Medicare/CMS and Payment for Cardiology Services The Carrier Advisory Committee (CAC) of the Oregon Chapter of the ACC intends to keep you updated on the activities of Oregon's CAC and the effect it may have on your cardiovascular practice. Along with representatives of other specialties, Cardiology (ACC) has a seat at the table where local Medicare payment policies are first discussed. This forum is termed the Carrier Advisory Committee (CAC). Here, proposals for policies regarding payments and approval of procedures are first aired. Please see Dr. George Waldmann's presentation about the CAC role for background. Dr. Waldmann is the contract CAC medical director of Noridian-Oregon, the administrator of various Medicare programs in the Western United States. Congress has mandated that local representation into the Medicare process be established by each "Carrier" or company providing the administrative services for Medicare in a region. Oregon has a CAC to which the ACC chapter names a representative. The ACC's National CAC can provide you with additional information on the process. On this page we will post brief notes about issues raised at the quarterly CAC meetings as well as other CMS issues relevant to Cardiology. February 2007 NOTES FROM THE CAC The Medicare (CMS-Noridian) Carrier Advisory Committee met on the 24th and there are a few things to pass along: • The comment period for the policy on MDCT is passed, but anyone who wants to have input let me know. • PQRI: Physician Quality Reporting Initiative • This program is scheduled to launch about July 2007. It is billed as a voluntary reporting to CMS on your compliance with certain criteria (Quality Measures) a full list of which is available. Although not stated, one might well see this as a lead in to “pay for performance” and cardiology offices might learn from participating in this trial. It’s worth a look, though not for the promised 1.5% payment bonus. • The OIG (the Feds) are currently keenly interested in charges coded as “consultations” and believes there has been misuse hence a closer scrutiny of such billings. • The CMS fee schedule as you know has been held at past year levels. However, on an individual charge basis there may well be decreases in order to maintain “budget neutrality”. In this context expect relative increases in E&M services and decreases in others (e.g. procedures). • All are probably aware they will need to sign up for a CMS ID…an NPI no later than may 2007 in order to get paid by CMS. • Noridian has posted on its web site a list (an LCD) of things they will not pay for. Cardiology not an issue as yet. • Acumentra Health (formerly OMPRO) is looking for case reviewers. • The CAC needs a representative of Nuclear Medicine to join the team. It might be an opportunity for a nuclear cardiologist Contact your CAC rep for details or input to CMS. FALL 2006 1. Multidetector Computed Tomography of the Heart and Great Vessels (MDCT) was discussed at the October meeting. Opportunity for comment on the Noridian proposed policy is open for 3 months. Oregon CAC Meeting Minutes 2. Send any comments to the chapter CAC representative, Oregon ACC-CAC COMMENTARY The proposed policy on MDCT raises some issues important to cardiologists: * MDCT tests yielding false positives would not be reimbursed * Not getting paid if an angiogram disagrees WITH A CT angiogram * Appropriateness guidelines are written by Noridian and do not necessarily conform to those painstakingly developed by the ACC. * Payments by CMS "law" can be made only to a single provider and this inhibits cooperation between radiologists and cardiologists * How to get these groups together since Medicare will only pay one For more information or to assist as a volunteer on this important committee, please contact the ACC CAC representative via e-mail. Len Christie, MD ACC Chapter Councilor