Medicare Compliance & Reimbursement

Plus: Look to your Medicare FI for Unna boot coverage.

Starting in May, you could have to list the national provider identifier (NPI) for every doctor who refers patients to you. Will you be ready?

The Centers for Medicare & Medicaid Services (CMS) hasn't yet decided whether it'll require you to list NPIs for all referring providers right away in May, CMS official Jim Bossenmeyer told the Jan. 23 physician Open Door Forum. But it makes sense to prepare for this possibility, experts warn.

Foot-dragging: CMS promised to issue a "dissemination notice" last fall explaining how you could obtain the NPI for doctors you do business with. But Bossenmeyer said this document is "still in clearance" and he can't predict when it'll come out.

Providers on the Forum expressed concern that if they share their NPIs too widely, they could open the door for a fraudulent provider to bill under their numbers. But if they don't share their NPIs, they could have trouble billing soon. CMS officials didn't really have an answer for this conundrum.

Asked whether you're required to share your NPI with other insurance companies, CMS officials said, "You're encouraged to share your NPI with trusted partners," but not required.

Clarification: CMS officials did clarify that solo practitioners only need to apply for one NPI, even if their practice is incorporated.

Check Locally For Unna Boot Coverage

Does Medicare reimburse Unna boots for venous insufficiency or any other diagnosis in an outpatient hospital setting?

The answer depends on what your Medicare fiscal intermediary (FI) has to say. Georgia's FI, Mutual of Omaha, does list Unna boot strapping (29580, Unna boot) in its local coverage determination. But if you bill this code, your documentation must support medical necessity of the patient requiring an Unna boot. In addition, your documentation should note the patient's medical history and provide a detailed description of the ulcer, such as size, depth, color, odor, etc., due to the venous insufficiency.

Tip: If you're providing bilateral Unna boots, you can bill two units of 29580--but you may need to use modifier 50 (Bilateral procedure) on the claim form. To see the full coverage determination, go to www.cms.hhs.gov/mcd/viewlcd.asp?lcd_id=2695&lcd_version=17&show=all.

CIMT Shows Promise For Stroke Victims
 
Stroke survivors who had lost function in one arm showed dramatic clinical improvements lasting a year after a special two-week rehabilitation regimen, researchers say.

Researchers funded by the National Institute of Child Health and Human Development (NICHD) and the National Institute of Neurological Disorders and Stroke (NINDS) tested 222 patients using constraint-induced movement therapy (CIMT). The study is featured in the Nov. 1 issue of The Journal of the American Medical Association.

CIMT involves training the weakened hand and arm through repetitive exercises, while restraining the unaffected hand and arm with a mitt like a boxing glove. The theory behind the hand restraint is that it forces the wearer to use the affected hand and arm.

The results: The study showed that CIMT can be helpful for between 5 and 30 percent of the stroke population, says the study's leader, Steven Wolf, professor of rehabilitation medicine at Emory University.

In Other News...

• Write to your Representative: A screening colonoscopy doesn't count toward your patient's Medicare deductible, thanks to a law that Congress passed last year.

But if a patient presents for a screening and then the doctor discovers and removes a polyp, then the deductible applies all of a sudden, Cecile Katzoff with the American Gastroenterological Association told the Jan. 23 Open Door Forum. CMS officials said this problem was out of their hands, and it would be up to Congress to fix it.