News & Resources Problems with the new Nuclear Cardiology Codes? Effective January 1, 2010, the billing for myocardial perfusion imaging (SPECT and planar) has changed. Practices must use CPT® codes (78451-78454) to report these procedures. Is your practice using the new codes and having problems with getting paid or receiving correct reimbursement for your nuclear cardiology studies? If you are having difficulties or questions, please let us know at the ACC Payer Hassle Factor Form. New Nuclear Cardiology codes: What you should know • The new 2010 Cardiology CPT® Codes • Insurer contracts: Provisions in your insurer contracts that may affect reimbursement 1. Is there language in the contract that governs the fee schedule? Is this language linked to a specific year? 2. Does the contract incorporate CMS changes automatically? 3. Is reimbursement tied to Work RVUs only, or are practice expenses and practice liability insurance also included? 4. Does the contract require advance notice for fee schedule changes? For more tips for reviewing your provider contracts, please visit the MPI Coding: Assessing the Current Situation Page. The Geographic Practice Cost Index (GPCI) Medicare is statutorily required to adjust payments for physician fee schedule services to account for differences in costs due to geographic location. There are currently 89 different localities which have not been revised since 1997. Medicare has been looking into revising GPCI system for several years, but has not finalized any proposals. CMS contracted a consulting firm to study alternative GPCI systems and released an interim study. Physician Fee Schedule Newsletters & Updates Action Alert! Visit your Congressperson Today Action Alert! Your Help is Needed The Final Stretch....Take Action for Access December 2009 Winter 2009 Newsletter Fall 2009 Update - Final Rule Includes Phased in Cuts for Cardiology Fall 2009 Newsletter Summer 2009 News Update - CMS Cuts Threaten Patient Care Summer 2008 Newsletter Fall 2007 Newsletter Summer 2006 Newsletter Spring 2005 Newsletter Summer 2002 Newsletter Summer 2001 Newsletter Briefing Materials Faced with cuts in Medicare reimbursement, rising medical liability premiums, and an increased focus on quality improvement programs and reducing growth in imaging, there is no better time for Congress to hear from physicians. For more information on these critical issues, click on the links below. Key Issues: Medicare Physician Payment Unless Congress acts this year, physicians will receive a 5.1 percent cut in Medicare physician payments on Jan. 1, 2007. ACC members need to tell Congress to pass legislation this year that will prevent a cut in 2007 and to fundamentally reform the current flawed payment system. In-Office Medical Imaging A new law imposed by the Deficit Reduction Act caps Medicare Part B reimbursement for imaging services at the Hospital Outpatient Prospective Payment System rate. ACC members need to urge Congress to examine the appropriateness of this policy, and to refrain from further cuts in Medicare payments for imaging services or from imposing overly restrictive standards that could unreasonably limit seniors� access to imaging services. Health Information Technology There are federal efforts underway to speed physicians' adoption of health information technology (HIT) and legislation to foster HIT use has been approved by the House and Senate. ACC members must urge Congress to include in final HIT legislation sufficient federal financial assistance (tax credits, grants, Medicare add-on payments or loans) to drive the integration of electronic health records (EHRs) into physician practices and to send a bill to the President this year to be signed into law. Resources American Imaging Management Clinical Information Worksheet UHC: Premium Physician Designation Program WSJ Editorial - The War on Specialists Medicare 101: Policy & Process 13 New practice expense methodology Calculate direct practice expense portion of RVUs with a bottom-up approach instead of current top-down method Eliminate non-physician work pool (NPWP) and use single methodology for all codes Incorporate supplemental practice expense data from cardiology and other specialties. 18 Non-physician work pool Services without physician work RVUs (e.g., technical component services) are in non-physician work pool (NPWP). 19 New method for direct expenses CMS ... Download a PowerPoint update from the ACC 2005 Legislative Conference. 10 2007 Physician payment changes Five year review of RBRVS New practice expense methodology DRA cut to in-office imaging This summer CMS announced several major changes in physician payment policy. 15 New practice expense formula Calculate direct practice expense portion of RVUs with a bottom-up approach instead of current top-down method Eliminate non-physician work pool (NPWP) Use supplemental practice expense data from cardiology and other specialties. CMS projects a 5.1 percent cut ... Download a PowerPoint update from the ACC 2006 Legislative Conference Questions? Contact: Rebecca Kelly Director, Regulatory Affairs Heart House 2400 N Street NW Washington DC, 20037 Phone: (202) 375-6000 Advocacy Issues Facing Cardiology Market Download a PowerPoint Presentation about Future Reimbursement Issues - Click here. Changes to CIGNA Government Services: CIGNA Revises Modifier (-25 and -59) Policy, April 20, 2009 CIGNA would like to make you aware of a new program that the Centers for Medicare & Medicaid Services (CMS) will be implementing as of September 1, 2005. CMS has issued Change Request (CR) 3951 which gives permission to all Medicare Provider Contact Centers to close for up to 8 hours per month. This time will allow the Provider Customer Service Representatives to receive training and/or staff development. CIGNA Government Services plans to implement our training program on Thursday, September 8, 2005. Beginning that day, our Provider Call Center will be closed every Thursday morning for training from 8 - 10 am. At 10:00 am, we will open the Provider Call Center. The Interactive Voice Response (IVR) unit will remain available for providers to use during that time. Please note the following telephone numbers for contacting CIGNA Government Services: IVR Toll-Free: 866.238.9651 Customer Service Representative: 866.655.7996 We continue to encourage Medicare providers and their staff to join the Electronic Mailing List at http://www.cignagovernmentservices.com/medicare_dynamic/mailer/subscribe.asp in order to receive important updates to the Medicare program. Please feel free to contact Deanna Harris at 336.821.4526 or on-line at Deanna.Harris@cigna.com, if I may be of further assistance. Heart Disease and Stroke Secondary Prevention Policy Survey Announcement Dear Provider: We are writing to request your assistance with the North Carolina Division of Public Health Heart Disease and Stroke Prevention Program's efforts concerning secondary prevention of cardiovascular disease. I would like to invite you to contribute to our efforts by completing a brief online questionnaire that assesses your organization's policies for secondary prevention of heart disease and stroke. You can find the questionnaire online at http://www.surveymonkey.com/s.asp?u=33372516618. The results of this assessment will inform us of how North Carolina's healthcare providers are addressing secondary prevention in their organizations. This information will be used to assist the Heart Disease and Stroke Prevention Program in identifying areas where it can be of assistance to improve systems of care through training and materials for patient education. The results and information gathered in this survey will remain confidential. Data will be presented only in aggregate form. If you have any questions or concerns, please contact Kristal Vardaman at the Heart Disease and Stroke Prevention Program at (919) 733-6859 or via email at Kristal.Vardaman@ncmail.net. Thank you in advance for your assistance in improving care for heart disease and stroke in North Carolina. Sincerely, Kristal Vardaman Policy Intervention Intern NC Heart Disease and Stroke Prevention Program The following N.C Chapter Members have been invited to serve on the following American College of Cardiology Committees: Thomas M. Bashore - Congenital Heart Disease and Pediatric Cardiology Committee David J. Bohle -Advocacy Committee Working Group John C. Cedarholm - Advocacy Committee Working Group on Evaluation and Management Documentation Paul G. Colavita - Advocacy Committee Working Group on Medicare Reform and Prescription Drugs Oscar R. Jenkins - Advocacy Committee Working Group Erik Magnus Ohman - Emergency Cardiac Care Committee Robert M. Rothbart - Advocacy Committee Working Group Sidney C. Smith -Awards Committee Kenneth D. Weeks - Advocacy Committee Working Group