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Government payers lighten up on disease screenings

CMS makes outpatient disease screenings easy on the wallet.
The 2005 updates to outpatient services are in - and it looks like an overall 6.6 percent increase in Medicare pay, the CMS revealed Aug. 9.
 
Next year's winners for reimbursement are preventive screenings - particularly mammograms. The rule to be published in the Aug. 16 Federal Register requires that traditional diagnostic mammograms be paid by Medicare under the Physician Fee Schedule, rather than the outpatient prospective payment system - a 40 percent increase in reimbursement. Digital diagnostic mammograms could see as much as a 60 percent hike, CMS says.
 
The forecast for other disease screening exams isn't too shabby either. Pelvic and breast exams, barium enemas, bone density studies, flexible sigmoidoscopies, screening colonoscopies and glaucoma screenings will all see increases ranging from 3 to 10.5 percent, according to the rule.
 
Tip: Get ready for the new "Wel-come to Medicare Physical" for new beneficiaries. CMS says that as long as the exam is done within six months of the beneficiary's enrollment, Medicare will reimburse $75 for the use of the facility when the exam is provided in a hospital outpatient department.
CMS will accept your comments until Oct. 8, 2004, with a final rule scheduled for Nov. 1, 2004.
"Science will decide" whether Medicare will pay for obesity treatments.
Though the ground hasn't broken yet, a new coverage determination from CMS could be the first tremor. A new policy unveiled July 16 by Health and Human Services Secretary Tommy Thompson clarifies CMS' position on obesity as a disease, rather than merely a comorbidity. If medical and scientific evidence concurs, the move could open the doors to coverage of obesity-related medical interventions farther down the road.
Confusing language in the Coverage Issues Manual, which classified obesity as "not an illness," will be replaced. The CIM,  CMS says, was intended to address the coverage of services - not the definitions of diseases.
The national coverage determination will now take into consideration that obesity could also be caused by conditions such as hypothyroidism, Cushing's disease, and hypothalamic lesions. CMS is calling for the submission of published, clinical trial data that demonstrate that obesity-related treatments improve the health of Medicare beneficiaries. The Medicare Coverage Advisory Committee plans to meet in fall 2004 to evaluate whether evidence supports bariatric surgery to reduce the risk of certain diseases.
 
To read the coverage decision, go to .
Brush up on changes to graduate medical pay.
While you're making way for the barrage of policy modifications due this fall, remember to add graduate medical education payments to your list. "Adjustments in the upcoming final rule will help ensure that CMS is [...]

- Published on 2004-09-11