Health Center Federal Policy, Uncategorized

Two Important Medicare Provisions Go Into Effect in 2011

by Susan Sumrell

Earlier this week CMS issued its final rule on the Medicare Physician Fee Schedule, and other provisions related to Medicare Part B. Typically, this rule has little effect on health centers, but this year it included two important provisions for health centers from the Affordable Care Act.  First, the rule finalizes the addition of a number of preventive services to the health center service package.  The new services include many services that health centers may have already been providing, but were receiving little or no payment for.  The new services that will be included are:

  • Initial preventive physical exam
  • Personalized prevention plan services
  • Screening mammography
  • Screening pap smears and pelvic exams
  • Colorectal cancer screening
  • Bone mass measurement
  • Screening for glaucoma
  • Cardiovascular screening blood tests
  • Diabetes screening tests
  • Ultrasound screening for abdominal aortic aneurysm

Additionally, the rule finalizes the 100 percent reimbursement for those services that receive a Grade A or B from the United States Preventive Services Task Force, meaning that for those services provided at health centers, the health center will be reimbursed 100 percent, instead of the typical 80 percent. Both the addition of these new services and the 100 percent reimbursement will go into effect January 1, 2011.

Second, the rule finalizes the provision that requires health centers to begin reporting Healthcare Common Procedure Coding System codes, otherwise known as HCPCS codes, also starting January 1, 2011.   These codes will only be used for a data collection and will not affect a health center’s payment. In the preamble to the final rule, CMS indicates that it will work with its contractors to ensure that health centers are properly trained in the coding requirements, and NACHC will be working with health centers on this important transition as well.

You can read the final rule here, and NACHC’s comments on the proposed rule here.