Medicare Compliance & Reimbursement

If you have more Stark questions than answers, CMS has a resource for you. Thanks to a new Q&A section on the CMS Web site, you can peruse 16 questions related to the physician self-referral law, with CMS' answers on everything from how a "physician practice" is defined under the "physician organization" umbrella (a medical practice with two or more physicians organized to provide patient care services) to examples of providers that don't qualify as physician organizations (for example, federally-qualified health centers).

CMS will continually update the Stark Q&A page as new answers are posted. You can visit the CMS Web page online at http://www.cms.hhs.gov/PhysicianSelfReferral/05a_FAQs.asp, and click on "All Physician Self-Referral FAQs."

• Florida physicians aren't waiting around for the government to fix Medicare. Instead, they've decided to take matters into their own hands.

After President Bush announced his proposed budget, which would cut $183 billion from the Medicare program, approximately 30 Florida physicians met with U.S. Rep. Vern Buchanan (R-Sarasota), according to the Feb. 6 Bradenton Herald.

Their mission? To let the congressman know that they are working twice as hard as ever for half as much money, and asking for Buchanan's help in instituting Medicare reform. Using the rationale that "Medicare reforms would be more realistic if approached as pilot projects on a state level, particularly if they were based in Florida, which has a large Medicare population," the physicians and Buchanan vowed to get Medicare reform on the table as a point of discussion.

• New York Attorney General Andrew M. Cuomo has had it with insurers' billing practices and plans to get to the bottom of what he sees as a discrepancy in how insurers determine patient balances.

Cuomo is investigating "whether health insurance companies have systematically forced patients to pay more than they should when using doctors and hospitals outside their insurer's networks," according to a Feb. 14 New York Times article outlining Cuomo's plans.

Key to the investigation is Cuomo's plan to sue insurer United Health Group, to find out how the insurer determines which portion of a physician's bill it will pay if the patient sees the physician under the payer's "out of network" benefit.