Medicare Physician Fee Schedule (MPFS)
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2010
Survey: Consultation Claim Denials by Medicare (02/26/2010) — With the elimination of the consultations services codes 99241-99245 and 99251-99255, clinicians must now bill consultation services using Evaluation and Management (E&M) codes for Medicare claims. In the past, some local Medicare carriers have denied claims, citing duplicate billing, when a cardiologist and an EP from the same group practice billed consultation services. If you are still experiencing this problem with the implementation of the new structure using the E&M codes, please take our quick survey to help the Society understand how these changes are affecting your practice. Learn more »
Medicare Discontinues Use of Consultation Codes (01/29/2010) — As of January 1, the Centers for Medicare and Medicaid Services (CMS) discontinued the use of consultation service codes 99241-99245 and 99251-99255 performed in the office and hospital setting. These services now must be billed differently. The Society has developed a list of answers to questions regarding the policy change. Learn more »
Lawsuit on Practice Expense Cut Dismissed (01/20/2010) — A lawsuit filed against the Department of Health and Human Services and Secretary Kathleen Sebelius seeking to reverse the practice expense cuts that went into effect on January 1, 2010 was dismissed on January 12, with the judge ruling that the U.S. District Court for the Southern District of Florida had no jurisdiction over the issue. Learn more »
Society Comments on the 2010 MPFS Final Rule (01/05/2010) — The Society recently issued comments to the Centers for Medicare and Medicaid Services in response to the Medicare Physician Fee Schedule Final Rule for calendar year 2010, focusing on two critical issues: the elimination of the consultation codes and the use of the American Medical Association Physician Practice Information Survey data to calculate practice expense inputs. Learn more »
2009
PPAC Recommends CMS Delay Policy to Eliminate Consultation Services (12/22/2009) — The Practicing Physicians Advisory Council (PPAC) held its quarterly meeting in Washington, DC to discuss final provisions of the 2010 Medicare Physician Fee Schedule, including the Physician Resource Use Measurement and Reporting Program and updates to the PQRI and e-Prescribing incentive programs. Learn more »
MEDPAC Considers 1.0 Percent Update for Physician Services and Full Market Basket Update for Hospitals in 2011 (12/22/2009) — The Medicare Payment Advisory Commission (MedPAC), which advises Congress on physician payment rates and other issues, met to assess the adequacy of Medicare payments for physician and hospital services in 2011. The Commission is considering draft recommendations to Congress that would provide a 1.0 percent increase in physician reimbursement and a full market basket update for both inpatient and outpatient hospitals. Learn more »
Legislation Introduced to Reverse Practice Expense Cuts (12/22/2009) — Representative Charles Gonzalez (D-TX) introduced H.R. 4371, legislation to reverse the practice expense cuts scheduled to take effect January 1, 2010. This legislation, cosponsored by 55 House Members, requires the Centers for Medicare and Medicaid Services (CMS) to use the 2009 Medicare Practice Expense Relative Value Units for certain cardiology services. Learn more »
The Society Meets with CMS on Medicare Consultation Services (12/16/2009) — On Wednesday December 16, the Society’s leadership met with officials from the Centers for Medicare and Medicaid Services (CMS) to discuss our concerns with the elimination of Medicare consultation codes scheduled to take effect on January 1st, 2010. Learn more »
Heart Rhythm Professionals Face Major Cuts Under Medicare Final Rule for 2010 (11/04/2009) — The President of the Heart Rhythm Society, Richard L. Page, MD, FHRS, sent a letter to all United States-based members detailing the policy changes that will significantly reduce payments for heart rhythm services, the Society's plan to advocate against the use of the American Medical Association’s Physician Practice Information Survey data and how Society members can get involved. Read letter »
2010 Medicare Physician Fee Schedule Final Rule- Cardiology Practice Expenses Cuts phased-in over four years (11/04/2009) — On October 30, the Centers for Medicare & Medicaid Services (CMS) released the final rule that will revise the Medicare Physician Fee Schedule (MPFS) for calendar year 2010. In the final rule, the practice expense cuts to cardiology services will be phased-in over the next four years. The Heart Rhythm Society is working along with the other cardiovascular medical societies to respond to the cuts. Learn more »
Society Comments on the Medicare Physician Fee Schedule Proposed Rule for Calendar Year 2010 (09/02/2009) — On August 31, the Heart Rhythm Society submitted comments to the Centers for Medicare and Medicaid Services (CMS) regarding the 2010 Medicare Physician Fee Schedule proposed rule. The proposed rule addressed numerous complex changes and refinements. Among the issues, concerns were raised regarding CMS’ proposals to use the American Medical Association Physician Practice Information Survey data to calculate practice expense inputs and eliminate consultation codes. Learn more »
Ask Congress to Help Stop Proposed Cuts to EP Services (05/08/2009) — Representatives Mike Rogers (R-MI) and Charles Gonzalez (D-TX) are currently circulating a “Dear Colleague” letter, which asks Members of Congress to support their outreach to the Secretary of Health and Human Services, Kathleen Sebelius. In the letter, they express their serious concerns about payment cuts to cardiology and oncology services and ask her to delay these cuts until further analysis is undertaken. Contact your representative asking him or her to sign on to the Gonzalez-Rogers letter to Secretary Sebelius. Learn more »
Society Works to Prevent Practice Expense Cuts (07/29/2009) — On July 28 the Society and other cardiovascular medical associations met with Centers for Medicare and Medicaid Services (CMS) officials to discuss its decision to use data from the American Medical Association's Physician Practice Information survey to calculate practice expense RVUs for cardiology services in 2010. Learn more »
CMS Releases Proposed MPFS Rule for 2010 (07/07/2009) — The Centers for Medicare & Medicaid Services (CMS) released a proposed rule on July 1 that would revise the Medicare Physician Fee Schedule in 2010. CMS is proposing a number of changes which would result in an 11 percent decrease for cardiology services. Learn more »
MedPAC Approves Recommendations for Payment Updates in 2010 (01/17/2009) — The Medicare Payment Advisory Commission (MedPAC) held a two-day meeting January 8-9, 2009 in Washington, DC to finalize its recommendations to Congress for updating physician, hospital and ambulatory surgical center payments (ASCs) for 2010. Payment recommendations adopted by MedPAC will be formally presented in a report to Congress in March. Learn more »
Society Submits Comments to CMS on the 2009 Physician Fee Schedule Final Rule (1/14/2009) — On December 22, 2008 the Heart Rhythm Society submitted comments to the Centers for Medicare and Medicaid Services (CMS) regarding the 2009 Medicare Physician Fee Schedule final rule. In the Society’s comments to CMS, three areas of concern related to the new cardiac monitoring device codes were addressed: reimbursement for programming evaluation of a dual lead ICD system (93283); practice expense equipment cost for codes 93279 through 93292; and practice expense equipment cost for transtelephonic rhythm strip pacemaker evaluation (93293). Learn more »
2008
MedPAC’s Draft Recommendations for Hospital And Physicians FY 2010 Payments (12/17/2008) — The Medicare Payment Advisory Commission (MedPAC) met December 4-5 to discuss recommendations for hospital and physician services for fiscal year (FY) 2010. As a starting point, the initial draft recommendations call for a full “market basket” payment update for hospitals services in 2010. The Commission is scheduled to vote on draft recommendations at the January 2009 meeting. Learn more »
2009 Medicare Physician Fee Schedule Final Rule (11/05/2008)— The Centers for Medicare & Medicaid Services (CMS) released the Medicare Physician Fee Schedule (MPFS) final rule for calendar year (CY) 2009 on October 30. Among the highlights of the final rule are decisions on payment rates and changes, as well as information on 2009 PQRI. The rates and policies adopted in the final rule will apply to services furnished on or after January 1, 2009. Learn more »
Heart Rhythm Society Responds to 2009 Rules (09/10/2008) — On August 29 the Heart Rhythm Society submitted comments to CMS in response to the "Medicare Program; Revisions to Payment Policies Under the Physician Fee Schedule and Other Revisions to Part B for CY 2009; and Revisions to the Amendment of the E-Prescribing Exemption for Computer Generated Facsimile Transmissions; Proposed Rule" published in the Federal Register on July 7, 2008. In addition, the Society submitted a second comment letter on September 3 to CMS regarding its "Proposed Changes to the Hospital Outpatient Prospective Payment System and CY 2009 Payment Rates; Proposed Changes to the Ambulatory Surgical Center Payment System and CY 2009 Payment Rates," which was published in the Federal Register on July 9, 2008. Learn more and access the Society's comments on these proposed rules »
Congress Overrides Presidential Veto Of Medicare Legislation — Fee Schedule Rates Stabilized, Medicare Will Resume Claims Processing (07/16/2008) — On July 15, Congress overwhelmingly overrode President Bush's veto of HR 6331, the Medicare Improvement for Patients and Providers Act. The bill reverses the 10.6 percent Medicare physician payment cut that went into effect July 1 and will extend the .5 percent update to physician payments through the end of 2008 and provide a 1.1 percent update for 2009. A number of other provisions such as an extension of PQRI and bonuses for e-prescribing are also included. This temporary fix comes after months of Society and other medical association staff lobbying and Society member grassroots communications. Learn more »
2009 Medicare Physician Fee Schedule Proposed Rule Highlights (07/02/2008) — On June 30, 2008, the Centers for Medicare and Medicaid Services (CMS) released the Medicare Part B Physician Fee Schedule (MPFS) proposed rule for calendar year (CY) 2009 for public display. The Society has evaluated the impact on EP services. Learn more »
10.6% Pay Cut Effective July 1st – CMS to Hold Claims for 10 Business Days (07/02/2008) — Medicare’s current fee schedule calls for a 10.6% cut in physician reimbursement effective July 1. CMS is working with Congress, health care providers, and the beneficiary community to avoid disruption in the delivery of health care services and payment of claims paid under the Medicare physician fee schedule, beginning July 1. Learn more about the immediate impact on your billing processes »
Washington Report: Congress Fails to Pass Legislation Stopping 10.6% Medicare Physician Payment Cut Going Into Effect July 1 (06/27/2008) — Congress failed to pass legislation which would have halted the 10.6% Medicare Physician payment cut. Therefore, the cut will be going forward as scheduled and will affect services rendered on or after July 1, 2008. Physicians should continue putting pressure on their legislators to rectify this unacceptable situation. Learn more »
MedPAC Review of CMS' Estimate of the Physician Update for 2009 (04/24/2008) —On April 10, the Medicare Payment Advisory Commission (MedPAC) reviewed the Centers for Medicare and Medicaid Services' (CMS) preliminary estimate of the physician update for 2009. In calculating the update, CMS projects the update for 2009 to be -5.4%. To calculate the update, CMS used estimates that are consistent with recent trends. In addition, the MedPAC continued last month's discussion on the feasibility of bundled payments around a hospitalization and supported a revised package of draft recommendations for hospitals and physician services over an episode of care for select conditions. Learn more »
2007
2008 Medicare Physician Fee Schedule (MPFS) (11/02/2007) — The Centers for Medicare and Medicaid Services released its final rule for the 2008 MPFS. Learn more »
The Society Comments on the Medicare Physician Fee Schedule Proposed Rule for 2008 (08/31/2007) — The Society sent a letter to Herb Kuhm, Action Deputy Administrator of CMS regarding the Proposed MPFS for 2008. View the letter »
Summary of 2008 Medicare Physician Fee Schedule Proposed Rule (07/09/2007) — On July 2, 2007, the Centers for Medicare & Medicaid Services (CMS) released a proposed rule that would revise the Medicare Physician Fee Schedule (MFPS) for calendar year 2008. Learn more »
2006
Congress Passes Legislation Averting 5% Medicare Physician Payment Cut (12/11/2006) — Congress has passed legislation that stops the 5% Medicare physician payment cut, scheduled to go into effect January 1, 2007. Learn more »
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Inpatient Prospective Payment System (IPPS)
2009
CMS Releases IPPS Proposed Rule for FY 2010 (05/06/2009) — On May 1, the Centers for Medicare & Medicaid Services (CMS) released proposed policies and payment rates for the Medicare Inpatient Prospective Payment System (IPPS) for fiscal year (FY) 2010. Under the proposed rule, it is estimated that there will be a decrease of $979 million in combined operating and capital payments to hospitals. The Society’s health policy staff is reviewing the ruling to determine its likely impact on cardiac arrhythmia services and will provide a more detailed analysis in the coming weeks. View the summary of the major changes proposed by CMS »
2008
CMS Issues Final Rule for FY 2009 IPPS (08/20/2008) —The Centers for Medicare and Medicaid Services (CMS) published a final rule in the Federal Register that will change Medicare payment rates and policies for inpatient hospital services furnished by acute care hospitals in fiscal year 2009. The changes will apply to more than 3,500 hospitals paid under the Inpatient Prospective Payment System (IPPS) effective for discharges on or after October 1, 2008 through September 30, 2009. Learn more »
2009 Inpatient Prospective Payment System Proposed Rule Highlights (04/22/2008) — On April 14, 2008, CMS released the Inpatient Prospective Payment System (IPPS) proposed rule for fiscal year (FY) 2009. The changes would apply to more than 3,500 hospitals paid under the IPPS effective for discharges on or after October 1, 2008 through September 30, 2009. The proposed rule will be published in the Federal Register on April 30, 2008. View the highlights »
2007
CMS releases the final 2008 IPPS ( Medicare Inpatient Payment System) rule for hospital (08/22/2007) — The final rule for the Inpatient Prospective Payment System (IPPS) for fiscal year (FY) 2008 from the Centers for Medicare and Medicaid Services (CMS) was published in the Federal Register today, August 22. Learn more »
2006
CMS Issues Final Hospital Inpatient Rule for FY 2007 — Major Heart Rhythm Cuts Averted (08/06/2006) — The final rule for the Inpatient Prospective Payment System (IPPS) for fiscal year (FY) 2007from the Centers for Medicare and Medicaid Services (CMS) was published in the Federal Register today, August 1. Learn more »
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Outpatient Prospective Payment System/Ambulatory Surgical Center (OPPS/ASC)
2009
2010 OPPS/ASC Final Rule Highlights (12/11/2009) — The Centers for Medicare and Medicaid Services (CMS) issued a final rule updating the Hospital Outpatient Prospective Payment System (OPPS) and the Ambulatory Surgical Center (ASC) payment system for Calendar Year (CY) 2010. The rule was published in the Federal Register on October 30. Most payment rates that affect heart rhythm procedures increased from 2009 payment rates. CMS will accept comments on the proposed rule until December 29. Learn more »
2008
Heart Rhythm Society Responds to 2009 Rules (09/10/2008) — On August 29, 2008 the Society submitted comments to the Centers of Medicare and Medicaid Services (CMS) in response to the "Medicare Program; Revisions to Payment Policies Under the Physician Fee Schedule and Other Revisions to Part B for CY 2009; and Revisions to the Amendment of the E-Prescribing Exemption for Computer Generated Facsimile Transmissions; Proposed Rule" published in the Federal Register on July 7, 2008. In addition, the Society submitted a second comment letter on September 3 to CMS regarding its "Proposed Changes to the Hospital Outpatient Prospective Payment System and CY 2009 Payment Rates; Proposed Changes to the Ambulatory Surgical Center Payment System and CY 2009 Payment Rates," which was published in the Federal Register on July 9, 2008. Learn more and access the Society's comments on these proposed rules »
2009 OPPS/ASC Proposed Rule Highlights (07/08/2008) — On July 3, 2008, the Centers for Medicare and Medicaid Services issued a proposed rule that will update payment rates paid under both the Outpatient Prospective Payment System (OPPS) and the ambulatory surgical center (ASC) payment system for calendar year (CY) 2009. View the highlights »
2007
The Heart Rhythm Society comments on hospitals outpatients prospective payment system (OPPS) changes (09/14/2007) — The Heart Rhythm Society wrote a letter to CMS commenting the changes to the OPPS for 2008. Learn more »
The Heart Rhythm Society and the American College of Cardiology (ACC) comment on Final Changes for Procedures Payable in an Ambulatory Surgical Center (ASC) (09/14/2007) — The Heart Rhythm Society and ACC wrote a letter to CMS addressing our concern regarding the changes for procedure payable in an ASC. Learn more »
2006
CMS Hospital Outpatient Prospective Payment System Fact Sheet is Now Available (11/20/2006) —The Hospital Outpatient Prospective Payment System Fact Sheet is now available in downloadable format on the Centers for Medicare & Medicaid Services Medicare Learning Network (MLN). Learn more »
The Society's Comments on Proposed Changes to Procedures Payable in an Ambulatory Surgical Center for 2007(11/06/2006) — View the letter »
The Society Comments on the Proposed Hospital Outpatient Prospective Payment System Rule for 2007 (10/06/2006) — View the letter »
2005
Hospital Outpatient Prospective Payment System (OPPS): ICD APCs Reduced, Pacemaker APCs Increased (09/15/2005) — HRS Urges CMS to Follow the APC Advisory Panel's Recommendation — The Society wrote a letter to Mark McClellan, MD, Ph.D., Administrator of CMS to express our concerns with the proposed reductions for device related procedures, specifically for ICD. Learnmore »
Physicians' Financial Relationships
2008
MedPAC Recommends Public Reporting of Financial Relationships (10/08/2008) — The Medicare Payment Advisory Commission (MedPAC) held a public meeting on October 2, which Heart Rhythm Society staff attended, to discuss four draft recommendations regarding public reporting of physician’s financial relationships. The panel's recommendations will likely be included in the new version of the Sunshine Act, which will be re-introduced next year. Learn more »
MedPAC Discusses Policy Options for Reporting Physicians’ Financial Relationships (09/17/2008) — The Medicare Payment Advisory Commission (MedPAC) met to continue its review on public reporting of physicians’ financial relationships on September 4, 2008. No formal recommendations were made at that time; instead, the purpose of the meeting was to seek guidance to shape draft recommendations on a proposed framework for collecting data on physicians’ financial relationships with drug and device companies, hospitals and ambulatory surgical centers (ASCs). Learn more »
Bundled Services
2009
CMS to Delete 90-Day Remote Monitoring Pacemaker and ICD Edits Retroactive to January 1 (04/01/2009) — On April 1, 2009, the Centers for Medicare and Medicaid Services (CMS) will retroactively reverse a National Correct Coding Initiative (NCCI) edit implemented on January 1, 2009 (Version 15.0) that prohibited billing CPT code 93294 with 93296 and 93295 with 93296. Providers who received claim denials based on the edits prior to April 1 may resubmit or appeal their claims. Learn more »
CMS Responds to Request to Delete NCCI Edits for 93296 A major error with two of the finalized National Correct Coding Initiative (NCCI) edits published for the new device monitoring services effective January 1, 2009 (Version 15.0 )was discovered and immediately brought to the attention of the Centers of Medicare and Medicaid Services (CMS) by the Heart Rhythm Society and the American College of Cardiology. CMS has stated that it will delete the pair edits in Version 15.1, the next quarterly update scheduled for implementation on April 1, 2009. The deletion will be retroactive to the January 1 implementation date. Learn more»
NCCI Challenges Successful (01/21/2009) — The Heart Rhythm Society succeeded once again in its objection to proposed National Correct Coding Initiative (NCCI) edits — scheduled to take effect on April 1, 2009 (Version 15.1) — that would have discontinued modifier usage for billing of an insertion or replacement of a pacemaker or ICD pulse generator (33212-33214, 33240 and 33249) performed on the same day as a device interrogation and/or programming service (93279-93284 and 93288-93289). Learn more »
2008
The Heart Rhythm Society Successfully Advocates To Maintain Reimbursement for Comprehensive EP Evaluation Services (11/03/2008) — The Heart Rhythm Society, in conjunction with the American College of Cardiology (ACC), seem to be headed for a significant victory over the AMA CPT/RUC Joint Workgroup in maintaining separate reimbursement for comprehensive EP study codes 93620 and 93621. Learn more»
CMS to Test Use of Bundled Payments for Both Hospitals and Physician Services (05/16/2008) — The Centers for Medicare & Medicaid Services (CMS) has announced a new Acute Care Episode (ACE) demonstration for hospitals, designed to align financial incentives across providers and offer flexibility to hospitals and physicians by bundling all related inpatient services into an “episode of care.” The ACE demonstration is scheduled to begin operation in January 2009. Learn more »
MedPAC Discusses Bundling Services Related to Selected Procedures Performed in Hospital (03/13/2008)— On March 5-6, 2008, the Medicare Payment Advisory Commission (MedPAC) met in Washington, D.C. to discuss ways to change Medicare payment for an episode of care surrounding a hospitalization as a way to encourage greater “systemness” in health care delivery and improve the accountability for cost and quality of care. Learn more »
Advisory Panel on Ambulatory Payment Classification Groups (APC) Recommends CMS Reinstate Separate Payment for Intracardiac Echocardiography (ICE) (03/05/2008) — On March 5, the Advisory Panel on Ambulatory Payment Classification Groups (APC) met at CMS headquarters in Baltimore, Maryland. The Panel recommended that CMS reinstate separate payment for intracardiac echocardiography (ICE), CPT code 93662. The rationale that guided this decision is that packaging payment for this low volume service financially rewards hospitals that do not use ICE. Learn more »
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Other
2009
Medicare Provider Enrollment, Chain and Ownership System (PECOS) Policy Changes Delayed for 2010 (12/22/2009) — On October 5, 2009, the Center for Medicare and Medicaid Services (CMS) began implementing the first phase of a new policy under which Medicare would not pay claims for services when the referring or ordering physician or health care practitioner is not in the Provider Enrollment, Chain and Ownership System (PECOS) database. CMS announced the policy in Change Requests 6417 and 6421. Learn more »
Update on September MedPAC Meeting (09/23/209) — The Medicare Payment Advisory Commission (MedPAC) held a two-day public meeting September 17-18 in Washington, DC. The agenda included discussions and presentations regarding the context for an upcoming chapter on Medicare Policy, comparative effectiveness and episodes of care that account for the greatest share spending and fastest growth of Medicare. Learn more »
2007
Washington Report: Modifier-51 (11/02/2007) — Heart Rhythm Society wrote a letter to members to make them aware of a change in the Modifier-51 that will take effect on January 1, 2008, which will result in a change in reimbursement for EP studies and ablation procedures from Medicare and eventually all private insurance third-party payers. Learn more »
Washington Report: Heart Rhythm Society Successes with NCCI and MUE Challenges (06/13/2007) — The Society prevailed in its objection to the National Correct Coding Initiative (NCCI), Version 13.3 edits scheduled to take effect on October 1, 2007 by convincing the Centers for Medicare & Medicaid Services (CMS) to defer action on implementation. Learn more »
2005
APC Advisory Panel's Recommendation to CMS (08/26/2005) — The Centers for Medicare and Medicaid Services (CMS) hosted a meeting of the Advisory Panel on Ambulatory Payment Classification (APC) Groups. The discussion included two specific APC groups, 0107 Implantation of Cardioverter-Defibrillator and 0108 Insertion/Replacement/Repair of Cardioverter Defibrillator Leads and Insertion of Cardioverter-Defibrillator, which have a direct impact on heart rhythm procedures performed in the outpatient setting. Learn more »
American Medical Association (AMA) letter to Congress voices opposition to extension of 18-month moratorium on physician referrals to specialty hospitals (06/10/2005) —On April 22nd, 2005 the American Medical Association (AMA) sent letters to the Speaker of the House J. Dennis Hastert and Senate Majority Leader Bill Frist, MD, expressing support for physician-owned specialty hospitals. Learn more »
