Medicare Liason Report

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Medicare Liason Report

Alfred H. Moffit, Jr., MD - Medicare Representative

The quarterly meeting was held in Orlando on February 11, 2006 and we reviewed seven (7) policies, with the Leuprolide Acetate Policy being the only one of interest to our society. It was reviewed to add new drugs to the policy.

Of special interest to all of Medicare is the fact that the 4.4% reduction enacted on January 1, 2006 by Congress has been reversed and we are back to last year's 2005 rates. However, the handling of supplemental refunds to patients because of the reversal will be addressed at a later date and you can visit the CMS website to see how to handle this.

The federal government has instituted a process to try and recover improper fees and coding by using a Recovery Audit Commission (RAC) demonstration project and will review three states: Florida, California and New York. It has been suggested that this group will audit approximately 10% of all claims for the years 2005–2008. If you receive an inquiry, try to comply in a timely fashion. If you have questions, visit the following government website to obtain more information about this program: cmsrecoveryauditdemo@cms.hhs.gov

Also, because many physicians withdrew from Medicare participation after the 4.4% reduction went into effect (by not rejoining the participating group annually), the CMS has instituted a second participation enrollment period. The new period begins February 15, 2006 and ends on March 31, 2006. Participation changes will be retroactive to January 1, 2006. Providers not making participating/nonparticipating status changes, need not do anything. Remember to increase all managed care plan rates that were tied to a percent of medicare by 4.4%.