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 IMPORTANT PCMS MEDICARE Legislation Update The PCMS learned today that last night the House of Representatives passed H.R. 5063, which included language that provides legal protection for retroactive lawsuits against CMS, should the administration replace past data errors in the SGR formula with accurate numbers. The legislation now in the Senate has a number of Senators with objections to the legislative process employed by the House and the failure to address payment issues for hospitals and other providers. It appears that Congress will not pass H.R. #5063 which would mean that for 2003, Medicare officials have projected an additional payment cut of 4.4% on top of the 5.4% cut that occurred in 2002. In the face of an impending 4.4% cut in Medicare a number of physicians have inquired about their options with regard to Medicare billing arrangements. At this time, Medicare carriers are planning at the end of November to send a letter to each physician with information about Medicare's payment rates for 2003 and a "Medicare Participating Physician/Supplier Agreement." Physicians will then have 45 days to decide whether or not to sign or continue Medicare participation agreements for 2003. Both the date that the carrier's letter is sent out and the deadline for 2003 participation decisions could be delayed. The participation decision that physicians made last year will remain in effect through December; any change in a physician's participation status would not become effective until 2003. The Polk County Medical Society to help ensure that physicians are making informed decisions about their contractual relationships with the Medicare program are sharing the AMA developed various participation options that are available to physician. Listed below are three options that are available to physicians as outlined by the AMA. Neither the AMA nor the PCMS is advising or recommending any one of the three options described in this document. The purpose of the document is merely to ensure that physician decisions about Medicare participation are made with complete information about the available options. Special Considerations in the 2003 Participation Decision For physicians who view the 2003 Medicare payment rates as an important consideration in deciding whether or not to sign a Medicare participation agreement for the coming year it is recommended you defer your decision until late December. Medicare officials have indicated that if Congress takes action in late November or December that affects the 2003 Medicare payment rates, the decision period could potentially be extended once again. Once made, Medicare participation and non-participation decisions are binding for the entire year. Physicians who are currently participating (PAR) and who want to remain PAR for 2003 do not need to do anything to maintain their current status. Likewise, physicians who are currently non-participating (non-PAR) and who want to remain non-PAR for 2003 do not need to do anything to maintain their current status. To switch from being PAR to non-PAR for the coming year, however, or from non-PAR to PAR, physicians must notify their Medicare carrier in writing before December 31, 2002. The Three Options There are basically three Medicare contractual options for physicians. 1) Physicians may sign a PAR agreement and accept Medicare's allowed charge as payment in full for all of their Medicare patients. 2) Physicians may elect to be a non-PAR physician, which permits them to make assignment decisions on a case-by-case basis and to bill patients for more than the Medicare allowance for unassigned claims. 3) Physicians may become a private contracting physician, agreeing to bill patients directly and forego any payments from Medicare to their patients or themselves. Physicians who wish to change their status from PAR to non-PAR or vice versa must do so by December 31, 2002. Once made, the decision will be binding throughout calendar year 2003 except where the physician's practice situation has changed significantly, such as relocation to a different geographic area or a different group practice. To become a private contractor, physicians must give 30 days notice before the first day of the quarter the contract takes effect. Those considering a change in status should first determine that they are not bound by any contractual arrangements with hospitals, health plans or other entities that require them to be PAR physicians. For a detailed explanation of the options please call PCMS at 288-0172. 1 |
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