Medicare Compliance & Reimbursement

Plus:  Abbreciations may shorten your patients' lives.

A desire to prevent a cut to your payments in January is "the biggest driver" behind Congress' desire to pass Medicare legislation this year, according to The Hill.

The American Medical Association (AMA) will be putting a full-court press on stopping the roughly 4.6 percent cut scheduled for next year. But many in Congress balk at the high cost of stopping another round of pay cuts for your practice, estimated at around $10 billion.

You also have to compete with physical therapists, who want Congress to eliminate the annual cap on their services at a cost of around $500 million.

Bottom line: Don't expect Congress to act until after the November elections, observers predict.

Why Abbreviations Can Harm Patients

Abbreviations kill thousands of people per year, according to the Food & Drug Administration (FDA). The FDA is joining with the Institute for Safe Medication Practices to stamp out your doctor's abbreviations on medical notes.

Among the killers are the letters "IU," which stands for "international unit," but could be mistaken for "intravenous." Also, your doctor should write a zero before a decimal point, as in "0.4 ml." Also, it's easy to mix up "Q.D.," meaning once per day, with "Q.O.D.," meaning "every other day," the San Francisco Chronicle reports.

Fraud Recoveries Net Big Money For OIG

The HHS Office of Inspector General (OIG) recovered more than $1 billion from health care fraud and abuse in the first half of 2006, according to its semiannual report. One doctor repaid the OIG $881,000 to settle charges of billing both the professional and technical component of vascular services when the doctor only performed the professional component.

Also, a Maine physician repaid $200,000 to settle Stark self-referral charges that he referred patients to an oxygen company he owned.
 
Medicare Will Target HHAs With Higher M0175 Adjustments

The OIG is keeping M0175 on the front burner. In its latest semiannual report to Congress, the OIG recaps its reports on the OASIS item regarding prior inpatient stays, emphasizing that home health agencies (HHAs) improperly coded the question on all 400 claims sampled.

Medicare overpaid HHAs $48 million in fiscal years 2002 and 2003 based on incorrect M0175 answers, the OIG estimates. The report fails to mention the amount that Medicare owes back to agencies for underpayments made in Medicare's favor.

Beware: In response to the report, the Centers for Medicare & Medicaid Services (CMS) agreed to "develop data analysis techniques to identify [HHAs] with significant numbers of claims rejected or adjusted by the new [M0175] payment controls, and then to subject those agencies to corrective action," the OIG notes.

The report is at www.oig.hhs.gov/publications/docs/semiannual/2006/SemiannualSpring2006.pdf.

In Other News...

· Medicare will never cover blood-derived non-autologous products for treatments using becaplerman, according to transmittal 59, dated June 9. Previously, Medicare said coverage of becaplerman was up to carrier discretion.

· At a June 12 meeting, the AMA considered proposals to limit flu vaccine access for visiting nurse associations and other community immunizers, the Visiting Nurse Associations of America (VNAA) notes in a release. VNAA urged the AMA reps at the meeting not to adopt the resolutions.

The proposals would cause AMA to seek legislation enforcing distribution to physicians first while restricting public clinics' access, VNAA says. VNAs furnished 3 million flu shots last season, according to the trade group.