American Academy of Home Care Physicians
Promoting the art, science and practice of medicine in the home.
2000 Vol. 12 No. 1
Issn# 1049-0028

Government Update:
Year 2000 Medicare Physician fee Schedule Published - Good News!
By: Gresham Bayne, MD and Constance Row, Executive Director

In a final rule published November 2, HCFA set the new payment schedule for physician and nurse practitioner payments for home care as well as for other payments.

And there is good news! Payments to physicians in the Year 2000 will rise an estimated 5.4% on average, compared with a 2.3% increase in 1999. Home visits reimbursement increased between 4 and 8% across the family of codes. Care Plan Oversight is also increased next year to a national value of $99 for physicians who participate in Medicare. Further increases to $112 is expected by 2002. Assuming that there is no drastic reduction in the National Correction Factor, the Level 5 new patient home visit will have a national value of more than $206 for Medicare-participating physicians.

Travel expenses remain an uncovered item, and there has also been no change in payments for rest homes. These are two issues that the Academy is pursuing aggressively. Also the Academy is concerned about the removal of payment for pulse oximetry in all settings, and the re-definition of debridements to require anesthesia which so limits payment that extensive home debridements of pressure sores will be economically discouraged. We must caution members against billing a higher level home visit codes, or billing a home visit for a service that was provided in a Domiciliary Facility, simply as a means of obtaining higher compensation and covering travel costs or other perceived injustices in the reimbursement structure. Billing must be done by the book. The Academy has learned the processes that are required to change the rules in the book, and we are working on your behalf in this regard.

The final rule also contains additional provisions affecting nurse practitioners. Included are a) progressively enhanced qualifications over the next few years to be eligible to direct bill Medicare Part B; b) revision of current regulations to state that no physician supervision is required for nurse practitioners performing diagnostic tests when they are authorized by the State to perform these tests and c) further specifications for the terms and conditions under which nurse practitioners may be paid directly by carriers for diagnostic tests under the physician fee schedule. Further information is contained in the American Academy of Nurse Practitioners November, 1999 Newsletter. You can reach their web site through ours or directly through www.nurse.org/acnp.