News You Can Use: Shoot Smart With Vaccine Reporting in 2005

Medicaid may be looking over your shoulder

Are your vaccine codes raising a red flag?

The HHS Office of Inspector General could single you out if you're billing Medicaid improperly under the Vaccines for Children program. And if you think low-dollar errors won't show up on the agency's radar, think again.
In the Nov. 24 "Audit of Arizona's Medicaid Payments for Vaccines Obtained Through The Vaccines for Children Program for Federal Fiscal Year 2003" (A-09-04-00041), Arizona was cited for making $21,058 in unallowable Medicaid payments to fee-for-service providers for vaccines obtained through the VFC. 
The problem: Providers billed for vaccines without the required modifiers, and incorrectly used both the vaccine procedure code and the separate immunization administration code.
To read the report, go online to www.oig.hhs.gov/oas/reports/region9/90400041.htm.
Your list of covered procedures just got shorter

CMS tipped its hand on which codes will be slashed from the ambulatory surgical center list of covered procedures. The agency plans to add 25 new Medicare-approved codes but also plans to scrap 100 established codes, according to a proposed rule in the Nov. 26 Federal Register. Certain procedures were slated for deletion because they were performed in a physician's office more than 50 percent of the time, labeled as a "safety concern" by medical specialty organizations, performed predominantly in the inpatient setting, or marked for deletion by the HHS Office of Inspector General (OIG).
 
However, CMS wants to keep three of the 11 CPT codes the OIG has proposed to delete from coverage. CMS still plans to cover cautery and laryngoscopy codes 30802, 31525 and 31570, because physicians perform the procedures less than 50 percent of the time in the office, according to 2002 claims data.
To read more, go online to http://www.access.gpo.gov/su_docs/fedreg/a041126c.html.
What you need to know about possible reimbursement rules for nonhospital settings

Good news, hospitals: The HHS Office of Inspector General (OIG) has voted to extend a 2004 moratorium that allows medical education payments for physician supervision of certain residents. If CMS agrees, fiscal intermediaries will pay even when a teaching hospital does not incur the costs related to physician supervision of osteopathic and allopathic family practice residents.
But it's not a long-term fix. In a final report, "Alternative Medicare Payment Methodologies for the Costs of Training Medical Residents in Nonhospital Settings" (A-02-04-01012), the OIG outlines alternative methodologies for paying training costs.
 
You may be looking at one of these new payment rules soon:

  current regulations would remain unchanged, but would contain a clarified definition of direct teaching costs, including volunteer time;

  in addition to paying the resident's fringe benefits (travel and lodging), each hospital would be required to pay the non-hospital [...]

- Published on 2005-01-22