TrailBlazer Using New Medicare Fee Schedule

Keywords: Medicare  Reimbursement  

TrailBlazer Health Enterprises, the Texas Medicare carrier, is now paying physicians the new fee schedule rates approved by Congress last month. TrailBlazer is paying the 0.5-percent fee increase retroactive to July 1, according to a Centers for Medicare & Medicaid Services (CMS) notice posted on the TrailBlazer Web site.

Congress instituted the 0.5-percent increase in July when it passed legislation – and then overrode President Bush's veto – scrapping the 10.6-percent cut that had taken effect July 1. Meanwhile, an American Medical Association statement [PDF] says CMS "will automatically reprocess any claims paid at the reduced rates and provide the balances due to physician practices that are shortchanged, most likely as a single batched check."

CMS has produced a brochure [PDF] of notices it issued after Congress acted. The brochure includes information on:

  • New 2008 Medicare physician payment rates effective for dates of service July 1 through Dec. 31;
  • Extension of the exceptions process for the therapy caps;
  • A delay in the Medicare durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) competitive bidding program;
  • Reinstatement of the moratorium that allows independent laboratories to bill for the technical component of physician pathology services furnished to hospital patients; and
  • Extension of the payment rule for brachytherapy and therapeutic radiopharmaceuticals.

Meanwhile, the U.S. Department of Health and Human Services Office of Inspector General (OIG) has issued an advisory [PDF] that says physicians who assumed the 10.6-percent cut would not be overturned, and collected copayments from Medicare patients will not be subject to OIG administrative sanctions.


Action, Aug. 1, 2008

Last Published: 7/31/2008

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