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Part B Insider (Multispecialty) Coding Alert

PHYSICIAN NOTES:

Let Doctors Help With Flu Shot Crisis, Association Calls

Published on Sat Oct 30, 2004

Doctors should be in the loop on the government's plans to distribute scarce flu vaccine, the American College of Physicians said in a release.

ACP applauded the government's efforts to provide vaccine to the most high-risk people, including the elderly and those with chronic illnesses. But because internists treat those patient groups, the government should provide vaccine to internal medicine doctors.

For many patients, the doctor's office is the best place to be immunized, ACP noted. Also, the government shouldn't penalize physicians for failing to follow emergency orders that the government hasn't kept clear and timely, ACP says. Orders should provide for "due process to resolve situations outside the physician's control," ACP added.

  • The January release of the Shared System will include some hours for the system maintainer to correct some inconsistencies between the system which the carriers use and the troubled Provider Enrollment Chain and Ownership System (PECOS), CMS revealed in Change Request 3536. Exactly what these incompatibilities were, and whether they'll spell more enrollment delays, wasn't clear from the transmittal.

  • CMS unveiled a number of new Remittance Advice Remark Codes, which the carriers can use to deny your claims, in Change Request 3466. If your documentation, X-rays, consent form or other paperwork is incomplete or invalid, you could see code N225 through N245.

    CMS also revised a number of other codes, and added five new temporary Claim Adjustment Reason Codes (D16-D20) for claims missing prior payment information, diagnosis information or other data.

  • By next April, carriers should automatically specify which local coverage determination they used to deny a claim when they send a notice of denial, CMS says in Change Request 3363. Separately, Change Request 3370 says the Part B carriers should process claims for blood clotting factor.

  • Patients with type II diabetes who require insulin therapy have a much higher risk of colorectal cancer, according to a study published in the American Gastroenterological Association's journal Gastroenterology. A study of 24,918 type II diabetics found insulin-users were three times more likely than others to develop colorectal cancer.

  • The National Institutes of Health launched a new Web site, www.betterdiabetescare.nih.gov, aimed at helping providers "make a difference in the way diabetes is prevented and treated." The site includes resources to help physicians assess their patients' needs, plan strategies to overcome issues, take actions and evaluate their progress.

  • There's no proof that disease management programs cut health care costs, the Congressional Budget Office said in a study of DM literature. But that doesn't mean the programs are worthless, the CBO conceded.

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