
Page 333 and 334:
CMS-1403-FC does not respond to the
Page 335 and 336:
CMS-1403-FC facsimiles in all insta
Page 337 and 338:
CMS-1403-FC Similarly, other commen
Page 339 and 340:
CMS-1403-FC proposed rule's publica
Page 341 and 342:
CMS-1403-FC elimination of the comp
Page 343 and 344:
CMS-1403-FC exemption originally cr
Page 345 and 346:
CMS-1403-FC dispensers are not requ
Page 347 and 348:
CMS-1403-FC products, or, where upg
Page 349 and 350:
CMS-1403-FC take time to develop, a
Page 351 and 352:
CMS-1403-FC integrated this technol
Page 353 and 354:
CMS-1403-FC Version 10.2 or higher)
Page 355 and 356:
CMS-1403-FC proposed January 2009 c
Page 357 and 358:
CMS-1403-FC L. Comprehensive Outpat
Page 359 and 360:
CMS-1403-FC examination. In order t
Page 361 and 362:
CMS-1403-FC qualifications for HHAs
Page 363 and 364:
CMS-1403-FC distinction in the lice
Page 365 and 366:
CMS-1403-FC (2) Have successfully c
Page 367 and 368:
CMS-1403-FC risk-taking behaviors,
Page 369 and 370:
CMS-1403-FC Therefore, we proposed
Page 371 and 372:
CMS-1403-FC commenter stated that o
Page 373 and 374:
CMS-1403-FC psychological services
Page 375 and 376:
CMS-1403-FC 3. CORF Conditions of P
Page 377 and 378:
Page 379 and 380:
Page 381 and 382:
CMS-1403-FC The following is a summ
Page 383 and 384:
CMS-1403-FC We are not making any c
Page 385 and 386:
CMS-1403-FC N. Physician Self-Refer
Page 387 and 388:
CMS-1403-FC arrangements, and the l
Page 389 and 390:
CMS-1403-FC below are related to ea
Page 391 and 392:
CMS-1403-FC clinical practice. With
Page 393 and 394:
CMS-1403-FC In the CY 2009 PFS prop
Page 395 and 396:
CMS-1403-FC would be outside the sc
Page 397 and 398:
CMS-1403-FC reflect objective quali
Page 399 and 400:
CMS-1403-FC quality resulting from
Page 401 and 402:
CMS-1403-FC payments should be reas
Page 403 and 404:
CMS-1403-FC changes in referral pat
Page 405 and 406:
CMS-1403-FC the alternative, we pro
Page 407 and 408:
CMS-1403-FC finalize this condition
Page 409 and 410:
CMS-1403-FC and “quality maintena
Page 411 and 412:
CMS-1403-FC date. We seek comments
Page 413 and 414:
CMS-1403-FC existing exceptions to
Page 415 and 416:
CMS-1403-FC our general rulemaking
Page 417 and 418:
CMS-1403-FC these approaches. We pr
Page 419 and 420:
CMS-1403-FC building in which the b
Page 421 and 422:
CMS-1403-FC were concerned that thi
Page 423 and 424:
CMS-1403-FC supplier will be subjec
Page 425 and 426:
CMS-1403-FC numerical test for the
Page 427 and 428:
CMS-1403-FC space in which the orde
Page 429 and 430:
CMS-1403-FC disadvantage nonproblem
Page 431 and 432:
CMS-1403-FC would be simpler to not
Page 433 and 434:
CMS-1403-FC IDTF standards in §410
Page 435 and 436:
CMS-1403-FC that rule, the Governme
Page 437 and 438:
CMS-1403-FC with comment period, th
Page 439 and 440:
CMS-1403-FC 1842(n)(1) of the Act,
Page 441 and 442:
CMS-1403-FC anti-markup provisions
Page 443 and 444:
CMS-1403-FC her group practice woul
Page 445 and 446:
CMS-1403-FC A commenter representin
Page 447 and 448:
CMS-1403-FC tenens arrangements cou
Page 449 and 450:
CMS-1403-FC other supplier. We are
Page 451 and 452:
CMS-1403-FC on pathology reports or
Page 453 and 454:
CMS-1403-FC patients. According to
Page 455 and 456:
CMS-1403-FC from sharing a practice
Page 457 and 458:
CMS-1403-FC Group A orders the TC a
Page 459 and 460:
CMS-1403-FC physicians the flexibil
Page 461 and 462:
CMS-1403-FC Response: We recognize
Page 463 and 464: CMS-1403-FC Response: Because the d
Page 465 and 466: CMS-1403-FC limited by the proposed
Page 467 and 468: CMS-1403-FC Response: With respect
Page 469 and 470: CMS-1403-FC to focus on the medical
Page 471 and 472: CMS-1403-FC service” approach bec
Page 473 and 474: CMS-1403-FC have the right to recei
Page 475 and 476: CMS-1403-FC 2 approach finalized he
Page 477 and 478: CMS-1403-FC the ordering physician
Page 479 and 480: CMS-1403-FC ensure an adequate nexu
Page 481 and 482: CMS-1403-FC entity” should be def
Page 483 and 484: CMS-1403-FC between the performing
Page 485 and 486: CMS-1403-FC supplier” to encompas
Page 487 and 488: CMS-1403-FC to continue to provide
Page 489 and 490: CMS-1403-FC requirements of the Alt
Page 491 and 492: CMS-1403-FC supervised in the offic
Page 493 and 494: CMS-1403-FC reducing access to care
Page 495 and 496: CMS-1403-FC commenter supported ado
Page 497 and 498: CMS-1403-FC “outside supplier,”
Page 499 and 500: CMS-1403-FC group could recover onl
Page 501 and 502: CMS-1403-FC incurred, thereby compe
Page 503 and 504: CMS-1403-FC needed to provide the t
Page 505 and 506: CMS-1403-FC performing supplier for
Page 507 and 508: CMS-1403-FC providers, the services
Page 509 and 510: CMS-1403-FC commenter also expresse
Page 511 and 512: CMS-1403-FC overutilization of in-o
Page 513: CMS-1403-FC provisions for single-s
Page 517 and 518: CMS-1403-FC and PCs supervised or p
Page 519 and 520: CMS-1403-FC provisions will not app
Page 521 and 522: CMS-1403-FC (Pub. L. 110-173) (MMSE
Page 523 and 524: CMS-1403-FC reporting data on quali
Page 525 and 526: CMS-1403-FC PQRI and a more detaile
Page 527 and 528: CMS-1403-FC and our responses to th
Page 529 and 530: CMS-1403-FC provisions of the Priva
Page 531 and 532: CMS-1403-FC reducing eligible profe
Page 533 and 534: CMS-1403-FC administrative or judic
Page 535 and 536: CMS-1403-FC professionals who did n
Page 537 and 538: CMS-1403-FC base the incentive paym
Page 539 and 540: CMS-1403-FC A few commenters noted
Page 541 and 542: CMS-1403-FC administrative burden t
Page 543 and 544: CMS-1403-FC requested that more det
Page 545 and 546: CMS-1403-FC incentive payments for
Page 547 and 548: CMS-1403-FC December 31, 2009 and J
Page 549 and 550: CMS-1403-FC the reporting period fo
Page 551 and 552: CMS-1403-FC proposed to carry forwa
Page 553 and 554: CMS-1403-FC measures group is appli
Page 555 and 556: CMS-1403-FC measures results and nu
Page 557 and 558: CMS-1403-FC (Delmarva Foundation fo
Page 559 and 560: CMS-1403-FC registries to report on
Page 561 and 562: CMS-1403-FC reporting options for r
Page 563 and 564: CMS-1403-FC incentive payment for P
Page 565 and 566:
CMS-1403-FC to report 2009 PQRI qua
Page 567 and 568:
CMS-1403-FC Comment: We received nu
Page 569 and 570:
CMS-1403-FC Comment: One comment su
Page 571 and 572:
CMS-1403-FC quality measures result
Page 573 and 574:
CMS-1403-FC requirements listed on
Page 575 and 576:
CMS-1403-FC a data submission vendo
Page 577 and 578:
CMS-1403-FC As we stated in the CY
Page 579 and 580:
CMS-1403-FC whether eligible profes
Page 581 and 582:
CMS-1403-FC ● Agree that the regi
Page 583 and 584:
CMS-1403-FC soon thereafter as is t
Page 585 and 586:
CMS-1403-FC Comment: We received ma
Page 587 and 588:
Page 589 and 590:
CMS-1403-FC additional 2.0 percent
Page 591 and 592:
CMS-1403-FC EHRs in 2009. The measu
Page 593 and 594:
CMS-1403-FC i. Overview and Summary
Page 595 and 596:
CMS-1403-FC voluntary consensus sta
Page 597 and 598:
Page 599 and 600:
CMS-1403-FC the AMA-PCPI should be
Page 601 and 602:
CMS-1403-FC are appropriate and do
Page 603 and 604:
CMS-1403-FC to make any changes to
Page 605 and 606:
CMS-1403-FC post the measures for p
Page 607 and 608:
CMS-1403-FC beneficiaries. We now h
Page 609 and 610:
CMS-1403-FC identified in Tables 15
Page 611 and 612:
CMS-1403-FC important difference in
Page 613 and 614:
CMS-1403-FC not use Measures #73 Ca
Page 615 and 616:
CMS-1403-FC measures, but which are
Page 617 and 618:
CMS-1403-FC with comment period. Ho
Page 619 and 620:
CMS-1403-FC ● Measure #41 Osteopo
Page 621 and 622:
CMS-1403-FC professional to simply
Page 623 and 624:
CMS-1403-FC measures. We consider t
Page 625 and 626:
CMS-1403-FC Measure Number and Titl
Page 627 and 628:
CMS-1403-FC Measure Number and Titl
Page 629 and 630:
CMS-1403-FC ● Measure #120 CKD: A
Page 631 and 632:
CMS-1403-FC For the 2009 PQRI quali
Page 633 and 634:
CMS-1403-FC rule indicated that the
Page 635 and 636:
CMS-1403-FC Response: As suggested
Page 637 and 638:
CMS-1403-FC required for the measur
Page 639 and 640:
CMS-1403-FC ● Achievement of NQF
Page 641 and 642:
CMS-1403-FC These additional measur
Page 643 and 644:
CMS-1403-FC We did not include this
Page 645 and 646:
CMS-1403-FC Comment: Many commenter
Page 647 and 648:
CMS-1403-FC groups must have a part
Page 649 and 650:
CMS-1403-FC selected for inclusion
Page 651 and 652:
CMS-1403-FC Measure Title Measure S
Page 653 and 654:
CMS-1403-FC proposed HIV/AIDS measu
Page 655 and 656:
CMS-1403-FC set of denominator spec
Page 657 and 658:
CMS-1403-FC results, for this purpo
Page 659 and 660:
CMS-1403-FC informed decision-makin
Page 661 and 662:
Page 663 and 664:
CMS-1403-FC prior commitments that
Page 665 and 666:
CMS-1403-FC groups who successfully
Page 667 and 668:
CMS-1403-FC ● Eligible profession
Page 669 and 670:
CMS-1403-FC patients, families, and
Page 671 and 672:
CMS-1403-FC that have satisfactoril
Page 673 and 674:
CMS-1403-FC e-prescribing quality m
Page 675 and 676:
CMS-1403-FC Douglas S. and Friedman
Page 677 and 678:
CMS-1403-FC subsequent year, if the
Page 679 and 680:
CMS-1403-FC eligible professional f
Page 681 and 682:
CMS-1403-FC and is included in the
Page 683 and 684:
CMS-1403-FC The measure becomes app
Page 685 and 686:
CMS-1403-FC is, Measure #125) appli
Page 687 and 688:
CMS-1403-FC outpatient setting. Whi
Page 689 and 690:
CMS-1403-FC ability of an electroni
Page 691 and 692:
CMS-1403-FC October 2005 (hereinaft
Page 693 and 694:
CMS-1403-FC We are aware that there
Page 695 and 696:
CMS-1403-FC provided during the enc
Page 697 and 698:
CMS-1403-FC denominator of a measur
Page 699 and 700:
CMS-1403-FC cases. If the is determ
Page 701 and 702:
CMS-1403-FC during 2009; and (3) wh
Page 703 and 704:
CMS-1403-FC on this quality measure
Page 705 and 706:
CMS-1403-FC become effective until
Page 707 and 708:
CMS-1403-FC and CY 2007 PFS final r
Page 709 and 710:
CMS-1403-FC directly affected by th
Page 711 and 712:
CMS-1403-FC requires advanced pract
Page 713 and 714:
CMS-1403-FC applaud CMS for recogni
Page 715 and 716:
CMS-1403-FC standardization of DNP
Page 717 and 718:
CMS-1403-FC for the most part, been
Page 719 and 720:
CMS-1403-FC that the requirement fo
Page 721 and 722:
CMS-1403-FC degree in radiologic te
Page 723 and 724:
CMS-1403-FC the physicians that fur
Page 725 and 726:
CMS-1403-FC is associated with a te
Page 727 and 728:
CMS-1403-FC facility in which a tec
Page 729 and 730:
CMS-1403-FC by the Medicare program
Page 731 and 732:
CMS-1403-FC pressure (CPAP)” and
Page 733 and 734:
CMS-1403-FC for example chronic obs
Page 735 and 736:
CMS-1403-FC thus they believe leadi
Page 737 and 738:
CMS-1403-FC Excepting attended faci
Page 739 and 740:
CMS-1403-FC supplier separately. Ho
Page 741 and 742:
CMS-1403-FC final rule’s provisio
Page 743 and 744:
CMS-1403-FC as a DME supplier and p
Page 745 and 746:
CMS-1403-FC Moreover, given our gen
Page 747 and 748:
CMS-1403-FC resources and infrastru
Page 749 and 750:
Page 751 and 752:
CMS-1403-FC organization through a
Page 753 and 754:
CMS-1403-FC After reviewing the pub
Page 755 and 756:
CMS-1403-FC the nonparticipating ho
Page 757 and 758:
CMS-1403-FC be costly and burdensom
Page 759 and 760:
CMS-1403-FC adopting our proposal t
Page 761 and 762:
CMS-1403-FC We are not persuaded to
Page 763 and 764:
CMS-1403-FC §424.36(b)(6)(ii)(C)(2
Page 765 and 766:
CMS-1403-FC be made to obtain the s
Page 767 and 768:
CMS-1403-FC willing to sign at the
Page 769 and 770:
CMS-1403-FC and not suppliers, may
Page 771 and 772:
CMS-1403-FC crew member would have
Page 773 and 774:
CMS-1403-FC In order to determine f
Page 775 and 776:
CMS-1403-FC retrieval of the variou
Page 777 and 778:
CMS-1403-FC plan that demonstrates
Page 779 and 780:
CMS-1403-FC conviction, license sus
Page 781 and 782:
CMS-1403-FC The following is a summ
Page 783 and 784:
CMS-1403-FC faith reduces the time
Page 785 and 786:
CMS-1403-FC suspension or revocatio
Page 787 and 788:
CMS-1403-FC 9 percent per year. 2 I
Page 789 and 790:
CMS-1403-FC magnetic resonance imag
Page 791 and 792:
CMS-1403-FC Committee for Quality A
Page 793 and 794:
CMS-1403-FC measures in CMS’ VBP
Page 795 and 796:
CMS-1403-FC the Boston program site
Page 797 and 798:
CMS-1403-FC conditions that are hig
Page 799 and 800:
CMS-1403-FC reports? ● Do physici
Page 801 and 802:
CMS-1403-FC most Evaluation and Man
Page 803 and 804:
CMS-1403-FC III. Medicare Improveme
Page 805 and 806:
CMS-1403-FC Specifically, section 1
Page 807 and 808:
CMS-1403-FC period. The public will
Page 809 and 810:
CMS-1403-FC Section 101(b) of the M
Page 811 and 812:
CMS-1403-FC 1 year after the effect
Page 813 and 814:
CMS-1403-FC applies to both adult m
Page 815 and 816:
CMS-1403-FC period is limited to th
Page 817 and 818:
CMS-1403-FC 2007 through 2010. In a
Page 819 and 820:
CMS-1403-FC Section 1848(m)(3)(D) o
Page 821 and 822:
CMS-1403-FC In addition to the prov
Page 823 and 824:
CMS-1403-FC during the 2009 and 201
Page 825 and 826:
CMS-1403-FC prescribers for 2009 ar
Page 827 and 828:
CMS-1403-FC requirement by making a
Page 829 and 830:
CMS-1403-FC continue to bill the Me
Page 831 and 832:
CMS-1403-FC therapy and speech-lang
Page 833 and 834:
CMS-1403-FC ● Section 1835(a) of
Page 835 and 836:
CMS-1403-FC The amendments made by
Page 837 and 838:
CMS-1403-FC national associations a
Page 839 and 840:
CMS-1403-FC On November 9, 2006, we
Page 841 and 842:
CMS-1403-FC our regulations states
Page 843 and 844:
CMS-1403-FC rental period. The supp
Page 845 and 846:
CMS-1403-FC reasonable useful lifet
Page 847 and 848:
CMS-1403-FC to use the equipment be
Page 849 and 850:
CMS-1403-FC oxygen contents after t
Page 851 and 852:
CMS-1403-FC the oxygen contents and
Page 853 and 854:
CMS-1403-FC Section 414.210(e)(2) a
Page 855 and 856:
CMS-1403-FC reported to us that, ba
Page 857 and 858:
CMS-1403-FC non-routine maintenance
Page 859 and 860:
CMS-1403-FC As a result, we will ma
Page 861 and 862:
CMS-1403-FC 31, 2009 amounts for gr
Page 863 and 864:
CMS-1403-FC under section 332(a)(1)
Page 865 and 866:
CMS-1403-FC furnishing services via
Page 867 and 868:
CMS-1403-FC required to furnish dir
Page 869 and 870:
CMS-1403-FC mental health services
Page 871 and 872:
CMS-1403-FC Skilled Nursing Facilit
Page 873 and 874:
CMS-1403-FC where the SNF resident
Page 875 and 876:
CMS-1403-FC describes the methodolo
Page 877 and 878:
CMS-1403-FC The RUC has created the
Page 879 and 880:
CMS-1403-FC Response: Although we r
Page 881 and 882:
CMS-1403-FC occurring code pairs. T
Page 883 and 884:
CMS-1403-FC a standing panel of exp
Page 885 and 886:
CMS-1403-FC extraction of the assoc
Page 887 and 888:
CMS-1403-FC TABLE 26: AMA RUC Recom
Page 889 and 890:
CMS-1403-FC AMA RUC Rec Site of Ser
Page 891 and 892:
Page 893 and 894:
Page 895 and 896:
CMS-1403-FC Note: The RUC reviewed
Page 897 and 898:
CMS-1403-FC C. Interim 2008 Codes 1
Page 899 and 900:
CMS-1403-FC national noncoverage de
Page 901 and 902:
CMS-1403-FC CPT codes for 2008. In
Page 903 and 904:
CMS-1403-FC associated work RVUs, t
Page 905 and 906:
CMS-1403-FC CPT 1 AMA RUC Work RVU
Page 907 and 908:
CMS-1403-FC # New CPT code. 1 All C
Page 909 and 910:
CMS-1403-FC ● 27218, Open treatme
Page 911 and 912:
CMS-1403-FC RVUs for G0412; 15.73 w
Page 913 and 914:
CMS-1403-FC Therefore, we disagree
Page 915 and 916:
CMS-1403-FC generally contractor pr
Page 917 and 918:
CMS-1403-FC In addition, we believe
Page 919 and 920:
CMS-1403-FC RVU for CPT code 93289
Page 921 and 922:
CMS-1403-FC time to better understa
Page 923 and 924:
CMS-1403-FC ● 93306, Echocardiogr
Page 925 and 926:
CMS-1403-FC Although not discussed
Page 927 and 928:
CMS-1403-FC for New and Revised 200
Page 929 and 930:
CMS-1403-FC item. In addition, the
Page 931 and 932:
CMS-1403-FC 90956, 90957, 90958, 90
Page 933 and 934:
CMS-1403-FC place of these two new
Page 935 and 936:
CMS-1403-FC beneficiary or any othe
Page 937 and 938:
CMS-1403-FC ● Adding the followin
Page 939 and 940:
CMS-1403-FC Tables 29 and 30 also i
Page 941 and 942:
CMS-1403-FC RADIOLOGY AND CERTAIN O
Page 943 and 944:
CMS-1403-FC 93320 Doppler echo exam
Page 945 and 946:
CMS-1403-FC index data, that the hi
Page 947 and 948:
CMS-1403-FC TABLE 32: Increase in t
Page 949 and 950:
CMS-1403-FC C. The Update Adjustmen
Page 951 and 952:
CMS-1403-FC end of the prior year a
Page 953 and 954:
CMS-1403-FC CY 2009, the statute re
Page 955 and 956:
CMS-1403-FC Actual08 = Estimated Ac
Page 957 and 958:
CMS-1403-FC 1848(f)(3)(C)(i) of the
Page 959 and 960:
CMS-1403-FC ● Screening mammograp
Page 961 and 962:
CMS-1403-FC payments while promotin
Page 963 and 964:
CMS-1403-FC E. Final Sustainable Gr
Page 965 and 966:
CMS-1403-FC included in the SGR (us
Page 967 and 968:
CMS-1403-FC that this figure will c
Page 969 and 970:
CMS-1403-FC physicians' services in
Page 971 and 972:
CMS-1403-FC imaging services, the M
Page 973 and 974:
CMS-1403-FC CY 2007. Table 42 illus
Page 975 and 976:
CMS-1403-FC year to the entire year
Page 977 and 978:
CMS-1403-FC the CF. Therefore, this
Page 979 and 980:
CMS-1403-FC estimate that CY 2009 R
Page 981 and 982:
CMS-1403-FC Table 44: Calculation o
Page 983 and 984:
CMS-1403-FC XI. Payment for Certain
Page 985 and 986:
CMS-1403-FC In the Competitive Acqu
Page 987 and 988:
CMS-1403-FC glasses, hand magnifier
Page 989 and 990:
CMS-1403-FC Our interpretation of t
Page 991 and 992:
CMS-1403-FC Response: We understand
Page 993 and 994:
CMS-1403-FC defines “eyeglass”
Page 995 and 996:
CMS-1403-FC this statutory exclusio
Page 997 and 998:
CMS-1403-FC advances in the use of
Page 999 and 1000:
CMS-1403-FC is paid for his or her
Page 1001 and 1002:
CMS-1403-FC XII. Provisions of the
Page 1003 and 1004:
CMS-1403-FC these RUC recommendatio
Page 1005 and 1006:
CMS-1403-FC services. We believe a
Page 1007 and 1008:
CMS-1403-FC Section 144(b) of the M
Page 1009 and 1010:
CMS-1403-FC rulemaking with respect
Page 1011 and 1012:
CMS-1403-FC (respectively) of this
Page 1013 and 1014:
CMS-1403-FC completing and submitti
Page 1015 and 1016:
CMS-1403-FC §424.516(d)(1). Additi
Page 1017 and 1018:
CMS-1403-FC to several associated i
Page 1019 and 1020:
CMS-1403-FC incentive payment for 2
Page 1021 and 1022:
CMS-1403-FC year of PQRI reporting)
Page 1023 and 1024:
CMS-1403-FC Based on the assumption
Page 1025 and 1026:
CMS-1403-FC these activities for th
Page 1027 and 1028:
CMS-1403-FC per hour, we estimate t
Page 1029 and 1030:
CMS-1403-FC Because of the large nu
Page 1031 and 1032:
CMS-1403-FC threshold, and hence al
Page 1033 and 1034:
CMS-1403-FC shoes, the regulation i
Page 1035 and 1036:
CMS-1403-FC with comment period for
Page 1037 and 1038:
CMS-1403-FC substance of State laws
Page 1039 and 1040:
CMS-1403-FC $20 million from what e
Page 1041 and 1042:
CMS-1403-FC ● Impact of Work RVU
Page 1043 and 1044:
CMS-1403-FC imaging services from t
Page 1045 and 1046:
CMS-1403-FC ● Impact of section 1
Page 1047 and 1048:
CMS-1403-FC management, could have
Page 1049 and 1050:
CMS-1403-FC Table 50 illustrates, f
Page 1051 and 1052:
CMS-1403-FC CPT/ HCPCS Mod Descript
Page 1053 and 1054:
CMS-1403-FC impact associated with
Page 1055 and 1056:
CMS-1403-FC The fourth column shows
Page 1057 and 1058:
CMS-1403-FC the CY 2007 claims. The
Page 1059 and 1060:
CMS-1403-FC 1059 4/This column show
Page 1061 and 1062:
CMS-1403-FC requirements is to allo
Page 1063 and 1064:
CMS-1403-FC This amendment of the e
Page 1065 and 1066:
CMS-1403-FC 4 minutes per call, lab
Page 1067 and 1068:
CMS-1403-FC e-prescribing and who m
Page 1069 and 1070:
CMS-1403-FC anti-markup provisions
Page 1071 and 1072:
CMS-1403-FC approximately $50 per h
Page 1073 and 1074:
CMS-1403-FC e-prescribing measure i
Page 1075 and 1076:
CMS-1403-FC we estimate that each e
Page 1077 and 1078:
CMS-1403-FC P. Prohibition Concerni
Page 1079 and 1080:
CMS-1403-FC that provides a calcula
Page 1081 and 1082:
CMS-1403-FC treatment) that occur a
Page 1083 and 1084:
CMS-1403-FC locality (+5.37 percent
Page 1085 and 1086:
CMS-1403-FC additional rental payme
Page 1087 and 1088:
CMS-1403-FC T. Competitive Acquisit
Page 1089 and 1090:
CMS-1403-FC Program; II.T. Electron
Page 1091 and 1092:
CMS-1403-FC which means that in 200
Page 1093 and 1094:
CMS-1403-FC List of Subjects 42 CFR
Page 1095 and 1096:
CMS-1403-FC For the reasons set for
Page 1097 and 1098:
CMS-1403-FC (1) Except as specified
Page 1099 and 1100:
CMS-1403-FC pressure, a visual acui
Page 1101 and 1102:
CMS-1403-FC (ii) A speech-language
Page 1103 and 1104:
CMS-1403-FC during the hours that t
Page 1105 and 1106:
CMS-1403-FC (i) Be certified as a n
Page 1107 and 1108:
CMS-1403-FC 14. Section 410.155 is
Page 1109 and 1110:
CMS-1403-FC prostate cancer screeni
Page 1111 and 1112:
CMS-1403-FC B. Amending the definit
Page 1113 and 1114:
CMS-1403-FC The revisions and addit
Page 1115 and 1116:
CMS-1403-FC or institution other th
Page 1117 and 1118:
CMS-1403-FC substantially all (whic
Page 1119 and 1120:
CMS-1403-FC psychiatric diagnostic
Page 1121 and 1122:
CMS-1403-FC repairing, maintaining,
Page 1123 and 1124:
CMS-1403-FC B. Deleting paragraph (
Page 1125 and 1126:
CMS-1403-FC during any period of me
Page 1127 and 1128:
CMS-1403-FC (c)(1). A. Revising the
Page 1129 and 1130:
CMS-1403-FC * * * * * (b) * * * (2)
Page 1131 and 1132:
CMS-1403-FC assigned to such drug p
Page 1133 and 1134:
CMS-1403-FC 33. In §415.130(d), th
Page 1135 and 1136:
CMS-1403-FC (6) An ambulance provid
Page 1137 and 1138:
CMS-1403-FC §424.57 Special paymen
Page 1139 and 1140:
CMS-1403-FC Final adverse action me
Page 1141 and 1142:
CMS-1403-FC (b) Reporting requireme
Page 1143 and 1144:
CMS-1403-FC of Medicare billing pri
Page 1145 and 1146:
CMS-1403-FC (a) Physicians, nonphys
Page 1147 and 1148:
CMS-1403-FC * * * * * (g) Effective
Page 1149 and 1150:
CMS-1403-FC that meet the qualifica
Page 1151 and 1152:
CMS-1403-FC (3) Have equivalent tra
Page 1153 and 1154:
CMS-1403-FC §485.711 Condition of
Page 1155 and 1156:
CMS-1403-FC Subpart C--Conditions f
Page 1157 and 1158:
CMS-1403-FC Authority: Catalog of F
Page 1159 and 1160:
CMS-1403-FC Addendum B means that C
Page 1161 and 1162:
CMS-1403-FC which they are incident
Page 1163 and 1164:
CMS-1403-FC T = There are RVUs for
Page 1165 and 1166:
CMS-1403-FC ADDENDUM B: Relative Va
Page 1167 and 1168:
CMS-1403-FC Physi- cian Work Fully
Page 1169 and 1170:
Page 1171 and 1172:
Page 1173 and 1174:
Page 1175 and 1176:
Page 1177 and 1178:
Page 1179 and 1180:
Page 1181 and 1182:
Page 1183 and 1184:
Page 1185 and 1186:
Page 1187 and 1188:
Page 1189 and 1190:
Page 1191 and 1192:
Page 1193 and 1194:
Page 1195 and 1196:
Page 1197 and 1198:
Page 1199 and 1200:
Page 1201 and 1202:
Page 1203 and 1204:
Page 1205 and 1206:
Page 1207 and 1208:
Page 1209 and 1210:
Page 1211 and 1212:
Page 1213 and 1214:
Page 1215 and 1216:
Page 1217 and 1218:
Page 1219 and 1220:
Page 1221 and 1222:
Page 1223 and 1224:
Page 1225 and 1226:
Page 1227 and 1228:
Page 1229 and 1230:
Page 1231 and 1232:
Page 1233 and 1234:
Page 1235 and 1236:
Page 1237 and 1238:
Page 1239 and 1240:
Page 1241 and 1242:
Page 1243 and 1244:
Page 1245 and 1246:
Page 1247 and 1248:
Page 1249 and 1250:
Page 1251 and 1252:
Page 1253 and 1254:
Page 1255 and 1256:
Page 1257 and 1258:
Page 1259 and 1260:
Page 1261 and 1262:
Page 1263 and 1264:
Page 1265 and 1266:
Page 1267 and 1268:
Page 1269 and 1270:
Page 1271 and 1272:
Page 1273 and 1274:
Page 1275 and 1276:
Page 1277 and 1278:
Page 1279 and 1280:
Page 1281 and 1282:
Page 1283 and 1284:
Page 1285 and 1286:
Page 1287 and 1288:
Page 1289 and 1290:
Page 1291 and 1292:
Page 1293 and 1294:
Page 1295 and 1296:
Page 1297 and 1298:
Page 1299 and 1300:
Page 1301 and 1302:
Page 1303 and 1304:
Page 1305 and 1306:
Page 1307 and 1308:
Page 1309 and 1310:
Page 1311 and 1312:
Page 1313 and 1314:
Page 1315 and 1316:
Page 1317 and 1318:
Page 1319 and 1320:
Page 1321 and 1322:
Page 1323 and 1324:
Page 1325 and 1326:
Page 1327 and 1328:
Page 1329 and 1330:
Page 1331 and 1332:
Page 1333 and 1334:
Page 1335 and 1336:
Page 1337 and 1338:
Page 1339 and 1340:
Page 1341 and 1342:
Page 1343 and 1344:
Page 1345 and 1346:
Page 1347 and 1348:
Page 1349 and 1350:
Page 1351 and 1352:
Page 1353 and 1354:
Page 1355 and 1356:
Page 1357 and 1358:
Page 1359 and 1360:
Page 1361 and 1362:
Page 1363 and 1364:
Page 1365 and 1366:
Page 1367 and 1368:
Page 1369 and 1370:
CMS-1403-FC CPT 1 / HCPCS Mod Statu
Page 1371 and 1372:
CMS-1403-FC CPT 1 / HCPCS Mod Statu
Page 1373 and 1374:
Page 1375 and 1376:
CMS-1403-FC Contractor Locality Loc
Page 1377 and 1378:
CMS-1403-FC ADDENDUM E: 2009 Geogra
Page 1379 and 1380:
CMS-1403-FC Work** PE MP Contractor
Page 1381 and 1382:
CMS-1403-FC 70492 Ct soft tissue ne
Page 1383 and 1384:
CMS-1403-FC 73201 Ct upper extremit
Page 1385 and 1386:
CMS-1403-FC 10780 10900 11020 11100
Page 1387 and 1388:
CMS-1403-FC 12420 12540 12580 12620
Page 1389 and 1390:
CMS-1403-FC 14060 14260 14484 14500
Page 1391 and 1392:
CMS-1403-FC 16820 16860 16940 16974
Page 1393 and 1394:
CMS-1403-FC 17980 18020 18140 18580
Page 1395 and 1396:
CMS-1403-FC 19804 20020 20100 20220
Page 1397 and 1398:
CMS-1403-FC 22500 22520 22540 22660
Page 1399 and 1400:
CMS-1403-FC 25020 25060 25180 25260
Page 1401 and 1402:
CMS-1403-FC 26980 27060 27100 27140
Page 1403 and 1404:
CMS-1403-FC 28700 28740 28940 29020
Page 1405 and 1406:
CMS-1403-FC 30860 30980 31020 31084
Page 1407 and 1408:
CMS-1403-FC 33140 33260 33340 33460
Page 1409 and 1410:
CMS-1403-FC 35300 35380 35644 35660
Page 1411 and 1412:
CMS-1403-FC 37340 37380 37460 37620
Page 1413 and 1414:
CMS-1403-FC 39300 39340 39380 39460
Page 1415 and 1416:
CMS-1403-FC 40580 40660 40900 40980
Page 1417 and 1418:
CMS-1403-FC 41940 41980 Sabana Gran
Page 1419 and 1420:
CMS-1403-FC 43340 43580 43620 43780
Page 1421 and 1422:
CMS-1403-FC 45940 46060 46140 46220
Page 1423 and 1424:
CMS-1403-FC 47940 48140 48260 48300
Page 1425 and 1426:
CMS-1403-FC 1425
Page 1427 and 1428:
CMS-1403-FC CBSA Code Nonurban Area
Page 1429 and 1430:
CMS-1403-FC HCPCS Descriptor 71260
Page 1431 and 1432:
Page 1433 and 1434:
Page 1435 and 1436:
Page 1437 and 1438:
CMS-1403-FC 78122 Blood volume 7813
Page 1439 and 1440:
CMS-1403-FC 96125 Cognitive test by
Page 1441 and 1442:
CMS-1403-FC 70240 X-ray exam, pitui
Page 1443 and 1444:
CMS-1403-FC 72120 X-ray exam of low
Page 1445 and 1446:
CMS-1403-FC 73720 Mri lwr extremity
Page 1447 and 1448:
CMS-1403-FC 76856 Us exam, pelvic,
Page 1449 and 1450:
CMS-1403-FC 78456 Acute venous thro
Page 1451 and 1452:
CMS-1403-FC 93320 Doppler echo exam
Page 1453 and 1454:
CMS-1403-FC A9571 Indium In-111 aut
Page 1455 and 1456:
CMS-1403-FC 77333 Radiation treatme
Page 1457 and 1458:
CMS-1403-FC C2638 Brachytx, strande
Page 1459:
CMS-1403-FC P3000 Screen pap by tec
show all

Notice: This CMS-approved document has been submitted - Philips ...

You also want an ePaper? Increase the reach of your titles

Delete template?

Save as template?