Part B Insider (Multispecialty) Coding Alert
Carriers Tout Safeguard Hauls
Medicare carriers are boasting once again about the financial fallout from their medical review, fraud-fighting and other payment safeguard activities.
Trailblazer Health Enterprises LLC boasts $832 million in payment safeguard savings in 2002, up from $792.1 million the previous year. Trailblazer is the Part B carrier for Texas, Maryland, Delaware, Virginia and Washington, D.C.
Prosecutors maintain that Mauskar also participated in the submission of medicare claims performed by unlicensed technicians without a physician's supervision and of claims for services that were never rendered. Mirage Medical Group ended up submitting more than $1.4 million in improper claims in 1999-2000 for which it got paid more than $500,000.
The improper billings - which also included claims for endoscopies he never performed - occurred between 1996 and 2000. Prosecutors Yesmin Saide and Faith Devine maintain that the doctor altered patient charts and medical reports to back up the inappropriate claims.
The Centers for Medicare & Medicaid Services plans to release two key regulations on the Stark physician self-referral law in coming months, according to the U.S. Department of Health and Human Services Semiannual Regulatory Agenda. Published in the May 27 Federal Register, the agenda says the much-anticipated final version of "Phase II" of the mammoth Stark physician self-referral rule is scheduled for a June release.
Also, CMS says that in July it plans to issue a proposal that could hit specialty hospitals hard. The agency says it plans to change self-referral rules to keep physician investors in certain specialty hospitals from using the "whole hospital" exception to the self-referral ban. Physician-owned specialty hospitals have been under fire lately, including proposed legislation and a General Accounting Office report.
Part B Insider (Multispecialty) Coding Alert
- POLITICS & POLICY:
Senate Rural Health Plan Goes Back To The Barn
A U.S. Senate amendment to the Republican tax bill that would have boosted payments to [...] - REIMBURSEMENT:
Rural Reforms Snard in Medicare Reform Tangle
Now that the U.S. House of Representatives has shot down Sen. Charles Grassley's (R-Iowa) provision [...] - Providers Still Working on SGR Fix
Providers continue to work on Capitol Hill to win reform of the formula Medicare uses [...] - Appeals:
Avoid Appeals Doldrums With Documentation
Cash-strapped carriers may begin pushing your appeals to the bottom of their in-boxes unless you [...] - RVUS:
CMS Slashes More Than a Dozen Codes
CMS giveth, and CMS taketh away.
At the start of 2003, [...] - COMPLIANCE PERSPECTIVES:
Docs' Coding Savvu Can Boost Reimbursement, Enhance Compliance
Many physicians are loathe to add coding knowledge to their repertoire, but biting the coding [...] - Understand Modifiers for Non-Covered Services
Want to bill Medicare for a service you're sure it's going to deny? You still [...] - COVERAGE:
National Coverage Policies Should Rule, Report Says
Confused by your carrier's local coverage policies? If the General Accounting Office gets its way, [...] - LOCAL COVERAGE POLICIES:
CIGNA Policies Limit Sinus Endoscopy
In Tennessee, Cigna Healthcare unveiled two new draft local medical review policies with comments due [...] - REIMBURSEMENT:
When You Take Extra Time, Make It Count
If your physician is spending more than the usual amount of time with a patient, [...] - ABNs:
Game of Musical Diagnoses Leaves Patient Without Chair
A signed advance beneficiary notice gives you the right to tell a patient, "I told [...] - LUNG-VOLUME REDUCTION:
Study Suggests Who Gains From Disputed Surgery
The Centers for Medicare & Medicaid Services opened a national coverage determination process on lung-volume [...] - MEDICARE REFORM:
AWP Cuts, Redistribution Not Dead Yet
Rural physicians can cling to hope of relief on Medicare payment levels, while oncologists and [...] - MEDICARE REFORM:
Grassley Provisions Unpopular With Many
The cancer community, including patient advocacy groups, oncologists, oncology nurses and others, continues to advocate [...] - PHYSICIAN NOTES:
Carriers Tout Safeguard Hauls
Medicare carriers are boasting once again about the financial fallout from their medical review, fraud-fighting [...] - CHART:
Prolonged Services
Documentation of physician time is critical to charge for prolonged services (CPT 99354 [...]
