Medicare Compliance & Reimbursement

Plus: Don't let a CMS edit keep you from appealing radiology claims

Cancer practices are doing fine, insists the HHS Office of Inspector General in the latest of a long line of reports on oncology drugs.

The OIG surveyed a dozen oncology practices and found that nine of them could buy 15 cancer drugs at the Medicare rate or cheaper. The other three practices, however, had to pay more than the Medicare rate for at least half of those drugs.

Unfortunately, 11 out of 12 practices didn't have any way to track the costs of providing the drugs, apart from the drugs themselves.

That means the OIG was unable to tell whether the Medicare payments were enough to cover all the other costs that go along with providing the drugs.

Bottom line: The newest report "provides additional evidence of the adequacy of Medicare payment for Part B drugs used in cancer treatment," commented the Centers for Medicare & Medicaid Services (CMS).

Don't Stand For X-Ray Denials On Admission Dates

Start appealing those denied radiology Technical Component (TC) claims now, CMS officials urged.

CMS imposed an edit last April, saying that Medicare wouldn't pay for the TC of radiology services, if they happened on the same date as a patient's hospital admission or discharge.

Example: A provider calling into the Aug. 14 physician Open Door Forum said patients sometimes come into the office and receive X-rays. Then the doctor decides to admit the patient to the hospital the same day.

Medicare will deny the TC payment for those X-rays because they're on the same day as the hospital admission.

The edit which is causing these denials will disappear on Oct. 1, according to Transmittal 1295 (Change Request 5675).

"CMS has determined that some imaging services performed on the admission and discharge dates are being denied," CMS said in the Transmittal.

Medicare should pay for imaging and pathology services on the admission and discharge dates, as long as someone other than the hospital provides them.

So if you've received denials based on this edit since April, you should "bring them to the attention of the contractor," one CMS official advised. "An appeal is one way to do that."

In Other News...

• Electronic Medical Records (EMRs) could aid in preventing fraud if they included 14 safeguards, according to a new report from RTI International in Research Triangle Park, NC. These include audit functions, provider identification, user access authorization, and safeguards for evaluation & management coding.

Most doctors don't commit fraud and shouldn't be burdened by safeguards aimed at the few who do, notes the RTI report, prepared for the HHS Office of the National Coordinator for Health Information Technology. So any fraud protections in EMRs should also benefit every physician by making their coding more accurate.

• But EMRs don't necessarily improve the quality of your doctor's care, according to a study in the July 9 Archives of Internal Medicine. Researchers examined more than 50,000 patient records from more than 2,500 physician offices from the National Ambulatory Medical Care Survey.

The researchers found "no significant difference" between visits with or without EMRs for 14 out of 17 quality indicators. Doctors with EMRs performed much better on two indicators: avoiding routine urinalysis during exams and avoiding benzodiazepine use for depressed patients.

But the EMR doctors performed much worse on one measure, prescribing statin to patients with hypercholesterolemia.

• Six leading medical specialty societies are co-sponsoring a symposium on breast cancer prevention, to be held Sept. 7-8 at the San Francisco Marriott.

The Breast Cancer Symposium will bring together surgical, medical and radiation oncologists to discuss new research and help doctors apply new discoveries to treating people with breast cancer.

• High prescription-drug costs aren't the cause of the nation's rising healthcare costs, economists argue. Instead, they blame the fact that U.S. doctors make two to three times more than doctors from other industrialized countries, reports the New York Times. Also, instead of paying doctors a flat fee, payors reward doctors for performing more procedures, the Times insisted.

• Don't charge Medicare patients a routine surcharge, or you could face charges of your own. Olney, MD-based Montgomery Internal Medicine Associates agreed to settle an investigation by the Maryland attorney general's office. The practice charged patients a $25 annual administrative surcharge since 2005, for a total of $144,000 in fees, the Baltimore Sun reports.The attorney general's office said the extra charges violated state law and Medicare rules. The practice agreed to repay these fees and not to try to collect fees from patients whose payors prohibit extra fees.