Medicare Compliance & Reimbursement

CMS has been auditing Medicare Advantage (MA) plans since 2008, so practices may not be surprised to hear that those audits are still taking place. What is new, however, is the fact that CMS recently instituted a new initiative to slash errors in the MA program.

If you filed a claim during the legal battle between the American Medical Association (AMA) and UHC, you can expect your check by mid-April.

In early February, a federal judge approved the release of payments in the 2009 settlement against UHC. A total of almost $200 million will be paid out to physicians for 15 years of artificially low payments by UHC for out-of-network health services.

If you did not file a claim, unfortunately, it is too late to do so. But if you did, you should expect your portion of the settlement by April 15, 2012, according to the AMA Website. If you have questions about the settlement or your payment, you can review the AMA's FAQ about the settlement at www.ama-assn.org/resources/doc/psa/uhg-settlement-faqs.pdf.

What it is: The PCIP is an incentive payment of 10 percent of Medicare's program payments to be paid to primary care physicians and non-physician practitioners for services rendered from Jan. 1, 2011 until Dec. 31, 2015. Eligible services fall under CPT® codes:

Pediatric practices have been struggling to collect payment for administering the HPV vaccine Gardasil® to male patients. In its February 2012 "Medical Policy Update Bulletin," United Healthcare announced that "coverage of Gardasil® for males will be effective February 1, 2012," but that claims will not retroactively be adjusted for any services performed prior to Feb. 1.

To read the full UHC announcement, visit www.unitedhealthcareonline.com/ccmcontent/ProviderII/UHC/enUS/Assets/ProviderStaticFiles/ProviderStaticFilesPdf/Tools%20and%20Resources/Policies%20and%20Protocols/Medical%20Policy%20Update%20Bulletins/Policy%20Update%20Bulletins/Medical_Policy_Update_Bulletin_February_2012.pdf.