CMS Extends Form Deadline
The Centers for Medicare and Medicaid Services has extended the deadline for filing Medicare claims using its new version of claims form CMS-1500, because of formatting errors on the revised form, CMS announced. The original deadline for switching to the new form—known as CMS-1500 (08/05)—originally was April 2. But CMS said last month that contractors have been directed to continue to accept the old form until the agency notifies them to stop. Additionally, the agency advised physicians who must use the form to use legacy provider numbers, as the form cannot accommodate a National Provider Identifier (NPI) number.
New Imaging-Cut Moratorium
Several members of Congress introduced legislation last month to place a 2-year moratorium on cuts to Medicare payments for medical imaging that went into effect this year. The bill also requires a Government Accountability Office study of patient access to imaging. The bill—H.R. 1293—was introduced by Reps. Carolyn McCarthy (D-N.Y.), Gene Green (D-Tex.), and Joseph Pitts (R-Penn.), and had 49 cosponsors at press time. Rep. Pitts sponsored similar legislation in the last Congress; the cuts were mandated as part of the Deficit Reduction Act of 2005. A Senate companion bill is expected soon. Under the DRA, payments for the technical component of an imaging service are to be set at the hospital outpatient-department rate, if the payment under the Medicare physician fee schedule is higher. The Access to Medical Imaging Coalition said that a new report by the Moran Co. shows that the DRA mandate means physicians face reimbursement that's 18%–19% below that for outpatient departments. “The fact is, the DRA has decimated the imaging payments received by cardiologists, radiologists, and other providers,” said Tim Trysla, executive director of the coalition.
Stroke Networks Supported
The House Energy and Commerce Committee has approved the Stroke Treatment and Ongoing Prevention Act of 2007 (H.R. 477). That bill was introduced by Rep. Lois Capps (D-Calif.) and Rep. Charles Pickering (R-Miss.), and would fund a public awareness campaign to urge Americans to seek prompt treatment. It will also provide funds for the Paul Coverdell National Acute Stroke Registry and Clearinghouse at the Centers for Disease Control and Prevention, and also $50 million in grants from fiscal year 2008 to fiscal year 2012 to promote telemedicine to broaden access to immediate and high-quality stroke care. “The STOP Stroke Act will help save lives by enhancing awareness about stroke symptoms and ensuring that those who suffer a stroke are treated as rapidly as possible with the most appropriate therapy,” said Dr. Ralph Sacco, chairman of the American Stroke Association Stroke Advisory Committee.
Heart Hospitals = More Procedures
A study in the March 7 Journal of the American Medical Association found a higher volume of cardiac revascularization procedures in areas that gained specialty heart hospitals. Overall, the mean procedural volume in Medicare beneficiaries was fourfold higher at specialty hospitals than at cardiac programs at general hospitals, said the authors from the University of Michigan, Ann Arbor; the VA Ann Arbor Healthcare System; Harvard Medical School, Boston; and Yale University, New Haven. “These findings raise the concern that the opening of cardiac hospitals may lead to greater procedural utilization beyond the simple addition of capacity to a market,” they wrote. The rate of percutaneous coronary interventions (PCI) was higher for patients who had not had an acute myocardial infarction, which was of concern because the benefits of PCI in this group are not clear, said the author. There are several potential explanations for the higher volume: physician owners who refer for financial gain; specialty facilities that perhaps open in markets that are predisposed to higher revascularization rates because of patient characteristics; or general hospitals that more aggressively compete with the specialty facilities, driving up overall volume. The Agency for Healthcare Research and Quality paid for the study.
Prescription Drug Sales Up
U.S. prescription drug sales grew more than 8% to $275 billion in 2006, fueled by the Medicare Part D prescription benefit, increased use of generics within new therapy classes, and new drug launches, said the pharmaceutical data firm IMS Health Inc. Total dispensed prescriptions grew at nearly a 5% pace, compared with slightly more than 3% in 2005, the firm said. Part D was a large driver of the upward trend, lifting prescription volume by an estimated 1 to 2 percentage points and pharmaceutical sales by about 1 percentage point. The benefit “increased prescription coverage to the previously uninsured and underinsured, and provided generous plan benefits to seniors,” said Diana Conmy, corporate director, IMS Market Insights, in a statement. Sales of prescription drugs in the United States are expected to decline in 2007, IMS Health said.