On January 13, the GAO issued a report explaining its findings that the Medicare program needs to reform how it pays for assistants-at-surgery. The GAO found three flaws in Medicare's current payment policy. First, because Medicare pays for this service both through hospital inpatient PPS and the physician fee schedule, Medicare may be paying too much for some surgical care when the cost of assistants-at-surgery is not adjusted when the hospital is paid under the physician fee schedule. Second, the report stated that paying a health care professional under the physician fee schedule as an assistant-at-surgery, rather that including this payment in an all-inclusive PPS payment, gives neither the hospital nor the surgeon an incentive to use an assistant only when it is medically necessary. Last, there is no distinction to determine which assistants-at-surgery are eligible for payment under the physician fee schedule based on surgical education or past experience as an assistant. The GAO suggests that Congress consider consolidation of all Medicare payments for assistant-at-surgery services under the hospital impatient PPS system in order to fix the outlined problems.
The full text of the report is located at
http://www.gao.gov/cgi-bin/getrpt?GAO-04-97.
This material is not intended to create, and does not create, an attorney-client relationship between you and Vinson & Elkins L.L.P., and you should not act or rely on any of this information. As legal advice must be tailored to the specific circumstances of each case, nothing provided herein should be used as a substitute for advice of competent counsel. These materials do not constitute legal advice, do not necessarily reflect the opinions of Vinson & Elkins L.L.P. or any of its attorneys or clients, and are not guaranteed to be correct, complete, or up-to-date. Vinson & Elkins L.L.P. assumes no liability for the use or interpretation of information contained herein. This publication is provided "AS IS" WITHOUT WARRANTY OF ANY KIND, EITHER EXPRESSED OR IMPLIED, INCLUDING, BUT NOT LIMITED TO, THE IMPLIED WARRANTIES OF MERCHANTABILITY, FITNESS FOR A PARTICULAR PURPOSE, OR NON-INFRINGEMENT. Unless otherwise indicated, V&E attorneys listed are: not Certified by the Texas Board of Legal Specialization. None of the attorneys listed on this website is certified as an "expert" or "specialist" pursuant to any authority governing the practice of law in New York. Vinson & Elkins is a registered limited liability partnership. Principal office-Houston.
We operate a free-to-view policy, asking only that you register in order to read all of our content. Please login or register to view the rest of this article.