Part B Insider (Multispecialty) Coding Alert

Published on Sat May 19, 2007 PDF

Anti-trust actions could stop your collaborations in their tracks

Need help with the P's and Q's of the Physician Quality Reporting Initiative (PQRI)?

At the last moment, the Centers for Medicare & Medicaid Services (CMS) released a Tool Kit, including educational resources and specific worksheets for some quality measures. It includes the 2007 Coding for Quality Handbook, the 2007 Code Master and data collection worksheets. You can get it by going to www.cms.hhs.gov/pqri and scrolling down to the -PQRI Tool Kit- tab.

Meanwhile, CMS made some technical corrections and tweaks to the PQRI. You can view the details online at www.cms.hhs.gov/pqri and clicking on -Measures/Codes.-

In other news:

- CMS will give some patients access to a Personal Health Record (PHR) as part of a pilot program. The beneficiaries will be able to access their health records online through www.mymedicare.gov, including medical conditions, hospitalizations and physician visits. CMS hopes the information will help patients to manage their own care.

- The American Medical Association (AMA) unveiled its recommendations for reforming the Medicare program. They include combining the Part A and Part B funds into a single fund, which would be easier to administer; giving patients a single deductible and premium for all Medicare services; offering patients a choice of plans, with the same standard deductible and premium amounts; and allowing patients to start Medicare anywhere between the ages 62 and 70, with different benefit levels for each start age.

In the long term, the AMA wants to replace Medicare with a privately funded system that patients would pay for out of savings accounts, similar to President Bush-s failed Social Security reform proposal.

- In spite of all their critics, Medicare Advantage (MA) plans actually let physicians take better care of their patients, according to a new report from the California Association of Physician Groups. The reason? MA plans include -coordinated care- that follows high-risk patients from acute care to skilled nursing care to custodial care. For more information go to www.capg.org.

- If you make arrangements with other physician offices, the anti-trust laws could bite you. Illinois Attorney General Lisa Madigan sued two clinics in Champaign-Urbana for forming a consortium to boycott new Medicaid patients. Meanwhile, the Florida-based Federation of Physicians settled a Department of Justice lawsuit alleging the Federation conspired to raise amounts that insurers paid for OB-Gyn physicians in Cincinnati, OH. The Federation agreed not to coordinate its members- negotiations for fees and terms in future.

- The new Part B drug payment amounts that take effect July 1 are available at www.cms.hhs.gov/McrPartBDrugAvgSalesPrice/01a_2007aspfiles.asp. Click on -Downloads.-