Medicare program; establishing additional Medicare durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) supplier enrollment safeguards. Final rule.

This final rule will clarify, expand, and add to the existing enrollment requirements that Durable Medical Equipment and Prosthetics, Orthotics, and Supplies (DMEPOS) suppliers must meet to establish and maintain billing privileges in the Medicare program.

Billing basics for physician assistants and nurse practitioners.

In recent years, physicians have increasingly looked to nonphysician practitioners (NPPs) as a resource for delivering care to patients. While historically more prevalent in primary care groups, nonphysician practitioners have expanded their presence within medical subspecialty and surgical groups as well. Along with planning for appointment scheduling, credentialing, and introducing the nonphysician provider to patients and referring physicians, the savvy practice will thoroughly review how services for a nonphysician can and should be billed. In this article, we focus our attention on basic Medicare billing parameters for physician assistants and nurse practitioners, two types of nonphysician practitioners.

CMS issues new forms for Medicare provider enrollment.

In its continual efforts to manage Medicare provider enrollment, CMS has revised its provider application forms. Along with the revised forms is a new requirement for a three-year cycle revalidation process that could present a considerable challenge to large providers. Also of note are longer processing periods for initial enrollment, suspension of payments if current address information is not maintained, and deactivation of a provider's number if 12 months pass without claim activity. Improvements that providers may appreciate include electronic access to forms and a decrease in the amount of information required to enroll.

Using CPT frequency reports to analyze E&M use.

Evaluation and management utilization is a significant compliance concern in the current health care environment. Understanding utilization patterns will assist the physician in determining whether significant differences exist between the physician's billed services and group or national norms.

Alternative volume performance standards for Medicare physicians' services.

The Omnibus Budget Reconciliation Act of 1989 (OBRA89) established volume performance standards (VPSs) as a key element in Medicare physician reform. This policy requires making choices along three dimensions: the risk pool, the scope and nature of the standard, and the application of the standard. VPSs have most effectively controlled expenditures and changed physician behavior when they use states as the risk pool, are composed entirely of Medicare Part B services, and establish per capita utilization targets. The institution of separate standards for voluntarily formed physician groups would pose substantial administrative challenges and has the potential to effect adverse outcomes. Instead, Congress should continue to encourage prepaid plans for the purpose of lowering health care use. Under current law, VPSs will be used to adjust future price increases. Congress may not wish to emulate the example of countries that have imposed expenditure ceilings to control costs unless the current method of using VPSs proves unsuccessful.