News in brief - Feb. 28, 2011

Another judge rules in favor of health reform law - CMS plans to reprocess millions of 2010 Medicare claims - More primary care doctors could qualify for Medicare bonuses - Lawsuit opposing stem cell research dismissed

Another judge rules in favor of health reform law

In a legal victory for the Obama administration, a federal judge has upheld the constitutionality of the national health system reform law.

Judge Gladys Kessler, on the U.S. District Court for the District of Columbia, ruled Feb. 22 that Congress acted within its authority when it mandated that people buy health insurance or pay a penalty starting in 2014. In doing so, Kessler dismissed a lawsuit against the reform statute filed by the American Center for Law and Justice, a conservative Christian legal group.

Kessler's decision made her one of three federal judges who have upheld the health law in separate rulings. Two other federal judges have ruled all or part of the law as unconstitutional.

More than a dozen lawsuits have been filed against the health reform law since it was enacted in 2010. Judges have granted the government's motion to dismiss most of the cases, although those decisions are being appealed. Legal experts predict that the U.S. Supreme Court will ultimately decide the matter.

CMS plans to reprocess millions of 2010 Medicare claims

The Centers for Medicare & Medicaid Services has announced that it will begin automatically reprocessing millions of Medicare claims for services paid during the first few months of 2010. The action will result in about $200 million in additional payments to physicians.

The national health system reform statute signed into law in March 2010 included several retroactive changes to the 2010 Medicare physician fee schedule that sets payment rates for doctors under Part B. This required CMS to reprocess claims paid under an older version of the fee schedule between Jan. 1 and April 1, 2010.

The reprocessing effort involves millions of claims and will be a huge undertaking, CMS officials said. On Feb. 8, the agency said the effort would begin over the next several weeks. Physicians will not need to resubmit the claims to receive the additional payments they are owed.

The CMS announcement was in response to an American Medical Association inquiry about the status of the reprocessing effort. In a Dec. 10, 2010, letter to Health and Human Services Secretary Kathleen Sebelius, the AMA urged the administration to provide information about how it planned to pay physicians.

More primary care doctors could qualify for Medicare bonuses

The Centers for Medicare & Medicaid Services has changed the eligibility requirements for Medicare primary care incentives to include more newly enrolled physicians.

Starting this year, primary care physicians will earn quarterly bonuses equal to 10% of the primary care services they provide under Medicare Part B. CMS defines a primary care doctor as having a specialty designation of family practice, internal medicine, pediatrics or geriatrics. Nurse practitioners and physician assistants are eligible for bonuses, too.

Under the rule change, newly enrolled primary care physicians no longer will have to participate in the Medicare program for two years before they can start earning bonuses.

Physicians and others receiving the bonuses must have 60% of their services as primary care. For 2011 bonuses, CMS had been looking at the 2009 billing year to determine if doctors met this threshold. But under the recent rule change, the Medicare agency also will look at the preceding year's claims data when determining if a newly enrolled physician meets or exceeds the 60% mark.

Lawsuit opposing stem cell research dismissed

The 4th U.S. Circuit Court of Appeals has upheld a lower court's dismissal of a lawsuit filed on behalf of frozen human embryos that sought to stop federal funding for stem cell research.

The plaintiffs, which included adoptive parents who advocate for leftover embryos from fertility treatments to be donated for adoption, claimed such research hurts embryos and reduces the number available for adoption. In its Jan. 21 ruling, the appeals court said the parents could not prove that all frozen embryos in the U.S. would be harmed by the research and did not have valid standing to sue.

The judges noted that the opinion does not express views on any pending cases related to stem cell research.

The U.S. Appeals Court for the District of Columbia has yet to rule on another case against the government seeking to halt funding for stem cell research. In that case, a panel of appellate judges in September 2010 temporarily lifted a district judge's ban forcing the National Institutes of Health to suspend grants for the research. The panel said lifting the ban does not mean it supports or opposes either side. The court is expected to rule on the case this year.

This content was published online only.