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Part B Insider (Multispecialty) Coding Alert

Physician Notes:

Dermatologists and Urologists Win Big Under Resource-Based System

Published on Thu Mar 17, 2005

But thoracic surgeons and gastroenterologists lose out

The move to resource-based Practice Expense Relative Value Units (PE-RVUs) wound up benefiting 10 out of 15 physician specialties, according to a new report from the Medicare Payment Advisory Commission.

The biggest winners were dermatologists and urologists, who reaped annual PE-RVU increases of over 10 percent each. They also saw overall payments rise by around 5 percent annually. The biggest losers were thoracic surgeons and gastroenterologists, who saw PE-RVUs drop 10 percent and 4 percent respectively.

Other specialties only saw PE-RVUs rise or fall by 1 to 3 percent per year under the resource-based system, which Medicare phased in from 1999 to 2002.

In other news:

  •  The Centers for Medicare and Medicaid Services unveiled its latest game plan for the Quality Improvement Organizations. The Medicare contractors will focus on appeals, beneficiary complaints, payment errors and case review activities, and also help with electronic records and e-prescribing. In doctor's offices, the QIOs' main priorities will include chronic disease and prevention care, medication safety and effectiveness and increasing the use of quality-related dispute resolution.

  •  A two-year Medicare demonstration will try adding medical, diagnostic and therapy services to treat neuromusculoskeletal conditions. Starting April 1, Maine, New Mexico, 23 northern Illinois counties, Scott County, IA, and 17 Virginia counties can offer their Medicare Part B beneficiaries new trial chiropractic services. These include extraspinal manipulation or an adjustment of a body part other than the spine, X-rays, EMG and nerve conduction studies, electrotherapy, MRIs, CT scans and physical therapy referrals.

  •  Houston physician Callie Hall Herpin and her associate agreed to repay $1.88 million and could face up to five years' imprisonment plus fines after she admitted to writing bogus certificates of medical necessity for motorized wheelchairs for patients she never examined.

  •  CMS instructed carriers to put a hold on outpatient prospective payment claims from April 1 until April 18, while it completes major system changes, according to an April 7 Medlearn Matters article. The delay affects anti-colorectal cancer chemotherapy, PET scans for some cancers, implantable automatic defibrillators, and other claims.

  •  Newton, MA physician John Larossa repaid the government $447,145 in a civil settlement. The HHS Office of Inspector General claimed Larossa charged for consultations when he only provided regular visits, and also billed for blood draws and direct measurement cholesterol tests when he only delivered calculated test results.

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