Medicare Compliance & Reimbursement

Plus: PDP premiums predicted to climb

If you've been having trouble accessing the National Provider Identifier (NPI) database, you're not alone.

The Centers for Medicare & Medicaid Services (CMS) has been having "instability" with the NPI registry as well as the database, according to carrier announcements. CMS is working on changes that should eliminate the problem, but the NPI registry may remain down until the changes are complete.

Download the complete file of NPIs at http://nppesdata.cms.hhs.gov/cms_NPI_files.html.

Premium Increase Is On The Horizon

Most popular Medicare prescription-drug plans will raise their monthly premiums next year, and as many as 1.6 million low-income beneficiaries may have to find cheaper coverage, the Wall Street Journal reported on Sept. 29.

Washington consulting firm Avalere Health said its new analysis showed that private companies such as Humana Inc. and UnitedHealth Group Inc. will raise premiums due to higher operating costs and lower government subsidies, the Journal said.

Because the cost of the government-subsidized plans will be more than the law allows, the companies can't cover low-income beneficiaries.

Humana will increase its basic plan's monthly premiums by more than $10, and UnitedHealth will increase its AARP plan's monthly premium by $5, the Journal said.

In Other News...

• Since January, you should have been reporting contrast material used in MRIs separately, CMS cautions in MLN Matters article MM5677. You can bill codes Q9945-Q9954 and Q9958-Q9964 and receive payment separately, says CMS. If you've neglected to bill these codes in any claims for the past 10 months, you should go ahead and resubmit them. The carriers won't search on their own for claims where Medicare owes you money for contrast materials.

• Annual physical exams may not help patients, according to a new study in the Annals of Internal Medicine. The problem: The $8 billion per year which insurers spend on physical exams includes $350 million for unnecessary tests, like urine analyses and echocardiograms, which preventive health experts don't recommend. But the physical exams don't include recommended services, such as cholesterol screening and smoking cessation counseling, reports the Philadelphia Inquirer.

• You can view a chart listing all the preventive services that Medicare covers in the "Welcome To Medicare" exam by going to www.cms.hhs.gov/MLNProducts/downloads/MPS_QRI_IPPE001a.pdf.