Medicare Compliance & Reimbursement

Unprecedented beneficiary blight lightens some procedure rules.

Many physicians and other medical professionals are donating their time and resources to help the survivors of Hurricane Katrina, and the Centers for Medicare and Medicaid Services is doing its part to ease their efforts.

CMS says it's relaxing many of the normal procedures for Medicare and other federal health programs to make it easier to provide health care services to vulnerable beneficiaries. Many beneficiaries that were affected by the hurricane have no proof of their Medicare beneficiary status, and their health records may have been destroyed. So Medicare carriers won't require as much documentation of Medicare eligibility or health status as they normally would.

One consultant who works on billing for physician offices and hospitals in Louisiana tells MLR that a number of physicians have come to work in emergency rooms and practices where they're not credentialed. It's not clear whether to bill under those physicians' names or as locum tenens doctors, she notes.

A big question mark: If the claims aren't tied to the practice where the visiting physician is practicing, where will the payments go?

CMS says if a doctor furnishes services "in good faith" to hurricane victims and can't comply with normal program requirements, Medicare will pay for a physician's services and won't sanction him for non-compliance. For example, if doctors cross state lines to provide emergency care, Medicare will still pay for their services as long as they're licensed in their home states. Medicare will also pay for services that happen in facilities that aren't certified to take part in the program.

More leeway: Physicians also don't have to worry about normal privacy requirements under the Health Insurance Portability and Accountability Act, so they can talk to patients' family members about their conditions even if the patients can't grant permission. Medicare also will waive prior authorization and out-of-network rules for patients in Medicare managed care plans. And emergency rooms where a public health emergency has been declared can transfer patients to other facilities for assessment without worrying about the Emergency Medical Treatment and Labor Act.

The frequency of electronic claims slowed down after Katrina because a lot of claims were being routed through New Orleans, the Louisiana coding consultant says. Many providers expected to have to bill on paper, but the payers have somehow managed to keep receiving electronic claims, in some cases routing them through Austin.
 
"So much area was devastated that there are hubs that no longer exist," the consultant says.

Physicians having trouble getting through to their carriers can see the list of new contact numbers for carriers and regional offices at cms.hhs.gov, CMS officials advised the physician Open Door Forum Sept. 7.