Medicare Compliance & Reimbursement

Plus: 'Hospital Compare' database offers quality comparison The AMA's National Advocacy Conference wasn't the only place that physicians visited last week while in Washington, DC. Earlier that week, an estimated 1,000 doctors made a "house call" on Congress. Their goal? To meet with congressional lawmakers and request support of the Save Medicare Act of 2008, according to a statement released by the AMA. The government is already planning for what would happen if the pay cut was halted. According to the Congressional Budget Office's projections, if lawmakers decide to stop the physician pay cut that's due to take effect in July of this year, the cost to the government would be in the billions. On the other hand, the AMA counters that not stopping the pay cut will leave patients in the lurch because many physicians say they'll drop out of Medicare if they can't afford to stay in the program. In Other News ... • Did your emergency department score high in pneumonia treatment? Does your hospital outpatient surgery department rate high? Medicare beneficiaries can now find out the answers to those questions by searching a new database that offers quality comparison information for hospitals in their regions. The HHS debuted the new search tool, known as "Hospital Compare," last week. The database allows you to search the information based on specific hospitals, cities, states or ZIP codes, and the information is telling. In one area, for instance, you'll find a hospital with a 90-percent rating for pneumonia treatment but a 40-percent rating in diabetes treatment. Find out more: To check out the new resource, visit http://www.hospitalcompare.hhs.gov. • Submitting duplicate claims in lieu of audits? That's a no-no, according to a new directive from Empire Medicare, a Part B payer in New Jersey and New York. Empire reports that its medical review department recently noted a large volume of duplicate claims, particularly in chiropractic, E/M and psychiatric care. The carrier noted that many of the duplicates were for claims that had been denied or for claims under review. If your claim was denied, your best bet in collecting payment down the road is to submit an appropriate appeal rather than simply resubmitting the claim. In addition, Empire says, "When a claim is suspended for review, it is not appropriate to submit a duplicate claim."