NEWS YOU CAN USE: Check Your Cost-Report Dispute Twice

Appealing your FI's cost-report dispute can pay off

Your Medicare fiscal intermediary's (FI's) cost-report discrepancies could cheat you out of fair reimbursement, so read them twice.
Louisville, Ky.-based Kindred Healthcare Inc. announced on June 27 it will receive $55 million from its FI Mutual of Omaha in a settlement. Kindred operates hospitals, nursing centers and institutional pharmacies through its subsidiaries. After Kindred's reorganization in April 2001 through August 2003, its hospitals received reimbursement under Medicare's former cost-based rules. Kindred's hospitals claimed that Mutual didn't pay for its rent payments to Ventas Inc. because the FI considered the costs as a part of cost reporting periods prior to April 2001. Under the settlement, Mutual agreed that the amended rent payments are allowable costs beginning in April 2001, however.
Result: Kindred expects it will receive the $55 million cash settlement by April 30, 2006. Kindred plans to use portions of the settlement money for employee bonuses and donations to the Kindred Foundation Inc. to fund medical research.
To read the press release, go to http://www.kindredhealthcare.com/Press/2005-06-27.asp.


Now you can get paid for electrical osteogenic stimulation

Make sure you can provide Medicare with proper documentation to receive ultrasound stimulation coverage for nonunion fracture healing before any surgical interventions.

After a recent coverage reconsideration, CMS issued a national coverage determination (NCD) for ultrasonic osteogenic stimulators used in treating nonunion fractures, according to a June 24 transmittal.
Requirements: Your documentation must prove that there was no clinically significant evidence of fracture healing if you want to be reimbursed. CMS requires you to obtain two sets of radiographs, spaced 90 days apart, prior to starting treatment using the osteogenic stimulator. The radiographs must display multiple views of the fracture site, according to CMS.
Nonunion fractures of the skull and vertebrae, tumor-related nonunion fractures, fresh fractures, and delayed unions are still noncovered indications for noninvasive ultrasound stimulation.
How to report it: Effective for services performed on or after April 27, 2005, Medicare will pay for ultrasonic osteogenic stimulation using CPT code 20979 (Low intensity ultrasound stimulation to aid bone healing, noninvasive [nonoperative]). You can bill your Durable Medical Equipment Regional Carriers (DMERCs) for ultrasonic osteogenic stimulators using codes E0760 (Osteogenesis stimulator, low intensity ultrasound, non-invasive) or E1399 (Durable medical equipment,  miscellaneous) for other ultrasound stimulation.
To read CMS' transmittal, go to http://www.cms.hhs.gov/manuals/pm_trans/R41NCD.pdf.

Your QIO participation may not improve quality of care

Quality improvement organizations (QIOs) might do little to actually improve your Medicare beneficiaries' quality of care.

Reason: Hospitals participating in QIO programs had no statistically significant differences in quality-of-care [...]

- Published on 2005-07-20