Medicare Compliance & Reimbursement

At its meeting Dec. 6-7, the Medicare Payment Advisory Commission (MedPAC) proposed a 1.2 percent payment increase to physicians in 2009, along with a 1-percent boost for dialysis facilities. MedPAC will deliver its recommendations to Congress by March 2008, although the current proposal wording may change.

MedPAC is also mulling a recommendation that Congress should require the Centers for Medicare and Medicaid Services (CMS) to confidentially monitor the resources that physicians use in delivering care. This way, the Commission could eliminate inefficient care.

Starting in January, if you treat patients with Bexxar or Zevalin, Medicare could be shorting you about $14,000.

That's because Medicare will slash payment for these drugs to approximately $16,000, despite the fact that the medications cost nearly $30,000 apiece, according to a Dec. 7 New York Times article.

Medicare officials responded to the outcry over the drug price cuts by saying that $16,000 is a "fair price," the Times article noted.

In other news...

• If you're billing Medicare for neurobehavioral status exams via a telecommunications system, you may need a modifier.

Empire Medicare recently announced that practices reporting 96116 for services performed via a telecommunications device must append modifiers GT (Via interactive audio and video telecommunications system) or GQ (Via asynchronous telecommunications system) to claims for these procedures. Empire also requires that the originating site of these services must be a physician or practitioner's office, a hospital, a critical access hospital (CAH), rural health clinic or federally qualified health center.

To read Empire's article, visit http://www.empiremedicare.com/news/nynews07/ngs_120707telehealth.htm.

• Four ASCs submitted inflated claims to New York's Empire Plan after they inappropriately waived out-of-pocket costs for state and local government employees, costing taxpayers $8 million, according to audits released last week by New York State Comptroller Thomas P. DiNapoli.

New York auditors will most likely intensify their efforts following this news. The news release from DiNapoli states, "The systemic abuse revealed by these audits suggests that questionable if not fraudulent billing practices are much more prevalent than previously thought. It underscores the necessity for increased audit activity to ensure that taxpayer dollars are not wasted."

To read the audit report, visit http://www.osc.state.ny.us/press/releases/dec07/120307.htm.

• If you had trouble finding "Sengstaaken" in your medical dictionary, that's because it was a typo in CPT 2008.

The AMA has released its list of corrections to errors in CPT 2008, and the errors range from spelling mistakes (such as the misspelling of "Sengstaken" in the 43460 descriptor) to incorrect captions (for instance, the thoracentesis illustration that references 32421 should instead refer to 32422).

To read the full list of CPT 2008 corrections, visit the AMA's Web site at http://www.ama-assn.org/ama1/pub/upload/mm/362/08cptcorrections.pdf.

• If you're billing Medicare for oxygen therapy, you may be getting a lot of questions from patients and providers lately. A Nov. 30 article in the New York Times, "Oxygen Suppliers Fight to Keep a Medicare Boon," noted that Medicare pays significantly more for medically prescribed oxygen therapy delivered in the homes of Medicare beneficiaries than oxygen equipment provided by Internet suppliers to individuals. Many oxygen suppliers are balking at the article's tone, noting that their oxygen therapy involves just that -- therapy -- and not simply a filled oxygen tank, thus making their service a bit more costly than Web-ordered oxygen supplies.