December
4 , 2000
Newsletter Archive
Top
Story
Due
to an ACC-led effort, Health Care Financing Administration
(HCFA) staff has conceded that its implementation
of the new Correct Coding Initiative (CCI) edits
in October, requiring that evaluation and management
(E&M) services performed on the same day as specific
diagnostic services include modifier -25, was
flawed and has indicated it will revisit its policy.
After intense criticism during the December 3
meeting of the American Medical Association House
of Delegates (HOD), HCFA Medical Officer, Paul
Rudolph, M.D., J.D., admitted that HCFA had erred
in implementing the requirement, not just because
of the policy itself, but because it was done
without adequately notifying physicians. Dr. Rudolph
identified several options for resolving this
problem (or at least portions of it) but did not
have the authority to firmly commit the Agency
to a specific course of action. Of course,
turning HCFA's commitment to resolve these problems
into real change is the next challenge.
The
edit was made to prevent the few physicians who
may be inappropriately billing E&M services along
with every diagnostic test but not providing a
separately identifiable E&M service. The ACC
argued, through an official resolution presented
to the HOD, that it is unreasonable to make
all physicians change their coding to account
for the problems of a few, and it is absurd that
physicians are now having large numbers of claims
rejected when they were never notified of the
change. There was widespread support for this
resolution. According to HCFA, the next planned
edition of CCI edits is scheduled for April, 2000.
It is not clear whether the agency can or will
eliminate these edits prior to then.
Federal
News
The
House and Senate will reconvene for the lame-duck
session of Congress on December 4 and 5 respectively.
The federal government is currently operating
under a continuing resolution (CR) that will expire
on December 5. Among its first orders of business,
Congress will need to pass another CR. One possible
scenario is that Congress will pass a short-term
CR that will allow them to finish work on the
remaining FY 01 appropriations bills. If Congress
can not complete work on the spending bills within
a week, Congress may consider passing a CR that
would carry over into 2001.
If,
following the vote recount in Washington state,
Democrat Maria Cantwell holds her lead over Republican
incumbent Sen. Slade Gorton, then the partisan
split in the Senate will be 50/50. With that
prospect, Senate Minority Leader Tom Daschle,
SD, is seeking a more equal share of power for
Democrats on Senate committees—specifically
to co-chair and equalize the ratio of committees
and to increase office budgets and space. Reportedly,
Sen. Daschle and Majority Leader Trent Lott, Miss.,
are scheduled to meet next week to discuss the
operation of the Senate in the 107th Congress.
President
Clinton is reportedly open to compromise on Balanced
Budget Act relief legislation during the lame-duck
Congress. According to Clinton health policy
advisor Chris Jennings, the president would like
to see appropriate relief for providers; however,
he is concerned about a disproportionate amount
of the available funds targeted to Medicare+Choice
plans. Furthermore, the president maintains his
threat to veto the tax cut package passed by the
House and to which the House BBA relief bill is
attached. If lawmakers move to pass the BBA relief
bill separately, or attach it to a less controversial
vehicle, such as another continuing budget resolution,
then there may still be hope for relief this year.
The BBA relief bill contains a provision calling
upon the MedPAC
to study HCFA's implementation of the Medicare practice
expense payment system that the College opposes
Regulatory
and Legal Affairs
HCFA
has announced guidelines for Medicare+Choice organizations
to receive an extra risk adjustment payment for
outpatient care of enrollees with congestive heart
failure (CHF) beginning in 2002. CHF is the
leading cause of hospitalization among people
covered by Medicare. Medicare+Choice organizations
may qualify for extra payments if they meet the
following clinical quality indicators: 1) at least
75 percent of certain CHF enrollees have received
evaluation of left ventricular function; and 2)
at least 80 percent of those enrollees with left
ventricular systolic dysfunction have been appropriately
prescribed an ACE Inhibitor. The guidelines also
contain rules for the 2001 NCQA Performance Improvement
Project, required of all Medicare+Choice organizations.
The goal of the 2001 project is to reduce the
number of deaths and improve the overall quality
of life for patients with congestive heart failure.
More information is available on HCFA's
Website.
The
2001 Medicare fee schedule relative values
for work, practice and malpractice expense
and the geographic adjustment factors for
cardiovascular specialty services are now
available on the ACC Website. The information
is located under the Advocacy, Issues Center,
Medicare
Fee Schedule section. The ACC will not
be publishing a separate booklet; however,
the RVUs and GPCIs may be printed in both
Excel and PDF formats from the Website. A
summary of the final rule changes is also
available on the Website.
Practice
Organization and Management
The
Health Insurance Association of America (HIAA)
and the American Association of Health Plans (AAHP)
announced on November 30 that they are merging.
The HIAA generally represents traditional
health insurance companies, while the AAHP represents
managed care companies. According to reports,
AAHP President Karen Ignagni will lead the combined
organization. It is unclear whether HIAA President
Charles Kahn will have a role in the new organization.
It is rumored, that if Governor Bush wins the
presidency Kahn may become the new chief at HCFA.
It is hard to predict whether AAHP and HIAA will
be able to yield greater power on Capitol Hill
speaking with a unified voice. Both organizations
have staunchly opposed a patients' bill of rights.
Just recently, HIAA joined with the American Hospital
Association and Families USA in unveiling a new
proposal for reducing the number of uninsured
Americans.
Advocacy
Weekly is a product of the Advocacy Division of
the American College of Cardiology. Questions
or comments regarding this publication should
be directed to the Advocacy Division at 800-435-9203
or to advocacydiv@acc.org.
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