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Part B Insider (Multispecialty) Coding Alert

Physician Notes:

'Medically Unbelievable' Edits Put on Hold Indefinitely

Published on Wed Feb 16, 2005

No explanation for revocation

The "Medically Unbelievable" edits appear to have suspended their disbelief.

The Centers for Medicare and Medicaid Services has rescinded Transmittal 105, which detailed how Adminastar Federal would issue edits for units of particular codes that seemed unrealistic.
 
In Other News:

  •  Carrier Advisory Committees should include interventional pain management specialists, CMS spells out in Transmittal 106, issued March 4.

  •  Virginia neurologist Abdorasool Janati and his office manager Forouzandeh Janati were each sentenced Feb. 25 to 41 months in prison. The defendants also had to pay approximately $500,000 in restitution. From 1996 to 2003, the Janatis allegedly falsely billed comprehensive office visits involving an average of 40 minutes of face-to-face contact with the patient. The couple also altered patient billing and medical records, prosecutors said.

  •  For services performed on or after Dec. 17, 2004, a positive fasting beta cell autoantibody test can serve as an alternative to insulinopenia for the updated C-peptide testing requirement, CMS said Feb. 10.


    Insulinopenia is a fasting C-peptide level less than or equal to 110 percent of the lower limit of normal. Patients with renal insufficiency must have a fasting C-peptide level less than or equal to 200 percent of the lower limit. The "lower limit" is contingent on the laboratory's measurement method. Read more at www.cms.hhs.gov/manuals/pm_trans/R27NCD.pdf.

  •  CMS is seeking comments on its proposed demonstration project, which will use "advanced computer and telecommunication technology" to manage diabetes, CMS said in the March 4 Federal Register. CMS seeks approval for an extension of the project as it enters its second phase, which uses new advanced technologies to reduce the public burden associated with information collection.

  •  If you're hoping Medicare will cover vertebral body compression fracture treatments, now's your chance to say so. Medicare is holding a Coverage Advisory Commission meeting in May, CMS announced. Details are available at www.cms.hhs.gov/mcd/viewtrackingsheet.asp?id=154.

  •  J. Richard Jones and Connie Jean Jones of Westerville, MA were each sentenced to three years' probation after pleading guilty to health care fraud, and Richard Jones will serve six months' home confinement, prosecutors say.

    The feds say Richard Jones shirked the physician supervision requirement for EKG-type tests such as Holter monitor tests. On Medicare claims, he allegedly named physicians who were not working for their company, Cardio-Diagnostic Technology and Consultants, as the test providers. Jones also allegedly altered records requested by Medicare and falsely stated that testing occurred.

    Mrs. Jones reportedly admitted to forging signatures of doctors on business checks and sometimes "misdirecting" deposits.

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