Medicare Compliance & Reimbursement

Plus: CMS thinks e-prescribing is the answer to a dangerous problem.

Two major quality watchdog organizations are teaming up to make their quality information available to patients on the Internet.

The Ambulatory Care Quality Alliance (AQA) and the Hospital Quality Alliance (HQA) have created a new national Quality Alliance Steering Committee, the Agency for Healthcare Research and Quality (AHRQ) announced on July 21.

The new steering committee will "work closely with the Centers for Medicare & Medicaid Services (CMS)" and AHRQ to expand more than six ongoing pilot projects that are collecting and reporting physician-quality data across different care settings.

The steering committee's key responsibility is to figure out the best way to expand the scope, speed and adoption of the AQA's and HQA's work, according to AHRQ.

"This collaborative effort is an important step toward the critical goals of enabling consumers to make more informed health care decisions and supporting improvements in the quality and cost of health care in the United States," CMS administrator Mark McClellan clarified in a statement.

Physicians, hospitals, consumers and employers comprise the joint steering committee, AHRQ says.

For more information, visit www.ahrq.gov/news/press/pr2006/aqahqapr.htm.

Multi-Billion-Dollar Problem: Medication Errors Come Under The Microscope

More than 1.5 million adverse drug events occur every year from preventable medication errors, making medication errors "surprisingly common," a new Institute of Medicine (IOM) study reveals.

Although the IOM discovered that data on costs relating to medication errors is limited, "one study estimates the cost in the hospital setting alone at $3.5 billion," according to a July 20 statement from the Senate Finance Committee, which sponsored the IOM study, along with the CMS. "The IOM found that hospital patients are subjected to at least one medication error per day," the committee adds.

The medication errors stem from mostly confusion surrounding a drug's label, packaging and name, the IOM study finds. In addition to uncovering these staggering statistics, the study also offers a "national agenda" for preventing medication errors--which, not surprisingly, focuses on the Food and Drug Administration (FDA). 

"Drug names look and sound alike, labels are cluttered, and warnings are given inadequate prominence," Finance Committee chairman Sen. Chuck Grassley (R-IA) said in a statement. The IOM suggests that the FDA and others develop guidance documents for the drug industry by the end of this year, he notes.

The IOM's specific recommendations to reduce medication errors include:

• Making more resources available to consumers regarding drug information and medications self-management;

• Improving patient-provider communications;

• Increasing providers' and consumers' access to patient information;

• Setting standards for medication-related health information technologies, such as e-prescribing;

• Enhancing prescription drug naming, labeling and packaging; and

• Offering incentives for adopting practices and technologies that reduce medication errors.

In Other News...

• Downers Grove, IL psychiatrist Naseem Chaudhry allegedly billed for more than 24 hours worth of services in one day, prosecutors allege. He also allegedly admitted patients to a facility where he worked as medical director to claim Medicare reimbursement, when there was no medical necessity. Chaudhry faces 14 counts of health care fraud, according to the Chicago Tribune.

• More and more physicians are going house-call only, which means they don't have to have an office, according to an article in the Naples, FL News. The May issue of the Journal of the American Medical Association said that house calls to Medicare beneficiaries rose 40 percent since 1998, when Medicare boosted house-call payments. There are now 16 physicians in Florida who only do house calls, saving on the expense of nurses and office space.

Recent transmittals from CMS said that:

• CMS has posted a list of new, revised and deleted ICD-9 diagnosis codes online on its Web site at www.cms.hhs.gov/ICD9ProviderDiagnosticCodes/07_summarytables.asp. CMS also includes a complete list of the code changes in Transmittal 990, dated June 23.

• You should stop using the deleted codes for follow-up and confirmatory consults (99261-99263 and 99271-99275) for telehealth services. CMS also clarified that telehealth services can include end-stage renal disease related services and medical nutrition therapy, in Transmittal 53, dated July 7.

• You can bill separately for immunosuppressive therapy for kidney transplant patients. This therapy isn't included in the 90-day global period for the transplant operation, according to Transmittal 50, dated June 2.

• If you submit the non-payable tracking codes as part of the physician voluntary reporting program (PVRP), you'll receive a new tracking code, N365, meaning the codes aren't payable, according to Transmittal 230, dated June 16.