-Under CMS’ comments, in an attempt to undue the “administrative burden” they will increase the certification period from 30 days to 90 days erstwhile we are told by multiple national organizations to support the cap exceptions process which is more administratively burdensome then the certification process.
-Outpatient PT services will have reimbursement decreased by about 9% yet data demonstrates that CMS pays 112% to insurance companies that administer Medicare Advantage plans. If my “back of the envelope” calculation serves me right, this means an even greater margin for insurance companies that administer Advantage by further decreasing reimbursement to providers.
-we are now told by CMS that the new definition of a PT and PTA will apply in all inpatient and outpatient settings. So much for multiple personalities within our profession.
-CMS tells us that they cannot change any rule to POPTS and self-referral because there were too many comments to self-referral provisions. So much for productivity standards amongst CMS administrative folks. Personally, given the difficulty of submitting comments that we addressed in a prior post, the least they could have done was sent everybody a blue participation ribbon.
-the cap for CY 2008 is $1810 per beneficiary as long as we don’t allow the speech therapists to get any of it as it is still combined and the exceptions process will go away.
-according to an AMA editorial, if CMS paid to private insurers the same amount that it costs the government to administer medicare rather than the 12% subsidy, it would result in 54 Billion back into the system such that we wouldn’t have to take the 9% cut in 2008 (projected to be 15% thru 2009). Isn’t this an easy enough thing to figure out?
-lastly, survey data demonstrate that medicare advantage plans significantly deny the same coverage that CMS automatically pays (by a magnitude of 50%) and advantage plans pay less to the providers than medicare does for the same service! So much for privatizing medicare.
Thoughts?
