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CMS-1503-FC 984 should not be implemented until after CMS published regulations on the revised definition of AMP. A few commenters also recommended that CMS provide adequate notice to manufacturers prior to making a price substitution. One commenter suggested that additional OIG comparison studies are needed to examine the impact of the new definition of AMP. Several commenters requested clarification on and suggested changes to our proposed regulatory language. Another commenter requested clarification on the timing of price substitutions and suggested that any price substitution policies should not be implemented until the lag time between when the comparison is made and when the substitution would be implemented was decreased. One commenter noted that the OIG studies are not a reliable indicator of predicted savings since the substitution timeframes within the studies differed from that in our proposal. All commenters agreed that any price substitution policy should not be implemented until after the preliminary injunction is vacated. Moreover, several commenters provided additional information related to the comparison between ASP and AMP, including: • How ASP and AMP each encompass different sales and rebate data and are calculated based on differing statutory definitions; • The impact of restated AMP data on comparisons; and • The effect of price substitutions on physician acquisition of drugs. Response: We appreciate the comments submitted regarding our price substitution proposal. As discussed above, recent legislative and regulatory changes have further affected this issue.
CMS-1503-FC 985 After careful review and consideration of the comments received, we will not be finalizing our price substitution proposal at this time and thus we will not be finalizing the proposed regulation text at section 414.904(d). Specifically, we are not finalizing our proposal for a policy to substitute 103 percent of AMP for 106 percent of ASP for both multiple and single source drugs and biologicals as defined respectively at section 1847(A)(c)(6)(C) and (D) of the Act. This proposal specifically would have-- • Occurred when the applicable percentage had been satisfied for a number of calendar quarters as discussed elsewhere in this rule; • Permitted for a final comparison between the OIG's volume-weighted 103 percent of AMP for a billing code (calculated from the prior quarter's data) and the billing code's volume weighted 106 percent ASP, as calculated by CMS, for the current quarter to avoid a situation in which the Secretary would inadvertently raise the Medicare payment limit through this price substitution policy; and • Had the duration of the price substitution lasting for only one quarter. We are finalizing the portion of our proposal that sets the AMP threshold at 5 percent CY2011 and have revised the regulations text accordingly. We remain committed to proceeding cautiously as we continue to evaluate the impact of any future policy developments in this area. 6. Out of Scope Comments We received comments pertaining to: (1) Part B payment for insulin; (2) bona fide service fees; (3) price concessions and bundled arrangements in the calculation of manufacturer ASP data; (4) updating supplying and dispensing fees for Part B drugs; (5) developing standards for manufacturers to not submit related ASP data; (6) low
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DEPARTMENT OF HEALTH AND HUMAN SERV
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CMS-1503-FC 3 Centers for Medicare
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CMS-1503-FC 5 Elizabeth Truong, (41
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CMS-1503-FC 7 (1) The interim final
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CMS-1503-FC 9 Inputs (7) Equipment
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CMS-1503-FC 11 6. Medicare Economic
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CMS-1503-FC 13 6. Neuropsychologica
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CMS-1503-FC 15 (3) Equipment Time f
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CMS-1503-FC 17 2. Section 5501(b):
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CMS-1503-FC 19 Products (2) Final R
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CMS-1503-FC 21 a. Legislative and R
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CMS-1503-FC 23 17. Section 4103: Me
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CMS-1503-FC 25 ACC American College
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CMS-1503-FC 27 CBP Competitive Bidd
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CMS-1503-FC 29 E/M Evaluation and m
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CMS-1503-FC 31 HITECH Health Inform
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CMS-1503-FC 33 MIEA-TRHCA Medicare
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CMS-1503-FC 35 PACE Program of All-
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CMS-1503-FC 37 RVRBS Resource-Based
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CMS-1503-FC 39 rule with comment pe
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CMS-1503-FC 41 This resource-based
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CMS-1503-FC 43 premium data collect
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CMS-1503-FC 45 CY 2011 PFS proposed
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CMS-1503-FC 47 appropriately reflec
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CMS-1503-FC 49 appropriate payment
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CMS-1503-FC 51 highest level initia
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CMS-1503-FC 53 PFS update of -21.2
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CMS-1503-FC 55 final rule with comm
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CMS-1503-FC 57 period (74 FR 61743
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CMS-1503-FC 59 Practice Expense Inf
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CMS-1503-FC 61 the PPIS data. In th
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CMS-1503-FC 63 implemented PFS amou
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CMS-1503-FC 65 the service to deter
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CMS-1503-FC 67 f. Alternative Data
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CMS-1503-FC 69 used in the allocati
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CMS-1503-FC 71 develop further idea
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CMS-1503-FC 73 Step 8: Calculate th
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CMS-1503-FC 75 physician time for t
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CMS-1503-FC 77 specialties, from th
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CMS-1503-FC 79 minutes per year = m
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CMS-1503-FC 81 Step Source Formula
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CMS-1503-FC 83 expensive diagnostic
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CMS-1503-FC 85 assumption will be a
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CMS-1503-FC 87 3135(a) of the ACA),
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CMS-1503-FC 89 rate assumption appl
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CMS-1503-FC 91 CPT Code Short Descr
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CMS-1503-FC 93 supply item as a dir
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CMS-1503-FC 95 appear in the direct
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CMS-1503-FC 97 inputs for CPT code
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CMS-1503-FC 99 93786. After conside
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CMS-1503-FC 101 (four venoms) and 9
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CPT Code CMS-1503-FC 103 CMS Equipm
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CMS-1503-FC 105 CPT/ HCPCS Code Sho
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CMS-1503-FC 111 database. The comme
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CMS-1503-FC 113 of cardiac structur
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CMS-1503-FC 115 flawed. Response: A
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CMS-1503-FC 117 51729 were assigned
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CMS-1503-FC 119 inputs, we noted th
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CMS-1503-FC 121 requests on an ad h
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CMS-1503-FC 123 We solicited public
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CMS-1503-FC 125 high volumes in phy
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CMS-1503-FC 127 ongoing basis throu
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CMS-1503-FC 129 payment to cover th
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CMS-1503-FC 131 B. Malpractice Rela
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CMS-1503-FC 133 where they would be
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CMS-1503-FC 135 CY 2011 New/ CY 201
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CMS-1503-FC 137 CY 2011 New/ CY 201
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CMS-1503-FC 139 CY 2011 New/ CY 201
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CMS-1503-FC 141 RVUs. Services ment
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CMS-1503-FC 143 C. Potentially Misv
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CMS-1503-FC 145 equipment) for indi
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CMS-1503-FC 147 Section 1848(c)(2)(
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CMS-1503-FC 149 methodology (73 FR
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CMS-1503-FC 151 more. Over the past
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CMS-1503-FC 153 misvalued codes as
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CMS-1503-FC 155 including the use o
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CMS-1503-FC 157 overvaluation of pr
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CMS-1503-FC 159 requiring an initia
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CMS-1503-FC 161 payment for practit
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CMS-1503-FC 163 CPT Code Short Desc
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CMS-1503-FC 165 standard" to which
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CMS-1503-FC 167 than or equal to 0.
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CMS-1503-FC 169 Comment: A number o
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CMS-1503-FC 171 In the CYs 2009 and
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Pre- Service Time CMS-1503-FC 173 i
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CMS-1503-FC 175 The methodology dis
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CMS-1503-FC 177 inappropriate input
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CMS-1503-FC 179 RUC were not consis
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CMS-1503-FC 181 consumption of offi
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CMS-1503-FC 183 AMA RUC for CY 2012
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CMS-1503-FC 185 billed as an outpat
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CMS-1503-FC 187 inpatient or outpat
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CMS-1503-FC 189 MPPR policy, with t
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CMS-1503-FC 191 expanding the exist
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CMS-1503-FC 193 under the PFS) for
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CMS-1503-FC 195 MPPR policy in CY 2
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CMS-1503-FC 197 appropriately valui
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CMS-1503-FC 199 ultrasound. Another
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CMS-1503-FC 201 furnished with more
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CMS-1503-FC 203 acknowledge that th
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CMS-1503-FC 205 under the PFS. We b
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CMS-1503-FC 207 TABLE 17: CPT Code
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CMS-1503-FC 209 "always therapy" se
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CMS-1503-FC 211 Based on CY 2009 PF
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CMS-1503-FC 213 TABLE 19: Examples
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CMS-1503-FC 215 and position patien
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CMS-1503-FC 217 TABLE 20: Sample Pa
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CMS-1503-FC 219 respectively, notab
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CMS-1503-FC 221 Response: We apprec
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CMS-1503-FC 223 were systematically
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CMS-1503-FC 225 CY 2011 if there we
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CMS-1503-FC 227 However, we believe
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CMS-1503-FC 229 of therapy services
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CMS-1503-FC 231 and speech-language
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CMS-1503-FC 233 because SLP service
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CMS-1503-FC 235 Response: Through t
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CMS-1503-FC 237 commenters on the C
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CMS-1503-FC 239 service by the same
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CMS-1503-FC 241 under the PFS. Most
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CMS-1503-FC 243 prices for the 65 s
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CMS-1503-FC 245 because company pol
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CMS-1503-FC 247 CMS Supply Code Sup
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CMS-1503-FC 249 CMS Supply Code Sup
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CMS-1503-FC 251 on the GSA schedule
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CMS-1503-FC 253 that the periodicit
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CMS-1503-FC 255 is reasonable to us
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CMS-1503-FC 257 solely because larg
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CMS-1503-FC 259 more appropriately
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CMS-1503-FC 261 included the direct
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CMS-1503-FC 263 Prior to implementi
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CMS-1503-FC 265 individual high-cos
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CMS-1503-FC 267 D. Geographic Pract
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CMS-1503-FC 269 complete an analysi
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CMS-1503-FC 271 PE GPCI calculated
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CMS-1503-FC 273 ACA) requires that
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CMS-1503-FC 275 We proposed to assi
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CMS-1503-FC 277 CY 2011 PFS propose
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CMS-1503-FC 279 physicians' service
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CMS-1503-FC 281 that items such as
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CMS-1503-FC 283 GPCIs at least ever
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CMS-1503-FC 285 changes to the work
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CMS-1503-FC 287 Comment: Many comme
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CMS-1503-FC 289 files that are not
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CMS-1503-FC 293 the results on the
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CMS-1503-FC 295 In light of the com
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CMS-1503-FC 297 Medicare PFS. Comme
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CMS-1503-FC 299 than 48.3 percent (
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CMS-1503-FC 301 various studies reg
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CMS-1503-FC 303 this section. Confi
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CMS-1503-FC 305 summarizing or resp
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CMS-1503-FC 307 that the cost weigh
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CMS-1503-FC 309 both non-physician
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CMS-1503-FC 311 (7) Consumer Price
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CMS-1503-FC 313 We proposed to use
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CMS-1503-FC 315 categories, as well
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CMS-1503-FC 317 well as photocopier
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CMS-1503-FC 319 The proposed weight
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CMS-1503-FC 321 captured in the que
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CMS-1503-FC 323 judgments about rel
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CMS-1503-FC 325 TABLE 30: CMS Compo
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CMS-1503-FC 327 (11) Fixed Capital
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CMS-1503-FC 329 purchase, as well a
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CMS-1503-FC 331 was within 0.3 perc
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CMS-1503-FC 333 2006 Cost Categorie
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CMS-1503-FC 335 should move forward
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CMS-1503-FC 337 that the estimates
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CMS-1503-FC 339 • The Chemicals a
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CMS-1503-FC 341 Expense categories,
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CMS-1503-FC 343 Comment: One commen
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CMS-1503-FC 345 technology. Respons
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CMS-1503-FC 347 the MEI only increa
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CMS-1503-FC 349 by CMS. Suggested m
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CMS-1503-FC 351 price (ASP) and, si
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CMS-1503-FC 353 CY 1999 and CY 2004
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CMS-1503-FC 355 heavily weighted to
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CMS-1503-FC 357 adjustment to the w
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CMS-1503-FC 359 F. Allowed Expendit
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CMS-1503-FC 361 "physicians' servic
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CMS-1503-FC 363 ● Physician work
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CMS-1503-FC 365 TABLE 37: CY 2009 S
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CMS-1503-FC 367 We estimate that th
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CMS-1503-FC 369 This factor was cal
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CMS-1503-FC 371 (3) Factor 3--Estim
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CMS-1503-FC 373 the SGR of 1.6 perc
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CMS-1503-FC 375 + Computing the dif
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CMS-1503-FC 377 Consistent with sec
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CMS-1503-FC 379 specified that the
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CMS-1503-FC 381 period, we are resc
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CMS-1503-FC 383 acts to extend it.
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CMS-1503-FC 385 expected effects of
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CMS-1503-FC 387 the feasibility of
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CMS-1503-FC 389 (75 FR 40097 throug
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CMS-1503-FC 391 information about p
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CMS-1503-FC 393 dedicated professio
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CMS-1503-FC 395 are not medically r
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CMS-1503-FC 397 documentation in th
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CMS-1503-FC 399 similarly for effic
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CMS-1503-FC 401 feasibility of usin
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CMS-1503-FC 403 being furnished are
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CMS-1503-FC 405 commenters agreed t
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CMS-1503-FC 407 To that end, some c
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CMS-1503-FC 409 the efficiencies th
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CMS-1503-FC 411 valuation of therap
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CMS-1503-FC 413 commenters recommen
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CMS-1503-FC 415 intervention are in
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CMS-1503-FC 417 However, there are
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CMS-1503-FC 419 be important in mak
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CMS-1503-FC 421 B. Diabetes Self-Ma
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CMS-1503-FC 423 • That HCPCS G010
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CMS-1503-FC 425 HCPCS codes for KDE
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CMS-1503-FC 427 http://www.cms.gov/
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CMS-1503-FC 429 not show up for the
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CMS-1503-FC 431 requests, we refer
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CMS-1503-FC 433 process. After cons
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CMS-1503-FC 435 (End-stage renal di
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CMS-1503-FC 437 recommendations as
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CMS-1503-FC 439 code would clearly
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CMS-1503-FC 441 CY 2011 proposal to
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CMS-1503-FC 443 duration of acute e
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CMS-1503-FC 445 separate HCPCS code
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CMS-1503-FC 447 arms, legs; each ad
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CMS-1503-FC 449 sq cm or less) and
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CMS-1503-FC 451 application of skin
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CMS-1503-FC 453 fair and balanced t
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CMS-1503-FC 455 definitions would a
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CMS-1503-FC 457 application would b
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CMS-1503-FC 459 HCPCS code G0440 is
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CMS-1503-FC 461 and 15341 to HCPCS
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CMS-1503-FC 463 our crosswalk propo
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CMS-1503-FC 465 file. H. Intranasal
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CMS-1503-FC 467 Response: We would
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CMS-1503-FC 469 our CY 2011 proposa
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CMS-1503-FC 471 clarification. Spec
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CMS-1503-FC 473 the resources neede
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CMS-1503-FC 475 In the CY 2011 PFS
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CMS-1503-FC 477 Independent Diagnos
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CMS-1503-FC 479 for cardiac and oth
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CMS-1503-FC 481 data applied to all
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CMS-1503-FC 483 submission of $21,5
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CMS-1503-FC 485 as transparent and
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CMS-1503-FC 487 consultations, offi
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CMS-1503-FC 489 ● Offices of a ph
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CMS-1503-FC 491 Section 1834(m)(2)(
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CMS-1503-FC 493 Requestors should s
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CMS-1503-FC 495 diagnosis, medical
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CMS-1503-FC 497 rulemaking, we had
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CMS-1503-FC 499 furnished to the el
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CMS-1503-FC 501 individual as indiv
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CMS-1503-FC 503 services, and that
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CMS-1503-FC 505 commenters' shared
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CMS-1503-FC 507 psychiatric hospita
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CMS-1503-FC 509 telehealth consulta
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CMS-1503-FC 511 comprehensive, coor
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CMS-1503-FC 513 services. One comme
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CMS-1503-FC 515 proposed rule (74 F
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CMS-1503-FC 517 discussion of subse
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CMS-1503-FC 519 commenter agreed wi
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CMS-1503-FC 521 not believe that th
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CMS-1503-FC 523 any proposals regar
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CMS-1503-FC 525 ● Individual and
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CMS-1503-FC 527 V. Addressing Inter
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CMS-1503-FC 529 misvalued codes and
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CMS-1503-FC 531 experience which in
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CMS-1503-FC 533 2. CY 2010 Interim
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CMS-1503-FC 535 c. Myocardial Perfu
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CMS-1503-FC 537 included in the myo
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CMS-1503-FC 539 noted that when thi
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CMS-1503-FC 541 RVUs we established
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CMS-1503-FC 543 endorsed CMS' decis
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CMS-1503-FC 545 public notice and t
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CMS-1503-FC 547 Comment: Several co
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CMS-1503-FC 551 have replaced petro
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CMS-1503-FC 553 (or nerves innervat
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CMS-1503-FC 555 service since the o
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CMS-1503-FC 557 displayed in Table
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CMS-1503-FC 559 physical effort, an
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CMS-1503-FC 561 recommending the me
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CMS-1503-FC 563 recommended that th
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CMS-1503-FC 565 basis for CY 2011.
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CMS-1503-FC 567 perform this servic
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CMS-1503-FC 569 which is a value be
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CMS-1503-FC 571 and complex than CP
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CMS-1503-FC 573 with comment period
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CMS-1503-FC 575 generator and repla
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CMS-1503-FC 577 of 18 minutes. The
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CMS-1503-FC 579 for CPT code 90461
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CMS-1503-FC 581 Therefore we are as
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CMS-1503-FC 583 patient), and recom
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CPT Code 37220 37221 37222 37223 37
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CMS-1503-FC 587 The AMA RUC used a
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CMS-1503-FC 589 we are requesting t
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CMS-1503-FC 591 When the AMA RUC re
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CMS-1503-FC 593 and add new codes t
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CMS-1503-FC 595 work RVUs that are
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CMS-1503-FC 597 the CMS decision in
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CMS-1503-FC 599 52332. Therefore, w
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CMS-1503-FC 601 21.47 work RVUs to
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CMS-1503-FC 603 misvalued codes in
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CMS-1503-FC 605 maintain the curren
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CMS-1503-FC 607 code 99213, a more
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CMS-1503-FC 617 Many of the refinem
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CMS-1503-FC 619 For add-on codes, o
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CMS-1503-FC 621 equipment items in
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CMS-1503-FC 623 reflect the actual
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CMS-1503-FC 631 CPT Code 11042 1104
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CMS-1503-FC 635 CPT Code 37227 Shor
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CMS-1503-FC 645 CPT Code 93453 9345
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CMS-1503-FC 651 CPT Code 93464 9356
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CMS-1503-FC 653 CPT Code 95956 9644
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CMS-1503-FC 655 VI. Provisions of t
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CMS-1503-FC 657 care (74 FR 61846).
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CMS-1503-FC 659 January 1, 2012, an
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CMS-1503-FC 663 methods of reportin
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CMS-1503-FC 665 particular, noted t
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CMS-1503-FC 667 geographic adjustme
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CMS-1503-FC 669 risk adjusted and s
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CMS-1503-FC 671 influence. Others e
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CMS-1503-FC 673 In determining diff
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CMS-1503-FC 675 discontinue our use
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CMS-1503-FC 677 Some commenters men
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CMS-1503-FC 679 In addition, we rec
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CMS-1503-FC 681 Medicare Prescripti
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CMS-1503-FC 683 Section 136 of the
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CMS-1503-FC 685 2. Amendment to Sec
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CMS-1503-FC 687 to continue to oper
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CMS-1503-FC 689 Interactive Psychot
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CMS-1503-FC 691 H. Section 3108: Pe
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CMS-1503-FC 693 that any changes to
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CMS-1503-FC 695 Third, in order to
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CMS-1503-FC 697 payment is made) to
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CMS-1503-FC 699 K. Section 3122: Ex
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CMS-1503-FC 701 equipment to a 75 p
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CMS-1503-FC 703 forth in section 18
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CMS-1503-FC 705 beneficiary, not th
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CMS-1503-FC 707 Section 3136(a)(2)
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CMS-1503-FC 709 standard power whee
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CMS-1503-FC 711 power wheelchairs,
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CMS-1503-FC 713 commenter requested
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CMS-1503-FC 715 O. Section 3139: Pa
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CMS-1503-FC 717 In summary, we are
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CMS-1503-FC 719 proposed to be used
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CMS-1503-FC 721 other health care p
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CMS-1503-FC 723 To create a forecas
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CMS-1503-FC 725 if the update facto
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CMS-1503-FC 727 the annual update t
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CMS-1503-FC 729 percentage increase
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CMS-1503-FC 731 less than zero, the
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CMS-1503-FC 733 purposes, we have m
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CMS-1503-FC 735 proposed rule d. DM
Page 737 and 738:
CMS-1503-FC 737 sections 3401(m), (
Page 739 and 740:
CMS-1503-FC 739 or update of a list
Page 741 and 742:
CMS-1503-FC 741 Further, the ACA al
Page 743 and 744:
CMS-1503-FC 743 direct observation
Page 745 and 746:
CMS-1503-FC 745 ++ Ability to succe
Page 747 and 748:
CMS-1503-FC 747 term "health profes
Page 749 and 750:
CMS-1503-FC 749 include language on
Page 751 and 752:
CMS-1503-FC 751 vitamins. ++ Use or
Page 753 and 754:
CMS-1503-FC 753 beneficiary shall b
Page 755 and 756:
CMS-1503-FC 755 appropriate, to hea
Page 757 and 758:
CMS-1503-FC 757 However, other comm
Page 759 and 760:
CMS-1503-FC 759 recommendation at t
Page 761 and 762:
CMS-1503-FC 761 ++ The list of risk
Page 763 and 764:
CMS-1503-FC 763 or through an HRA,
Page 765 and 766:
CMS-1503-FC 765 therefore, we are i
Page 767 and 768:
CMS-1503-FC 767 satisfaction and re
Page 769 and 770:
Page 771 and 772:
CMS-1503-FC 771 in Opening a Nation
Page 773 and 774:
CMS-1503-FC 773 In summary, as a re
Page 775 and 776:
CMS-1503-FC 775 GXXXA or GXXXB, pro
Page 777 and 778:
CMS-1503-FC 777 AMA RUCs process to
Page 779 and 780:
CMS-1503-FC 779 as discussed in sec
Page 781 and 782:
CMS-1503-FC 781 visit for an establ
Page 783 and 784:
CMS-1503-FC 783 the CPT codes. We c
Page 785 and 786:
CMS-1503-FC 785 CY 2011 proposal to
Page 787 and 788:
CMS-1503-FC 787 beneficiaries when
Page 789 and 790:
CMS-1503-FC 789 ● The specific se
Page 791 and 792:
Page 793 and 794:
CMS-1503-FC 793 is an "additional p
Page 795 and 796:
CMS-1503-FC 795 considered "additio
Page 797 and 798:
Page 799 and 800:
CMS-1503-FC 799 Wellness Visits Pro
Page 801 and 802:
CMS-1503-FC 801 for clinical labora
Page 803 and 804:
CMS-1503-FC 803 and fecal occult bl
Page 805 and 806:
CMS-1503-FC 805 In §410.152, we pr
Page 807 and 808:
CMS-1503-FC 807 Response: Glaucoma
Page 809 and 810:
CMS-1503-FC 809 Medicare Part A or
Page 811 and 812:
CMS-1503-FC 811 publication of the
Page 813 and 814:
CMS-1503-FC 813 Medicare will conti
Page 815 and 816:
CMS-1503-FC 815 report, the CMS-222
Page 817 and 818:
CMS-1503-FC 817 with the provisions
Page 819 and 820:
CMS-1503-FC 819 Preventive Service
Page 821 and 822:
Page 823 and 824:
Page 825 and 826:
Page 827 and 828:
Page 829 and 830:
CMS-1503-FC 829 3. Extension of Wai
Page 831 and 832:
CMS-1503-FC 831 circumstances under
Page 833 and 834:
CMS-1503-FC 833 E/M visits; ● 992
Page 835 and 836:
CMS-1503-FC 835 practitioner, 89-ce
Page 837 and 838:
CMS-1503-FC 837 Medicare, arguing t
Page 839 and 840:
CMS-1503-FC 839 would limit the num
Page 841 and 842:
CMS-1503-FC 841 for the PCIP, regar
Page 843 and 844:
CMS-1503-FC 843 denominator for pur
Page 845 and 846:
CMS-1503-FC 845 CPT Code Descriptio
Page 847 and 848:
CMS-1503-FC 847 was limited to prim
Page 849 and 850:
CMS-1503-FC 849 optional method. Th
Page 851 and 852:
CMS-1503-FC 851 flexibility in dete
Page 853 and 854:
CMS-1503-FC 853 determining eligibi
Page 855 and 856:
CMS-1503-FC 855 applicable (eligibi
Page 857 and 858:
CMS-1503-FC 857 monitor changes in
Page 859 and 860:
CMS-1503-FC 859 or not the service
Page 861 and 862:
CMS-1503-FC 861 We note that Medica
Page 863 and 864:
CMS-1503-FC 863 2. Section 5501(b):
Page 865 and 866:
CMS-1503-FC 865 professional servic
Page 867 and 868:
CMS-1503-FC 867 "HPSA surgical ince
Page 869 and 870:
CMS-1503-FC 869 in surgical special
Page 871 and 872:
CMS-1503-FC 871 in areas that are d
Page 873 and 874:
CMS-1503-FC 873 1834(g)(2)(B) of th
Page 875 and 876:
CMS-1503-FC 875 (DHS) payable by Me
Page 877 and 878:
CMS-1503-FC 877 patient's signature
Page 879 and 880:
CMS-1503-FC 879 purposes of the phy
Page 881 and 882:
CMS-1503-FC 881 procedure or immedi
Page 883 and 884:
Page 885 and 886:
CMS-1503-FC 885 are finalizing our
Page 887 and 888:
CMS-1503-FC 887 notice include supp
Page 889 and 890:
CMS-1503-FC 889 referral be include
Page 891 and 892:
CMS-1503-FC 891 services for which
Page 893 and 894:
CMS-1503-FC 893 patient's main medi
Page 895 and 896:
CMS-1503-FC 895 minimum time limit
Page 897 and 898:
CMS-1503-FC 897 retroactive claims
Page 899 and 900:
CMS-1503-FC 899 State Medicaid Agen
Page 901 and 902:
CMS-1503-FC 901 from the date the p
Page 903 and 904:
CMS-1503-FC 903 intention to provid
Page 905 and 906:
CMS-1503-FC 905 an extension of tim
Page 907 and 908:
CMS-1503-FC 907 entitled to Medicar
Page 909 and 910:
CMS-1503-FC 909 because we did not
Page 911 and 912:
CMS-1503-FC 911 trigger when the ex
Page 913 and 914:
CMS-1503-FC 913 delays caused by th
Page 915 and 916:
CMS-1503-FC 915 benefits exhaust cl
Page 917 and 918:
CMS-1503-FC 917 year after the date
Page 919 and 920:
CMS-1503-FC 919 therefore will not
Page 921 and 922:
CMS-1503-FC 921 correction will tri
Page 923 and 924:
CMS-1503-FC 923 2. Subdividing Larg
Page 925 and 926:
CMS-1503-FC 925 We found that count
Page 927 and 928:
CMS-1503-FC 927 these islands or wh
Page 929 and 930:
CMS-1503-FC 929 commenter provide a
Page 931 and 932:
CMS-1503-FC 931 CBA Name County TAB
Page 933 and 934: CMS-1503-FC 933 items must currentl
Page 935 and 936: CMS-1503-FC 935 PAOC that removing
Page 937 and 938: CMS-1503-FC 937 DMEPOS Allowed Amou
Page 939 and 940: CMS-1503-FC 939 21 Additional MSAs
Page 941 and 942: CMS-1503-FC 941 additional reportin
Page 943 and 944: CMS-1503-FC 943 nation, in order to
Page 945 and 946: CMS-1503-FC 945 VII. Other Provisio
Page 947 and 948: CMS-1503-FC 947 Although problems w
Page 949 and 950: Previous Quarter Reported NDCs CMS-
Page 951 and 952: CMS-1503-FC 951 be done to obtain a
Page 953 and 954: CMS-1503-FC 953 Comment: A commente
Page 955 and 956: CMS-1503-FC 955 reported, then a ma
Page 957 and 958: CMS-1503-FC 957 monitor manufacture
Page 959 and 960: CMS-1503-FC 959 Although this secti
Page 961 and 962: CMS-1503-FC 961 the Act and is also
Page 963 and 964: CMS-1503-FC 963 amount for each HCP
Page 965 and 966: CMS-1503-FC 965 Product" indicates
Page 967 and 968: CMS-1503-FC 967 acquisition costs b
Page 969 and 970: CMS-1503-FC 969 prohibited. They st
Page 971 and 972: CMS-1503-FC 971 Response: For the r
Page 973 and 974: CMS-1503-FC 973 calculations be car
Page 975 and 976: CMS-1503-FC 975 supplier or any oth
Page 977 and 978: CMS-1503-FC 977 Response: We descri
Page 979 and 980: CMS-1503-FC 979 For CY 2011, we pro
Page 981 and 982: CMS-1503-FC 981 specify the timing
Page 983: CMS-1503-FC 983 Association of Chai
Page 987 and 988: CMS-1503-FC 987 B. Ambulance Fee Sc
Page 989 and 990: CMS-1503-FC 989 Claims Processing M
Page 991 and 992: CMS-1503-FC 991 mile or less than o
Page 993 and 994: CMS-1503-FC 993 Second, we consider
Page 995 and 996: CMS-1503-FC 995 system should be co
Page 997 and 998: CMS-1503-FC 997 instructions set fo
Page 999 and 1000: CMS-1503-FC 999 For the reasons dis
Page 1001 and 1002: CMS-1503-FC 1001 requiring that the
Page 1003 and 1004: CMS-1503-FC 1003 we monitored. (See
Page 1005 and 1006: CMS-1503-FC 1005 not change the amb
Page 1007 and 1008: CMS-1503-FC 1007 rates for ambulanc
Page 1009 and 1010: CMS-1503-FC 1009 overburdened and u
Page 1011 and 1012: CMS-1503-FC 1011 fractional mileage
Page 1013 and 1014: CMS-1503-FC 1013 trip computer, or
Page 1015 and 1016: CMS-1503-FC 1015 then implementatio
Page 1017 and 1018: CMS-1503-FC 1017 cannot comply with
Page 1019 and 1020: CMS-1503-FC 1019 billing policy is
Page 1021 and 1022: CMS-1503-FC 1021 be required to rep
Page 1023 and 1024: CMS-1503-FC 1023 requisition. While
Page 1025 and 1026: CMS-1503-FC 1025 documenting that t
Page 1027 and 1028: CMS-1503-FC 1027 are two different
Page 1029 and 1030: CMS-1503-FC 1029 services. One of t
Page 1031 and 1032: CMS-1503-FC 1031 laboratory test pa
Page 1033 and 1034: CMS-1503-FC 1033 shipping addresses
Page 1035 and 1036:
CMS-1503-FC 1035 physician. The com
Page 1037 and 1038:
CMS-1503-FC 1037 of analyses used t
Page 1039 and 1040:
CMS-1503-FC 1039 section 651 of MMA
Page 1041 and 1042:
CMS-1503-FC 1041 continue to update
Page 1043 and 1044:
CMS-1503-FC 1043 2. Estimating Per
Page 1045 and 1046:
CMS-1503-FC 1045 Comment: One comme
Page 1047 and 1048:
CMS-1503-FC 1047 access to dialysis
Page 1049 and 1050:
CMS-1503-FC 1049 Also, in the CY 20
Page 1051 and 1052:
CMS-1503-FC 1051 Using treatment co
Page 1053 and 1054:
CMS-1503-FC 1053 F. Issues Related
Page 1055 and 1056:
CMS-1503-FC 1055 "Physician Quality
Page 1057 and 1058:
CMS-1503-FC 1057 educational videos
Page 1059 and 1060:
CMS-1503-FC 1059 Response: As we no
Page 1061 and 1062:
CMS-1503-FC 1061 practice. Commente
Page 1063 and 1064:
CMS-1503-FC 1063 reported, and is c
Page 1065 and 1066:
CMS-1503-FC 1065 Quality Reporting
Page 1067 and 1068:
CMS-1503-FC 1067 2015, where it is
Page 1069 and 1070:
CMS-1503-FC 1069 Response: We appre
Page 1071 and 1072:
CMS-1503-FC 1071 reporting with res
Page 1073 and 1074:
CMS-1503-FC 1073 numerator and deno
Page 1075 and 1076:
CMS-1503-FC 1075 will include both
Page 1077 and 1078:
CMS-1503-FC 1077 The following is a
Page 1079 and 1080:
CMS-1503-FC 1079 period (that is, J
Page 1081 and 1082:
CMS-1503-FC 1081 in-person registry
Page 1083 and 1084:
CMS-1503-FC 1083 ● Obtain and kee
Page 1085 and 1086:
CMS-1503-FC 1085 and performance ra
Page 1087 and 1088:
CMS-1503-FC 1087 calculate the meas
Page 1089 and 1090:
Page 1091 and 1092:
CMS-1503-FC 1091 2011 will need to
Page 1093 and 1094:
CMS-1503-FC 1093 ● Be able to inc
Page 1095 and 1096:
CMS-1503-FC 1095 that self-nominate
Page 1097 and 1098:
CMS-1503-FC 1097 For the 2011 Physi
Page 1099 and 1100:
CMS-1503-FC 1099 required to report
Page 1101 and 1102:
CMS-1503-FC 1101 reporting threshol
Page 1103 and 1104:
CMS-1503-FC 1103 Reporting System q
Page 1105 and 1106:
CMS-1503-FC 1105 measures group app
Page 1107 and 1108:
CMS-1503-FC 1107 Based on the comme
Page 1109 and 1110:
CMS-1503-FC 1109 g. Reporting Optio
Page 1111 and 1112:
CMS-1503-FC 1111 reporting option i
Page 1113 and 1114:
CMS-1503-FC 1113 Response: We agree
Page 1115 and 1116:
Page 1117 and 1118:
CMS-1503-FC 1117 criteria for satis
Page 1119 and 1120:
CMS-1503-FC 1119 identical to the r
Page 1121 and 1122:
CMS-1503-FC 1121 such a short time
Page 1123 and 1124:
CMS-1503-FC 1123 • Agree to atten
Page 1125 and 1126:
CMS-1503-FC 1125 those Medicare Par
Page 1127 and 1128:
CMS-1503-FC 1127 nominating before
Page 1129 and 1130:
CMS-1503-FC 1129 Program, we propos
Page 1131 and 1132:
Page 1133 and 1134:
CMS-1503-FC 1133 groups can select
Page 1135 and 1136:
CMS-1503-FC 1135 VII.F.2.(i).(5). o
Page 1137 and 1138:
CMS-1503-FC 1137 opportunity to pro
Page 1139 and 1140:
CMS-1503-FC 1139 ++ Section 1848(k)
Page 1141 and 1142:
CMS-1503-FC 1141 programs to which
Page 1143 and 1144:
Page 1145 and 1146:
CMS-1503-FC 1145 depend on the deve
Page 1147 and 1148:
Page 1149 and 1150:
CMS-1503-FC 1149 151, 154, 155, 173
Page 1151 and 1152:
CMS-1503-FC 1151 groups should be a
Page 1153 and 1154:
CMS-1503-FC 1153 well. One commente
Page 1155 and 1156:
CMS-1503-FC 1155 Response: We will
Page 1157 and 1158:
CMS-1503-FC 1157 Although they were
Page 1159 and 1160:
CMS-1503-FC 1159 Physician Quality
Page 1161 and 1162:
Page 1163 and 1164:
Page 1165 and 1166:
CMS-1503-FC 1165 Please note that d
Page 1167 and 1168:
CMS-1503-FC 1167 applicable measure
Page 1169 and 1170:
Page 1171 and 1172:
CMS-1503-FC 1171 implementation, an
Page 1173 and 1174:
CMS-1503-FC 1173 Comment: Several c
Page 1175 and 1176:
CMS-1503-FC 1175 The titles of the
Page 1177 and 1178:
CMS-1503-FC 1177 • Measure #2: Di
Page 1179 and 1180:
CMS-1503-FC 1179 Comment: Because t
Page 1181 and 1182:
Page 1183 and 1184:
CMS-1503-FC 1183 Comment: We receiv
Page 1185 and 1186:
CMS-1503-FC 1185 would not be appro
Page 1187 and 1188:
CMS-1503-FC 1187 TABLE 85: Measures
Page 1189 and 1190:
CMS-1503-FC 1189 TABLE 89: Measures
Page 1191 and 1192:
CMS-1503-FC 1191 * This measures gr
Page 1193 and 1194:
CMS-1503-FC 1193 part of the PGP an
Page 1195 and 1196:
Page 1197 and 1198:
CMS-1503-FC 1197 on the Physician C
Page 1199 and 1200:
CMS-1503-FC 1199 report 2011 Physic
Page 1201 and 1202:
CMS-1503-FC 1201 • Ensure that th
Page 1203 and 1204:
CMS-1503-FC 1203 Comment: Some comm
Page 1205 and 1206:
CMS-1503-FC 1205 requirements throu
Page 1207 and 1208:
CMS-1503-FC 1207 not satisfactorily
Page 1209 and 1210:
CMS-1503-FC 1209 practice assessmen
Page 1211 and 1212:
CMS-1503-FC 1211 ("Additional Incen
Page 1213 and 1214:
CMS-1503-FC 1213 is required to qua
Page 1215 and 1216:
CMS-1503-FC 1215 experience with ca
Page 1217 and 1218:
CMS-1503-FC 1217 the year the eligi
Page 1219 and 1220:
CMS-1503-FC 1219 Response: While we
Page 1221 and 1222:
CMS-1503-FC 1221 System]." Therefor
Page 1223 and 1224:
CMS-1503-FC 1223 quality improvemen
Page 1225 and 1226:
CMS-1503-FC 1225 participation, the
Page 1227 and 1228:
CMS-1503-FC 1227 However, with resp
Page 1229 and 1230:
CMS-1503-FC 1229 comments of ensuri
Page 1231 and 1232:
Page 1233 and 1234:
CMS-1503-FC 1233 physicians exclude
Page 1235 and 1236:
Page 1237 and 1238:
CMS-1503-FC 1237 we believe interim
Page 1239 and 1240:
CMS-1503-FC 1239 improves successfu
Page 1241 and 1242:
CMS-1503-FC 1241 before July 1, 201
Page 1243 and 1244:
CMS-1503-FC 1243 professionals repo
Page 1245 and 1246:
CMS-1503-FC 1245 • Given that thi
Page 1247 and 1248:
CMS-1503-FC 1247 review process whe
Page 1249 and 1250:
CMS-1503-FC 1249 section 1848(m)(5)
Page 1251 and 1252:
CMS-1503-FC 1251 practice) earns an
Page 1253 and 1254:
CMS-1503-FC 1253 which eligible pro
Page 1255 and 1256:
CMS-1503-FC 1255 feedback reports w
Page 1257 and 1258:
CMS-1503-FC 1257 Under section 1848
Page 1259 and 1260:
CMS-1503-FC 1259 end of the 2012 pa
Page 1261 and 1262:
CMS-1503-FC 1261 Eligible professio
Page 1263 and 1264:
CMS-1503-FC 1263 Although we are fi
Page 1265 and 1266:
CMS-1503-FC 1265 patient visit. The
Page 1267 and 1268:
CMS-1503-FC 1267 Part B covered pro
Page 1269 and 1270:
CMS-1503-FC 1269 (a) Generate a com
Page 1271 and 1272:
CMS-1503-FC 1271 Inquiry and Respon
Page 1273 and 1274:
CMS-1503-FC 1273 We intend to post
Page 1275 and 1276:
CMS-1503-FC 1275 Comment: Several c
Page 1277 and 1278:
CMS-1503-FC 1277 claims data). If t
Page 1279 and 1280:
CMS-1503-FC 1279 incentive payment
Page 1281 and 1282:
CMS-1503-FC 1281 EHR Reporting"), t
Page 1283 and 1284:
CMS-1503-FC 1283 option for large g
Page 1285 and 1286:
CMS-1503-FC 1285 required to indica
Page 1287 and 1288:
CMS-1503-FC 1287 our proposal to re
Page 1289 and 1290:
CMS-1503-FC 1289 1848(a)(5) (A)(i)
Page 1291 and 1292:
Page 1293 and 1294:
CMS-1503-FC 1293 for the year. Unde
Page 1295 and 1296:
CMS-1503-FC 1295 electronic prescri
Page 1297 and 1298:
CMS-1503-FC 1297 if the successful
Page 1299 and 1300:
CMS-1503-FC 1299 disadvantage eligi
Page 1301 and 1302:
CMS-1503-FC 1301 they have successf
Page 1303 and 1304:
CMS-1503-FC 1303 Comment: While our
Page 1305 and 1306:
CMS-1503-FC 1305 • Eligible profe
Page 1307 and 1308:
CMS-1503-FC 1307 2012 to better ref
Page 1309 and 1310:
CMS-1503-FC 1309 electronic prescri
Page 1311 and 1312:
CMS-1503-FC 1311 G. DMEPOS Provisio
Page 1313 and 1314:
CMS-1503-FC 1313 The fee schedule m
Page 1315 and 1316:
CMS-1503-FC 1315 and services" in s
Page 1317 and 1318:
CMS-1503-FC 1317 revise the nationa
Page 1319 and 1320:
CMS-1503-FC 1319 proposed to define
Page 1321 and 1322:
CMS-1503-FC 1321 solicited public c
Page 1323 and 1324:
Page 1325 and 1326:
CMS-1503-FC 1325 (2) Definition of
Page 1327 and 1328:
CMS-1503-FC 1327 not result in the
Page 1329 and 1330:
CMS-1503-FC 1329 beneficiary’s ho
Page 1331 and 1332:
CMS-1503-FC 1331 replacement diabet
Page 1333 and 1334:
CMS-1503-FC 1333 For purposes of im
Page 1335 and 1336:
CMS-1503-FC 1335 Response: We disag
Page 1337 and 1338:
CMS-1503-FC 1337 manufacturer, mode
Page 1339 and 1340:
CMS-1503-FC 1339 may continue to as
Page 1341 and 1342:
Page 1343 and 1344:
CMS-1503-FC 1343 practitioner to hi
Page 1345 and 1346:
CMS-1503-FC 1345 include OTS orthot
Page 1347 and 1348:
CMS-1503-FC 1347 data. Therefore, t
Page 1349 and 1350:
CMS-1503-FC 1349 reduce the number
Page 1351 and 1352:
CMS-1503-FC 1351 with supporting in
Page 1353 and 1354:
CMS-1503-FC 1353 supplier’s contr
Page 1355 and 1356:
CMS-1503-FC 1355 We proposed the fo
Page 1357 and 1358:
CMS-1503-FC 1357 not involved with
Page 1359 and 1360:
CMS-1503-FC 1359 Issues to be resol
Page 1361 and 1362:
CMS-1503-FC 1361 The HO would make
Page 1363 and 1364:
CMS-1503-FC 1363 within 5 days of r
Page 1365 and 1366:
CMS-1503-FC 1365 terminate contract
Page 1367 and 1368:
CMS-1503-FC 1367 §414.226(c)(1)(ii
Page 1369 and 1370:
CMS-1503-FC 1369 b. Furnishing Oxyg
Page 1371 and 1372:
CMS-1503-FC 1371 For this reason, w
Page 1373 and 1374:
CMS-1503-FC 1373 payment period in
Page 1375 and 1376:
CMS-1503-FC 1375 H. Provider and Su
Page 1377 and 1378:
CMS-1503-FC 1377 Medicare program."
Page 1379 and 1380:
CMS-1503-FC 1379 certification revo
Page 1381 and 1382:
CMS-1503-FC 1381 specified in 14 CF
Page 1383 and 1384:
CMS-1503-FC 1383 J. Physician Self-
Page 1385 and 1386:
CMS-1503-FC 1385 c. Revisions Effec
Page 1387 and 1388:
CMS-1503-FC 1387 at 411.355(g), we
Page 1389 and 1390:
CMS-1503-FC 1389 RADIATION THERAPY
Page 1391 and 1392:
CMS-1503-FC 1391 recognized timely
Page 1393 and 1394:
CMS-1503-FC 1393 1861(ddd)(1), as a
Page 1395 and 1396:
CMS-1503-FC 1395 §410.32(a)(2)) wh
Page 1397 and 1398:
CMS-1503-FC 1397 remains unchanged
Page 1399 and 1400:
CMS-1503-FC 1399 bid items received
Page 1401 and 1402:
CMS-1503-FC 1401 data to CMS. While
Page 1403 and 1404:
CMS-1503-FC 1403 vary along with th
Page 1405 and 1406:
CMS-1503-FC 1405 being 1.75 minutes
Page 1407 and 1408:
CMS-1503-FC 1407 each measure the r
Page 1409 and 1410:
CMS-1503-FC 1409 the technical capa
Page 1411 and 1412:
CMS-1503-FC 1411 Quality Reporting
Page 1413 and 1414:
CMS-1503-FC 1413 Section VII.F.2 of
Page 1415 and 1416:
CMS-1503-FC 1415 measure X 25 cases
Page 1417 and 1418:
CMS-1503-FC 1417 clinical data ware
Page 1419 and 1420:
CMS-1503-FC 1419 individual eligibl
Page 1421 and 1422:
CMS-1503-FC 1421 XI. Regulatory Imp
Page 1423 and 1424:
CMS-1503-FC 1423 for managed care.
Page 1425 and 1426:
CMS-1503-FC 1425 governments in the
Page 1427 and 1428:
CMS-1503-FC 1427 ● Column A (Spec
Page 1429 and 1430:
CMS-1503-FC 1429 (A) (B) (C) (D) (E
Page 1431 and 1432:
CMS-1503-FC 1431 proportion of tota
Page 1433 and 1434:
CMS-1503-FC 1433 We note that in se
Page 1435 and 1436:
CMS-1503-FC 1435 TABLE 102: Impact
Page 1437 and 1438:
CMS-1503-FC 1437 CPT/ HCPCS Code MO
Page 1439 and 1440:
CMS-1503-FC 1439 Section 1848(e)(1)
Page 1441 and 1442:
CMS-1503-FC 1441 3. Section 3102: E
Page 1443 and 1444:
CMS-1503-FC 1443 7. Section 3107: E
Page 1445 and 1446:
CMS-1503-FC 1445 provided in a sing
Page 1447 and 1448:
CMS-1503-FC 1447 ESRD market basket
Page 1449 and 1450:
CMS-1503-FC 1449 In section VI.T of
Page 1451 and 1452:
CMS-1503-FC 1451 impact of this pro
Page 1453 and 1454:
CMS-1503-FC 1453 services. Effectiv
Page 1455 and 1456:
CMS-1503-FC 1455 various classes of
Page 1457 and 1458:
CMS-1503-FC 1457 through the ESRD P
Page 1459 and 1460:
CMS-1503-FC 1459 Improvements - Phy
Page 1461 and 1462:
CMS-1503-FC 1461 account for salary
Page 1463 and 1464:
CMS-1503-FC 1463 participating in P
Page 1465 and 1466:
CMS-1503-FC 1465 approximately 79 h
Page 1467 and 1468:
CMS-1503-FC 1467 An EHR vendor inte
Page 1469 and 1470:
CMS-1503-FC 1469 Program in prior y
Page 1471 and 1472:
CMS-1503-FC 1471 claims an individu
Page 1473 and 1474:
CMS-1503-FC 1473 that the costs for
Page 1475 and 1476:
CMS-1503-FC 1475 a. Off-the-Shelf (
Page 1477 and 1478:
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CMS-1503-FC 1483 List of Subjects 4
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CMS-1503-FC 1487 6. Section 409.20
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CMS-1503-FC 1489 Eligible beneficia
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CMS-1503-FC 1491 (viii) Furnishing
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CMS-1503-FC 1493 (vi) Furnishing of
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CMS-1503-FC 1495 as follows: * * *
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CMS-1503-FC 2023 Composite Rate ESR
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