CMS Puts 2012 Medicare Fee Cut at Nearly 30 Percent

Image via WikipediaBy Emily P. Walker, Washington Correspondent, MedPage Today

The Centers for Medicare and Medicaid Services (CMS) has estimated that in 2012 Medicare physician reimbursement will be cut by 29.5%.

When President Obama signed a bill in 2010 to postpone the scheduled 25% cut in Medicare reimbursement through 2011, physicians were aware that the pay cut would be greater than 25% come 2012. And, if CMS' estimate holds true, it will be.

Writing in a letter to the chairman of the Medicare Payment Advisory Commission (MedPAC), Jonathan Blum, deputy administrator of CMS' Center for Medicare, said that the "conversion factor" -- the dollar multiplier used to calculate physician payments under the current reimbursement system -- will be cut by an estimated 29.5% in 2012, from $33.98 to $23.94.

The cut is mandated by the sustainable growth rate (SGR), a formula that ties physician reimbursement to the gross domestic product; the SGR has called for cuts in pay every year since 2002. Every year since 2003, Congress has voted at the last minute to push those cuts down the road.

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Questionable Billing by Skilled Nursing Facilities

Image via WikipediaThe Department of Health and Human Services' Office of Inspector General has released the following report: Questionable Billing by Skilled Nursing Facilities (OEI-02-09-00202) http://go.usa.gov/rCy

Skilled nursing facilities (SNF) categorize beneficiaries into resource utilization groups (RUG) based on their care and resource needs. Medicare generally pays the most for ultra high therapy RUGs. Medicare also pays more for RUGs for beneficiaries who require more assistance with certain activities of daily living, such as eating.

The OIG found that SNFs increasingly billed Medicare for higher paying RUGs from 2006 to 2008, even though beneficiary characteristics remained largely unchanged. Specifically, they found large increases in RUGs for ultra high therapy, with payments to SNFs for ultra high therapy increasing by nearly 90 percent from 2006 to 2008, rising from $5.7 billion to $10.7 billion. In addition, RUGs for high levels of assistance with daily activities increased. The investigators  also found that for-profit SNFs were far more likely than nonprofit or government SNFs to bill for higher paying RUGs, and that a number of SNFs had questionable billing in 2008. Taken together, these findings raise concerns about the potentially inappropriate use of higher paying RUGs, particularly those for ultra high therapy.

Walgreens: no new Medicaid patients as of April 16 | Seattle Times Newspaper

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By Janet I. Tu - Seattle Times staff reporter

Effective April 16, Walgreens drugstores across the state won't take any new Medicaid patients, saying that filling their prescriptions is a money-losing proposition — the latest development in an ongoing dispute over Medicaid reimbursement.

The company, which operates 121 stores in the state, will continue filling Medicaid prescriptions for current patients.

In a news release, Walgreens said its decision to not take new Medicaid patients stemmed from a "continued reduction in reimbursement" under the state's Medicaid program, which reimburses it at less than the break-even point for 95 percent of brand-name medications dispensed to Medicaid patents.

Walgreens follows Bartell Drugs, which stopped taking new Medicaid patients last month at all 57 of its stores in Washington, though it still fills Medicaid prescriptions for existing customers at all but 15 of those stores.
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Federal Travel Regulation; Privately Owned Vehicle Mileage Reimbursement

SUMMARY: This final rule amends the mileage reimbursement rate for use of a privately owned vehicle (POV) when that mode of transportation is authorized or approved as more advantageous to the Government. The governing regulation is revised to increase the cost of operating: -- a privately owned airplane from $1.07 to $1.26 per mile, -- a privately owned automobile (POA) from $0.505 to $0.585 cents per mile, and -- a privately owned motorcycle from $0.305 to $0.585 cents per mile. DATES: Effective Date: This final rule is effective July 28, 2008. Applicability Date: This final rule applies to travel performed on or after August 1, 2008.