Provisions Relating to Part B
Amends Medicare part B (Supplementary Medical Insurance) to reinstate separate payment for electrocardiogram (EKG) interpretations performed or ordered to be performed as part of or in conjunction with a visit to or consultation with a physician.
Repeals provisions providing reduced Medicare payments to new physicians and other practitioners during their first four years of practice.
Prohibits the Secretary from modifying the methodology for determining the amount of time that may be billed for anesthesia services until January 1, 1997.
Requires the Comptroller General to conduct a study and report to the Physician Payment Review Commission and specified congressional committees on time reported for anesthesia services.
Provides that the initial review and revision of the geographic cost of practice index (GCPI) shall apply to services furnished on or after January 1, 1994 and shall be based on the most recent data on practice and malpractice expenses and physicians' work effort.
Authorizes the Secretary to adjust GCPI to account for unique local circumstances.
Requires the Secretary to study and report to specified congressional committees on the data necessary to review and revise geographical indices.
Requires the Physician Payment Review Commission to study and report to specified congressional committees on the feasibility and desirability of providing for a special adjustment to the index value of the medical equipment and supplies input component of the index used with respect to services:
(1) furnished by a physician who practices in an isolated area;
(2) requiring the presence of expensive medical equipment and supplies in the physician's office; and
(3) with respect to which the cost per service of operating the equipment is increased because of such physician's low volume of patients.
Prohibits nonparticipating physicians and suppliers from billing or collecting an actual charge in excess of the Medicare limiting charge.
Provides that no person is liable for payment of any amount billed in excess of the limiting charge.
Requires that excess charges be refunded on a timely basis.
Authorizes sanctions against physicians and suppliers who knowingly and willfully bill in excess of the limiting charge or fail to refund excess charges as required by this Act. Requires carriers to:
(1) notify physicians and suppliers within 30 days if they have billed in excess of the limiting charge; and
(2) include limiting charge information in the mailing explaining an individual's Medicare benefits after the submission of an unassigned claim on the individual's behalf which exceeds the limiting charge.
Specifies the nonphysician practitioners that may only bill for services on an assignment-related basis.
Provides that no person is liable for amounts billed in violation of such mandatory assignment rule.
Requires the Secretary to report to the Congress on the extent to which actual charges exceed Medicare limiting charges, the number and types of services involved, and the average amount of excess charges.
Directs the Secretary to appoint a Medicare Beneficiary Advisory Council to discuss proposed regulations, carrier manual instructions, and any other issues with an impact on delivery, cost, quality, or expansion of Medicare services.
Requires the Secretary to provide for national standards which suppliers of medical equipment and supplies must meet in order to receive payment for items furnished.
Prohibits payment unless a supplier also possesses a valid supplier number.
Requires the Secretary to revise such standards to include specified requirements.
Requires suppliers to meet such revised standards in order to receive a supplier number.
Requires the Secretary to develop one or more standardized certificates of medical necessity for:
(1) durable medical equipment (DME);
(2) prosthetic devices;
(3) orthotics and prosthetics; and
(4) surgical dressings, and certain other devices.
Modifies the OBRA of 1990 prohibition against the distribution of certificates of medical necessity by DME suppliers to extend its application, with certain exceptions, to suppliers of the other items directly listed above.
Requires the Secretary to:
(1) develop and establish uniform national coverage and utilization review criteria for 200 items of medical equipment and supplies selected in accordance with standards specified by this Act;
(2) publish the criteria as part of the instructions provided to fiscal intermediaries and carriers;
(3) review annually the coverage and utilization of such items to determine whether items not included among those selected should be subjected to such criteria (and, if appropriate, develop and apply such criteria to such additional items); and
(4) report to specified congressional committees on the effect of uniform criteria on utilization of items.
Prohibits the Secretary from issuing more than one supplier number to any supplier of medical equipment and supplies unless such issuance is appropriate to identify subsidiary or regional entities under the supplier's ownership or control.
Amends SSA title XI to modify anti-kickback provisions.
Amends Medicare to specify the circumstances under which Medicare beneficiaries are not financially liable for covered items furnished by suppliers on an unassigned basis.
Removes aspirators and nebulizers from the category of DME items requiring frequent and substantial servicing, and includes supplies relating to aspirators and nebulizers in the category of inexpensive and other routinely purchased equipment.
Adds payment rules for ostomy supplies, tracheostomy supplies, urologicals, surgical dressings, and other medical supplies.
Provides for a freeze in reasonable charges for parenteral and enteral nutrients, supplies, and equipment during 1993.
Directs the Comptroller General to study and report to specified congressional committees on:
(1) the types, volume, and utilization of services and supplies furnished to Medicare-eligible nursing facility residents; and
(2) changes made to descriptions relating to the codes for certain medical equipment and supplies.
Modifies the definition of "certified nurse-midwife" by eliminating language that limits reimbursable services to those related to the care of mothers and babies during the maternity cycle.
Revises payments provisions for services furnished by a certified registered nurse anesthetist who is medically directed.
Amends the OBRA of 1986 to extend Alzheimer's disease demonstration projects for an additional year.
Extends eligibility for designation as eye or eye and ear hospitals to hospitals that otherwise meet current law criteria but on October 1, 1987, operated as an eye or eye and ear specialty hospital or as a separate eye or eye and ear unit of a general acute care hospital which operates less than 20 percent of the beds that it operated on such date and has discontinued a substantial portion of its other acute care operations.
Extends the OBRA of 1990's cap on payments for intraocular lenses through 1994.
Expends the settings in which nurse practitioners, clinical nurse specialists, and physicians' assistants may bill Medicare part B for services performed.
Provides for Medicare coverage of:
(1) off-label cancer drugs that have been approved by the Food and Drug Administration, appeared in specified medical journals, or are included in one of three specified major medical compendia; and
(2) oral cancer drugs that contain the same active ingredients as anticancer drugs covered by Medicare when administered intravenously.