Medicare Compliance & Reimbursement

House and Senate set to hash out fate of health IT.

Stay tuned: You could be facing a tight deadline to adapt to the ICD-10 diagnosis code system, if the House of Representatives gets its way.
 
The House passed a health information technology (HIT) bill that would require you to start using ICD-10 instead of ICD-9 by October 2010, but the Senate is likely to pass a version which doesn't include that requirement. Also, the Senate bill would require HIT systems to be "interoperable," meaning they can all talk to each other. The House version doesn't have that requirement.

Call your representative: Once the Senate passes a bill, the House and Senate will have a "conference" to hash out the differences between their bills. If you want your health records system to be able to exchange information with your local hospital's, then it's not too late to let your member of Congress know. Or if you're concerned about the rush to ICD-10, you can also make your voice heard on that issue.

Medicare Turns E/M Coding Upside Down

Your hospital-based evaluation and management coding could change drastically next year. CMS wants to replace the existing CPT codes for Emergency Department visits with new "G" codes. The 17 codes will include five levels of hospital clinic visits, five levels of hospital ED visits, and five levels of "Type A emergency visit codes," for services provided by the ED itself, and two new critical care codes.

In Other News...

· Medicare should restrict pay for performance (P4P) to Medicare managed care plans and leave regular fee-for-service Medicare out of the experiment for now, advises a new white paper from the Cato Institute. "Given Medicare's patient population, size and sensitivity to interest group lobbying, any harm that could result from a P4P scheme would be more likely to occur within traditional Medicare than elsewhere," writes Cato scholar Michael Cannon.

· Meet the new boss, same as the old boss. Medicare chose the first of its Medicare Administrative Contractors (MACs), which will replace your carrier and cover both Part A and Part B. The winner: Noridian Administrative Services, which will administer claims in Arizona, Montana, North Dakota, South Dakota, Utah and Wyoming. Medicare will name 14 more MACs soon.

· Medicare contractors should waive the Part B deductible for colorectal cancer screenings furnished on or after Jan. 1, the Centers for Medicare & Medicaid Services instructed in Transmittal 1004.

· Plantation, FL chiropractor Barry Silverstein received a 34-month prison sentence, plus a $1.8 million refund and a $100,000 fine. Prosecutors say Silverstein bought car accident/victim information from third parties, and then paid those patients to come to his office for treatments they didn't actually receive.