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An interim final rule released by the Centers for Medicare and Medicaid Services (CMS) in May revisits an issue regarding ordering and referring providers that was included in the 2010 Medicare Physician Fee Schedule. CMS last summer issued changes requiring an individual ordering or referring an imaging or laboratory service to be a physician or other health care professional able to enroll in Medicare and permitted to order or refer for the service. According to CMS, claims that did not contain the name of an enrolled ordering or referring provider would not be paid beginning in January. However, based on concerns raised by the ACC and others, CMS agreed to push the implementation date to January 2011. The new rule makes several changes to the previously announced policy, including moving the implementation date from January 2011 to July 6, 2010. It also requires that individuals ordering or referring patients for “specialist services” be enrolled. While it is unclear at this time what is meant by specialist services and whether this changes which services now require orders or referrals, practitioners who traditionally have not billed Medicare for services but may have ordered or referred Medicare patients for services (including practit ioners working for the Department of Defense and Veterans Administration) must now be enrolled.Additionally, in the original ordering and referring policy, practitioners who were not in the Medicare provider enrollment database but were in the contractor’s master file were allowed to continue to order and refer for Medicare imaging and laboratory services. Under the new regulation, practitioners must be in the Medicare provider enrollment database in order to order and refer for Medicare services.The ACC anticipates that CMS will release additional guidance on this issue in the near future. At this point, the ACC recommends that members ensure that their Medicare provider enrollment information is current and accurate. Referral sources should be encouraged to do the same. In addition, the ACC continues to urge CMS to delay implementation of this provision until the implications are fully understood and all practitioners are properly enrolled in Medicare. The ACC also continues to request that CMS issue guidance and instructions as soon as possible to allow for the education of physician practices and their staffs and any changes in claims submission that must occur. For more information on this policy and Medicare enrollment requirements, go to the “Practice Management” section of CardioSource.org and click on “Coding and Billing.”
Palliative care encourages families to be involved in the care of the patient, to help when cognitive impairment, fatigue and breathlessness interfere with comfort and care. Almost six million Americans suffer from heart failure. Cardiovascular researchers are working hard to discover new and better medications, genetic markers and mechanical devices that offer hope for an eventual cure for heart failure. It is easy to get caught up in the excitement and the possibilities inherent in the search for the newest interventions, but transplant, left ventricular assist devices (LVADs) and stem cell therapies are available only to a few because of age, comorbidity, lack of insurance, inadequate self-care ability or lack of a caregiver.