Health reform law shortens claims filing deadline, extends therapy exemptions

Why This Topic Matters

The article highlights policy changes that can affect claim submission timing, payment expectations, preventive service billing, and compliance workflows across multiple practice settings. It matters to organizations tracking Medicare reform because it connects statutory changes to operational areas that affect reimbursement and reporting.

Article Sections

1. CMS implementation overview

   A general summary of the agency’s early response to the new health reform law and the types of Medicare-related changes expected to follow.

2. Therapy cap exceptions process extended

   Discussion of therapy-related implementation timing and the extension of the existing exception process for outpatient therapy services.

3. New timely filing deadline for claims

   Overview of the revised Medicare claims filing timeline and the phased interim dates CMS described for different service periods.

4. Overpayments must be repaid sooner

   Summary of the shortened timeframe for reporting and returning overpayments under the new law.

5. Medicare will cover annual wellness visit providing a personalized prevention plan

   Coverage changes related to preventive visit benefits, wellness planning, and associated Medicare beneficiary cost-sharing treatment.

6. Medicare and Medicaid coverage of preventive services broadened

   Broadening of preventive service coverage under Medicare and Medicaid, including related state incentive concepts.

7. The work geographic index floor extended and the practice expense geographic adjustment revised under the Medicare physician fee schedule

   Changes to physician fee schedule geographic adjustments and the expected impact on payment calculations across localities.

8. CMS will continue to review misvalued codes under the physician fee schedule

   Ongoing review of physician fee schedule valuations and CMS authority related to misvalued services.

9. Payment for bone-density tests

   Temporary payment restoration for a specific diagnostic imaging-related service during the stated years.

10. Presumed utilization rate increases for high-cost imaging equipment

    Changes to imaging payment assumptions for certain equipment and the types of imaging excluded from the adjustment.

11. PQRI changes

    Updates to the quality reporting initiative, including program duration, feedback, public reporting, and future payment adjustments.

12. Limitation on Medicare exception to the prohibition on certain physician referrals for hospitals

    Restrictions and conditions affecting physician-owned hospitals and Medicare participation under the new law.

13. A new independent payment advisory board

    Creation of a new advisory body, its general role in Medicare spending policy, and its relationship to future payment recommendations.

14. Contiguous body part discount rate to increase

    A payment adjustment affecting certain imaging services performed on adjacent body parts.

15. Self-referral disclosure

    An added disclosure requirement tied to the Medicare in-office ancillary exception and patient notification obligations.