US Supreme Court Schedules PPACA Oral Arguments for March

The US Supreme Court announced Monday that it will hear arguments on the Patient Protection and Affordable Care Act March 26-28, 2012, devoting an unprecedented full week to address the constitutionality of the federal health care reform law. The first day of arguments on March 26 will focus on whether Congress can require all Americans to purchase health care insurance or pay a fine. Arguments on March 27 and 28 will consider whether the remainder of the federal health care law can take effect if the mandate is ruled to be unconstitutional, and whether the federal government can cut off funding to states that refuse to participate in the federal health care reform plan.

Uncertainty over Medicare Physician Fee Schedule Prompts Hold on 2012 Medicare Claims in January

Palmetto GBA, the Medicare Administrative Contractor (MAC) for North Carolina, will hold claims containing 2012 services paid under the Medicare Physician Fee Schedule for the first ten business days of January. CMS announced the action on Tuesday as Congress continued to grapple with whether to delay 27.4 percent cuts in physician reimbursements scheduled to take effect January 1, 2012. The US Senate voted Saturday to delay the cuts until March 1, 2012, but the issue remained unresolved in the House as the Bulletin went to press today. It’s part of a legislative package involving a payroll tax provision and unemployment benefits.

NCMS is closely monitoring this situation and will provide updates from CMS and Palmetto GBA as they become available. Updates will be provided on the NCMS Website and in the Bulletin.

More information is also available from Palmetto GBA at: http://www.palmettogba.com/palmetto/palmetto.nsf/DocsCat/Home.

NCMS Opposes Proposed Revisions to Hospital Conditions of Participation (CoPs)

The NCMS has joined with other state and national physician organizations in opposing some proposed changes to the conditions that hospitals must meet to participate in the Medicare and Medicaid programs. In a letter to Acting CMS Administrator Marilyn B. Tavenner, RN, MHA, the organizations expressed support for CMS’ efforts to identify and eliminate burdensome regulations. However, they expressed concern and opposition to some specific revisions to CoPs involving medical staffs and governing bodies:

• Detrimental impact to the health and safety of patients in the hospital setting if CMS adopts proposed changes to the medical staff and governing body CopS, and lack of statutory authority for CMS to do so.
• Support for medical staff self-governance for each hospital within a multi-hospital system and not a single and separate staff for all hospitals in the system.
• Support for medical staffs to perform the important function of peer review and not a single medical staff that has little familiarity with the standard of care in that physician’s community.
• Opposition to a proposal to that would divide a hospital’s physicians into two distinct groups: those who are members of the medical staff, and those who are not. The organizations believe this would allow hospitals to grant privileges outside the medical staff and have a negative impact on peer review and raises concerns about possible fraud and abuse.
• Objection to CMS’ endorsement of the replacement of physicians with non-physician practitioners throughout the proposed rule, and the CMS’s effort to encourage states to widen their scope of practice laws.
• Revision of a proposal that would allow a governing body to grant privileges in accordance with hospital policies and procedures without the recommendation of the medical staffs.
• Support for each hospital facility to have a separate governing body and opposition to a proposal that would allow hospitals in multi-hospital systems to be governed by a single governing body.
• Opposition to a proposal to allow podiatrists to hold leadership positions within the medical staff of any hospital.
• Support for a proposal that provides for all orders, including verbal orders, must be dated, timed, and authenticated promptly by the ordering practitioner or another practitioner who is responsible for the care of the patient.

Click here to read the letter, to be delivered December 23, 2011.

The NCMS staff wishes you Seasons’ Greetings as we look forward to serving you in 2012.