Medicare Compliance & Reimbursement

Plus: Patients will come armed with questions, thanks to new site

A new bill to reform the Quality Improvement Organization (QIO) system also could bring back the dreaded Peer Review Organizations (PROs), which used to investigate complaints against physicians and examine doctors' claims data.

The bill, by Senate Finance Chair Max Baucus (D-MT) and ranking Republican Charles Grassley (R-IA) would empower new Medicare PROs, which would have similar case-review powers to the old PROs, warns the American Medical Association.

NIH Walks Patients Through Visit Process

Be prepared for patients to ask more questions when they talk to your physicians. The National Institute of Health posted a primer on "Talking With Your Doctor" online at NIHSeniorHealth.gov.

"Talking With Your Doctor" takes readers through the medical visit process from planning a visit to their doctors through conversations after diagnosis, and includes helpful links.

It also offers advice on asking questions about medications, medical tests and a diagnosis.

In Other News...

• Fewer doctors are working in solo or two-person practices, according to a new report from the Center for Studying Health System Change (HSC). In 1996-1997, 40.7 percent of physicians were on their own or in pairs, but this dropped to 32.5 percent of physicians in 2004-2005.

Pay-for-performance (P4P) plans and health information technology both push doctors to get into bigger practices, the CSHSC says.

• Maryland physician Pradeep Srivastava agreed to pay $476,000 to settle federal charges that he defrauded Medicare. The feds claimed Srivastava billed for services not rendered and also unbundled inappropriately.

For example, he billed for introduction of the catheter in addition to cardiac catheterization, transcatheter biopsies at the same time as cardiac catheterization or angioplasty, and all five subparts of percutaneous transluminal coronary angioplasty (PTCA) in addition to the PTCA itself.

He also allegedly billed for consults performed by another physician and consults without a documented request.

• Watch out for new reason codes that will explain why a supplemental insurer rejected your crossover claim from Medicare, according to MLN Matters article SE0728. These include 000100 (Duplicate claim), 000200 (Claim for provider ID/state should have been excluded), 000300 (Beneficiary not on eligible file), 000600 (Incorrect claim count) and 000700 (HIPAA error).

•  Houston physician Ira Klein didn't just defraud payors of $10 million by billing for services he didn't provide. He also allegedly schemed to murder an assistant U.S. Attorney, a Federal Bureau of Investigation agent and Klein's wife, according to the authorities.

Klein, who specialized in treating patients with hepatitis C, would provide drugs for patients to self-administer but bill as if he administered the drugs in his office. In jail awaiting trial, he offered other inmates $250,000 to kill his wife and the two federal officials. Klein faces 11 years in prison.

• Medicare has revised the CMS-1500 claim form, so now your rendering physician's NPI should go in box 24J of the form, and your group's NPI should go in box 33A, officials from the Centers for Medicare & Medicaid Services (CMS) said at a provider Q&A call.

There's a new MLN matters article on the CMS-1500 form online at www.cms.hhs.gov/MLNMattersArticles/downloads/SE0729.pdf.