Reimbursement News
CY 2008 Medicare HOPPS and PFS rates are released
The Centers for Medicare and Medicaid Services (CMS) have released their final CY 2008 Medicare Hospital Outpatient Prospective Payment Systems (HOPPS), ambulatory surgery center (ASC), physician fee schedule (PFS) rules, to be published on November 27 and effective on January 1, 2008. The final rule for Medicare HOPPS will include a significant change in Medicare payments for radiopharmaceuticals. Especially affected will be the payment for FDG, which will now be bundled with the imaging payment for a total of $1057.33.
Physician Fee Schedule CMS-1385-FC
HOPPS/ASC CMS-1392-FC
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The Numbers Don’t Lie…
The Centers for Medicare and Medicaid Services posted the hospital Outpatient Prospective Payment System (OPPS) rates for calendar year 2008. Once again there were major changes that will affect PET providers. Specifically, the changes include the packaging of all diagnostic radiopharmaceuticals into the APC rates and the move of PET•CT codes 78814, 78815, and 78816 from new-technology APC 1511 to existing APC 308. The APC change is reflective of claims which show that hospitals have not charged differently for PET versus PET•CT.
[FULL STORY]
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ACR attempts to delay CMS ruling for hospital OPPS
The ACR has requested a delay from the Centers for Medicare & Medicaid (CMS) in all packaging initiatives for imaging and drugs until the impact of the final ruling on the 2008 hospital outpatient prospective payment system (OPPS) is further studied.
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NOPR Update: Covered Indications
In August 2006 NOPR investigators reported a number of studies submitted to the NOPR by Medicare outside of the conditions of the registry. The NOPR has continued to monitor the frequency of such cases and are still finding that such cases are being submitted, with relatively little change in the frequency. PET facilities need to carefully review all clinical requests for PET in Medicare patients to determine whether the study is routinely covered or covered only under NOPR.
Read more about specific examples
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NOPR Update: Design & Analysis Plan paper published
The design and analysis plan of the National Oncologic PET Registry (NOPR) has been published in the November 1st issue of the Journal of Nuclear Medicine. The paper, “The National Oncologic PET Registry (NOPR): Design and Analysis Plan,” provides insight into the NOPR’s development, workflow, and statistical design. It also details how the data collected by the over 1600 participating PET facilities will be evaluated and reported to the Centers for Medicare and Medicaid (CMS).
Read the abstract and order the full text of this article
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New CMS rules will prohibit certain equipment leasing arrangements
When final rules for the 2008 Medicare Physician Fee Schedule are enacted Jan. 1, 2008, operators of independent diagnostic testing facilities will have one year to dissolve their imaging equipment leasing arrangements with referring physicians.
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Is your PET Center Accredited?
Are you interested in finding out where you stand in comparison to other Imaging Centers in our network?
Participate in our quick survey and then visit our Accreditation Tool Kit to learn practical information from a center who has recently mastered the ACR accreditation process.
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