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Part B Insider (Multispecialty) Coding Alert

PHYSICIAN NOTES:

Medicare 'Bounty Hunters' Haven't Targeted Physicians-Yet

Published on Fri Jun 24, 2005

Physicians must supervise nurse anesthetists in New Jersey

Physicians have been bracing themselves for another layer of scrutiny over their Medicare claims, this time from the Recovery Audit Contractors, which receive payments based on the amount of money they recoup from providers.

You can breathe a little easier. The RACs were supposed to begin auditing providers in California, New York and Florida in May. But so far no physicians appear to have heard from the RACs, according to William Rogers, a physician who runs the Physician Regulatory Issues Team at the Centers for Medicare & Medicaid Services. The PRIT lists the RACs as an issue it is following, Rogers notes.

"I have been talking to docs all the time in the states where the contracts are active, and I have not heard from a single doctor who has been audited yet," notes Rogers. "Either what is happening is so painless or non-intrusive that docs don't feel the need to call, or they're not auditing docs." He adds that the RACs may focus on "big-ticket" items at hospitals instead of smaller issues in physician offices.

Separately, the PRIT site says Medicare assigned a multiple surgery indicator of "2" to endovenous ablation codes 36476 and 36479, which debuted in 2005. Both codes are add-on codes, which usually are exempt from multiple surgery reductions. PRIT has contacted a CMS "policy expert" and expects to resolve the issue soon.

In other news:

  •  Carriers should implement edits to make sure providers don't provide more than eight smoking cessation counseling sessions per year, CMS said in Transmittal 605, issued July 15.
  •  The New Jersey Supreme Court upheld a state rule that effectively requires an anesthesiologist to supervise certified registered nurse anesthetists in most situations, says the American Association of Nurse Anesthetists. New Jersey is the only state that requires physician supervision of CRNAs in all physician office settings, but the 1998 rule has been on hold until now.
  •  Avon, CT physician Tadeusz Skowron pleaded guilty to treating Medicare patients after his license to practice medicine was suspended in May 2004. He faces up to 10 years imprisonment and a fine of up to $250,000.
  •  The new Office of Medicare Hearings and Appeals took over the Social Security Administration's running of administrative law judge hearings for Medicare appeals on July 1, HHS announced. OMHA will use video teleconferencing sites in more than 10,000 locations to reduce the need for patients to travel for Medicare hearings.

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