Medicare Compliance & Reimbursement

On Nov. 13, Mike Leavitt, secretary of the U.S. Department of Health and Human Services, revealed a new proposal for adopting e-prescribing standards.

According to the proposal, the Centers for Medicare & Medicaid Services (CMS) will attempt to reduce the approximately 530,000 adverse drug effects that occur each year due to problematic drug interactions by implementing new e-prescribing standards. Not only will the medication history stored in the electronic device help physicians and pharmacists avoid problematic interactions, but it will also allow practices to know which medications the Medicare patients' plans cover, CMS said in a statement.

"E-prescribing can improve quality of care by reducing errors and can also help save the Medicare program money and the beneficiary from paying higher out-of-pocket costs," said CMS Acting Administrator Kerry Weems.

CMS predicts that e-prescribing will benefit the economy by $100 million or more after it's put in place across-the-board.

You can view the proposed rules at http://www.cms.hhs.gov/EPrescribing/. Comments back to CMS regarding the proposal are due by Jan. 15, 2008.

CMS Consolidates Flu Coding Advice

You can now get all of the best Medicare flu billing resources in one MLN Matters article. CMS issued a Special Edition information sheet earlier this week, which can refer you to all of the best influenza coding advice that you need as you gear up to attack the upcoming flu season.

Go to http://www.cms.hhs.gov/MLNMattersArticles/downloads/SE0748.pdf for the article.

In Other News...

• Medicare may have to do some belt tightening in the very near future. On Nov. 13, President Bush vetoed a $606 billion bill that included more than $450 billion in mandatory spending on Medicare and Medicaid. House Democrats fell short of overriding that veto by just two votes.

• Lack of documentation and faulty billing systems can really hurt physicians, as a recent U.S. Department of Justice case demonstrates.

Earlier this month, a Massachusetts physician was ordered to pay $200,000 to settle allegations that he had defrauded Medicare between 2001 and 2007.

In the claim, the government alleged that Dr. Vladimiro Giua submitted claims for nursing home visits that he didn't perform and upcoded his office visits. Federal investigators also accused Giua of billing for services that practitioners who were not Medicare-approved actually performed.

Giua blamed a faulty billing system for the problems and did not admit guilt.