New Medicare pay rules: Time to revisit your contracts

Contract Language. By Steven M. Harris, AMNews contributor. Feb. 7, 2005.

CONTRACT LANGUAGE

A column examining the ins and outs of contract issues

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The Centers for Medicare & Medicaid Services on Jan. 1 established three final Medicare payment rules under the physician fee schedule, the hospital outpatient prospective payment system and the new inpatient psychiatric facilities prospective payment system. Make sure you understand these payment changes and consider how they may impact your practice, contracts and reimbursement.

The fee schedule final rule increases payments to physicians by an average 1.5% for 2005, which replaces what would have been a 3.3% cut in physician payment rates. The rule makes two other major changes.

The final rule implements a "Welcome to Medicare" physical for all new beneficiaries.

This exam gives you the opportunity to make an overall assessment of a patient's health and provide counseling on nutrition and other steps for a healthy lifestyle. Medicare also provides new coverage for screening for cardiovascular disease and for diabetes. You can bill and be paid separately for the screening electrocardiogram, in addition to the payment for the physical.

The new rule also increases payments for vaccinations and other types of injections. For example, payments for administering the influenza vaccine will rise from $8 to $18.

You also can be paid for injections and vaccinations, even when they are performed on the same day as other Medicare-covered services.

The final rule also expands access to other health care professionals and clarifies that Medicare will pay for care plan oversight for beneficiaries who receive home health care provided by nonphysician professionals if state law authorizes them to provide such services.