Medicare Compliance & Reimbursement

Plus:  OIG uncovers $20 million in Medicare overpayments for radiology services.

If the Centers for Medicare & Medicaid Services (CMS) goes ahead with plans to change how it calculates practice expense relative value units (PE-RVUs), it could create winners and losers among physicians, the Medicare Payment Advisory Commission (MedPAC) said Sept. 9.

The move to a new "bottom up" system would increase PE-RVUs by 5 percent for evaluation & management visits but decrease them the same amount for imaging services. Major procedures would see a shocking 10-percent PE-RVU drop, and "other procedures" would lose about 4 percent. Tests would see a 1.5-percent drop.

CMS Is Looking Out For Double Billings From Radiologists

Radiology providers billed Medicare inappropriately for a staggering 100,034 radiology services in 2001-2003, the HHS Office of Inspector General (OIG) warned in a new report (A-01-04-00528).

Medicare overpaid $20 million during that period for services where Medicare Part A covered radiology services, but providers still billed Part B for the technical component of those services as if they were outpatient services, the OIG said. That meant Medicare paid twice for the same services, the OIG warned.

CMS should chase down that $20 million in overpayments from the radiology providers, the OIG urges. Also, CMS and the carriers should put into place prepayment edits to make sure they're not paying under Part B for services that Part A has already covered.

The carriers also should be educating radiology suppliers about the most common payment errors and how to avoid them, the OIG says.

In Other News...

· Starting Oct. 1, Medicare will send only electronic remittance advice notices that comply with the Health Insurance Portability and Accountability Act, CMS said in MLN Matters Article SE0646.

· Miami physician Zabdy Westerburger received a 46-month prison sentence for her part in a scheme to write prescriptions for fake patients in return for kickbacks, the South Florida Sun-Sentinel reported.

• Help may be on the way for rural home health agencies trying to update their information technology (IT).

Reps. Greg Walden (R-OR) and Earl Pomeroy (D-ND), co-chairs of the House of Representatives Rural Health Care Coalition, recently introduced H.R. 6030, the "Health Care Access and Rural Equity Act" (HR 6030).

The bill would extend several expiring Medicare payment adjustments for rural practitioners, including rural home health agencies, and authorize health IT grants for rural practitioners, among other provisions.