Medicare Compliance & Reimbursement

• Time is money in a medical practice, and a new study shows just how much money you put into trying to collect your rightful reimbursement.

A report published in the May 14, 2009 edition of Health Affairs shows that clinicians spend more than 35 minutes each day performing billing and insurance-related functions, costing medical practices at least $85,276 per full-time physician -- or 10 percent of total revenue.

For each physician working in a practice, 0.67 nonclinical full-time staff members worked on billing and insurance functions, the report indicated.

• If you're looking for help on which discharge code you should use for hospice patients who die in the nursing home, you need to keep looking.

One hospice asked carrier Cahaba GBA which discharge code to use for a patient who expires in a skilled nursing facility where they are residing: 40 (Expired at home) or 41 (Expired at medical facility).

CMS and the National Uniform Billing Committee (NUBC) don't provide a definition of a patient's place of residence in regard to the patient status codes, Cahaba says in its May newsletter for providers.

"Therefore, because the patient status codes ... are not used to determine reimbursement or coverage, we suggest that you use the code you believe to be the most appropriate," Cahaba advises.

• Your home medical equipment claims will have to jump through more hoops regarding ordering physicians starting in October.

CMS is tightening up its claims checks for ordering physician numbers, according to April 24 Transmittal No. 480 (CR 6421). In the first phase that starts Oct. 1, the durable medical equipment Medicare Administrative Contractors (DME MACs) won't pay claims that are missing the ordering/referring physician's National Provider Identifier. In January, the DME MACs will step up to denying payment for claims if the ordering/referring physician's NPI isn't on the valid list from the Provider Enrollment, Chain, and Ownership System (PECOS).

The transmittal is online at www.cms.hhs.gov/transmittals/downloads/R480OTN.pdf.

• People who need hearing aids have advocates in Congress. Separate bills in the U.S. House and Senate address ways to help individuals afford hearing aids, says an announcement from the American Speech-Language Hearing Association. The Hearing Aid Assistance Tax Credit Act (S. 1019) gives individuals the opportunity to receive a $500 per hearing aid tax credit every five years.

A similar House bill (H.R. 1646) was introduced earlier this year, but says the only people eligible for the tax credit are children and adults over age 55 whose income does not exceed $200,000.

ASHA encouraged people to support the legislation via its Take Action web site at http://takeaction.asha.org/asha2/issues/alert/?alertid=13374676.

• Healthcare providers may be getting too X-ray-happy, according to a study performed by the Center for Studying Health System Change. "Rapidity and Modality of Imaging for Acute Low Back Pain in Elderly Patients," published in the May 25 Archives of Internal Medicine, revealed that almost one in three elderly Medicare patients received imaging services one month or less after a diagnosis of low-back pain.

However, "well-established guidelines suggest" that unless there's a specific clinical "red flag" such as cancer, patients with low-back pain should have a month of therapy before imaging is required, the study said.

But Medicare costs are not the only concern. Unnecessary imaging exposes patients to much more potential harm from the procedures. In addition, the study found that among plain X-rays, computed tomography (CT) and magnetic resonance imaging (MRI) scans, white patients were more likely to receive rapid imaging and CT/MRI scans than minority patients.

"As the nation confronts the need to control rapidly rising health care costs, identifying ways to encourage physicians to focus on both overuse and underuse of care is a way to generate more value for patients," said Hoangmai H. Pham, MD, MPH, the study's lead author.