Payment update: CMS officials may quibble over the size of the cut, but whether it's 4.4% or 4.5% it's not going to be good for your practice. See what else is in store for your specialty in 2006

Why This Topic Matters

The article gives a practical snapshot of how the final 2006 Medicare payment rule could affect reimbursement, workflow, and compliance across many specialties. It helps readers gauge whether the policy changes may affect their practice operations, billing mix, and participation in Medicare programs.

Article Sections

1. Overall Medicare payment update and specialty impact

   Introduces the 2006 Medicare Part B payment update and describes how the final rule is expected to affect physician reimbursement broadly. It also summarizes the estimated impact across specialties and practitioners.

2. Multiple imaging service payment reduction

   Covers CMS’s policy change for multiple imaging procedures performed on the same date. The section outlines the general implementation timing and the types of imaging services addressed.

3. IVIG add-on payments

   Summarizes CMS’s temporary payment adjustment related to intravenous immune globulin products. It also notes billing and reporting considerations associated with the change.

4. Nuclear medicine self-referral delay

   Explains the delayed implementation of a self-referral restriction involving nuclear imaging services. The section also mentions CMS’s update to the list of services affected by the prohibition.

5. Cancer care demonstration

   Describes a new demonstration project focused on cancer care quality measurement for oncology patients. It highlights the broad structure of the reporting and care-coordination initiative.

6. Competitive Acquisition Program (CAP)

   Summarizes changes to the competitive acquisition program for certain drugs and vendor participation. It addresses CMS’s efforts to revise the program before full implementation.

7. Glaucoma screening

   Covers an expansion of Medicare glaucoma screening eligibility. The section identifies the general population affected and references prior utilization levels.

8. Dispensing fee cuts

   Describes changes to payment for inhalation therapy drug dispensing through nebulizers. It notes revised payment amounts for different prescription timeframes.

9. Telehealth services

   Summarizes the expansion of covered telehealth services to include additional nutrition-related services. It also notes changes to the telehealth originating site payment.

10. Five-year review of work values

    Reviews CMS’s work-value refinement process involving potentially misvalued services. The section explains how recommendations are moving through specialty review channels.

11. ESRD pay changes

    Covers payment updates for end-stage renal disease facilities, including a revised add-on amount and adjustments related to drug reimbursement methodology. It also mentions urban and rural payment changes.

12. Opt-out and private contracts

    Describes proposed changes affecting physicians who have opted out of Medicare and then treat patients without the required private contract arrangements. The section focuses on enforcement and compliance timing.

13. Therapy codes

    Summarizes payment treatment for certain unlisted therapy service codes. It notes that the rule addresses carrier pricing for these services.

14. Supply Q-codes

    Covers CMS’s decision not to bundle cast and splint supply payments into procedure codes for 2006. The section explains that separate supply billing remains part of the rule framework.

15. Federally Qualified Health Centers and Medicare Advantage

    Describes supplemental payments for federally qualified health centers that treat Medicare Advantage patients. It also outlines the types of practitioners involved in the payment policy.

16. More time for national coverage decisions

    Summarizes a statutory change affecting the timeline for Medicare reconsideration of national coverage decisions. The section identifies the broader administrative effect of the mandate.

17. Denial data and comment period

    Notes CMS’s discussion of historical Medicare claim denial rates and the opportunity to submit comments on selected parts of the final rule. It also identifies the public file code for the rule.