Healthcare Law Briefs

Meeting the Challenge of Health Law

	What's Inside
	Medicare Electronic Claims Submission by 10/15/03
	Medicare 2004 Proposed Physician Fee Schedule
	Payment Reform for Part B Drugs
	MCARE Fund Lacks Money to Cover Claims

Healthcare Law Briefs

*READ PAST ISSUES OF THE HEALTHCARE LAW BRIEFS

NEW MEDICARE REGULATIONS

1. Medicare Electronic Claims Submission by 10/15/03

CMS issued an interim final rule, which was published in the Federal Register on August 15, 2003, beginning at page 48,805, clarifying the requirement of the 1999 Administrative Simplification Compliance Act (ASCA), requiring that all Medicare claims be submitted electronically no later than October 15, 2003. After that date, paper claims submitted to Medicare will not be paid.

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2. Medicare 2004 Proposed Physician Fee Schedule

Also on August 15, 2003, CMS published the proposed Physician Fee Schedule for 2004 in the Federal Register beginning at page 49030. You can review the fee schedule at the link below. Mike Cassidy will prepare an article for Tucker's quarterly newsletter identifying the significant proposed changes.

http://www.tuckerlaw.com/practice/healthresources.html

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3. Payment Reform for Part B Drugs

Finally, on August 20, 2003, CMS proposed four (4) different option for the reform of the Medicare payment procedure for Part B drugs, i.e.

Limiting reimbursement to what Medicare contractors pay for other insurance plans,
Application of a discount factor to Average Wholesale Pricing (AWP),
Use of market based pricing, and
Competitive acquisition programs implemented through a bidding process.

All of these regulations can be accessed at the following link: www.gpo.gov. Furthermore, the proposed 2004 Physician Fee Schedule can also be accessed on our website. http://www.tuckerlaw.com/practice/healthresources.html

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4. MCARE Fund Lacks Money to Cover Claims

The MCARE Fund has one-tenth of the money it needs to cover and estimated $350 million in claims that become due Dec. 31. While Gov. Ed Rendell has extended the delay in physicians� MCARE premium payments and has promised doctors since last December that he would find money to lower the payments, he has yet to find that money, reported the Scranton Times Tribune. The Office of Health Care Reform said the governor intends to stand by his commitment and noted that the MCARE Fund could borrow the money without legislative approval, if necessary, the Times Tribune noted. Other possible sources of revenue include an additional 13-cent tax on cigarettes, which could generate as much as $100 million, with the rest of the money to come from federal dollars, whereby hospitals would pay doctors' MCARE premiums and get the money back in the form of increased Medicaid reimbursements, the Times Tribune added, citing Senate Democratic Leader Robert J. Mellow of Peckville, who is heading up the proposal with the governor.

Scranton Times Tribune, August 13, 2003

PND NEWS BRIEFS - August 14, 2003

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>For more information about the topics presented in this newsletter please contact one of the Healthcare Attorneys: