Medicare Compliance & Reimbursement

Plus: Check out CMS' worksheets that can help you to keep track of your PQRI quality indicators.

You can have another crack at commenting on the general Advance Beneficiary Notice (ABN). The Centers for Medicare & Medicaid Services (CMS) has opened a second comment period on the ABN (CMS-R-131) that will close June 24, the agency notes. The general ABN and lab ABN will combine in the new form, among other changes, CMS notes.

But until the new form takes effect, be sure to continue using the current form, CMS' Elizabeth Carmody cautioned in a recent Open Door Forum.

Resource: Instructions for commenting are in the May 25 Federal Register notice at www.access.gpo.gov/sudocs/fedreg/a070525c.html scroll down to the "29322--29323 [07--;2578]" entry under CMS notices.

If You Report Only 2 Quality Measures, Make Sure You're Not Missing A Third

CMS will be posting worksheets to help you keep track of the quality indicators you're supposed to be reporting in the Physician Quality Reporting Initiative (PQRI), CMS says in a new list of frequently asked questions (FAQ) posted on its Web site. Other recent FAQ answers state that:

· If you report on only two or fewer measures, and it turns out there was a third measure you could have reported on, you won't receive any bonus payment.
· You don't need an electronic health record (EHR) to participate in the PQRI.
· You don't need to apply the "GP" modifier to the PQRI reporting codes for physical therapy claims.

In Other News...

· You can test out your claims submission under the PQRI ahead of time. CMS designated G8300 as a test code, so you can try adding G8300 as a line item on any claim, or in field 24D on the 1500 form, and enter $0.00 or $0.01 as the line item charge. Then check your remittance advice (RA) to make sure the carrier or contractor processed the test code. You should see RA remark code N365, which denotes a non-payable code used for information purposes only.

· CMS said it would limit coverage for erythropoiesis stimulating agents (ESAs) for some cancer patients, after a "black box" warning from the Food & Drug Administration. Medicare will only cover ESAs for treatment of anemia in certain cancers. ESAs include Epogen, Aranesp and Procrit.

· Three doctors paid patients a few hundred bucks, or offered a free tummy tuck, in exchange for consenting to unnecessary procedures to remove cysts or treat sweaty hemorrhoids, prosecutors claim. The authorities arrested the trio as part of a probe of an alleged $96-million scam at the Unity Surgery Center in Buena Park, CA, according to the Orange County Register.

Physicians allegedly performed a few dozen surgeries a day, and one doctor performed 180 unnecessary sweaty-palm surgeries during four months.

· A new federal bill would provide $4 billion in grants to help physicians and other providers pay for information technology. Sens. Debbie Stabenow (D-MI) and Olympia Snowe (R-ME) introduced the Health Information Technology Act of 2007, which targets 20 percent of its money to rural areas.

· Medicare plans to start covering ultrasound monitoring of cardiac output for patients in intensive care units (ICUs) and operative patients who need intra-operative fluid optimization. Monitoring the volume of blood ejected from the heart can help physicians to gauge the need for intravenous fluid replacement and drug therapy to maintain adequate blood flow.

But Medicare won't cover lumbar artificial disc replacement (LADR) for patients over 60 years old, according to a proposed coverage decision.