Part B Insider (Multispecialty) Coding Alert

Published on Sun Feb 11, 2007 PDF

Imaging providers fight back against unfair cuts

The Recovery Audit Contractors (RACs) will be coming to your town soon.

These so-called -bounty hunters- receive more money if they collect overpayments (or uncover underpayments). Until now, they-ve only operated in three states, but they-ll expand nationwide by Jan. 1, 2010. So far, they-ve collected $69 million, only 6 percent of which came from doctors, CMS officials told the March 5 Practicing Physicians Advisory Council meeting.

Because such an insignificant part of the RACs- bounty came from doctors, PPAC voted to urge CMS to instruct the RACs to focus only on hospitals.

The RACs will be hiring medical directors, according to Physician Regulatory Issues Team Director William Rogers. Also, if too many physicians successfully appeal overpayment demands from the RACs, the contractors may bear some financial penalties--or even lose their contracts.

PPAC advised CMS to give providers an extra 25 percent of any RAC-related overpayments that they appealed successfully, to compensate for the expense of appealing.

In other news:

- Mum's the word for many seniors when it comes to discussing their medications with their doctors. Nearly a third of seniors report not having talked to their doctors about all the medications they-re taking within the past year, according to an article in the January 2007 Journal of General Internal Medicine. Also, 27 percent of seniors who stopped taking their medications because of side effects or perceived lack of effect didn't tell their doctors this fact.

A startling 40 percent of seniors don't adhere to their prescribed course of medication. And where seniors fail to comply for cost reasons, 39 percent of them won't disclose this fact to their doctors, even when cheaper alternatives are available. Meanwhile, 38 percent of seniors who failed to take meds for cost reasons switched to a cheaper drug--and those tended to be the seniors who discussed this fact with their doctors.

- Rep. Carolyn McCarthy (D-NY) and colleagues introduced a bill to overturn the law capping imaging services at hospital outpatient levels. Meanwhile, the Access to Medical Imaging Coalition (AMIC) unveiled a report from The Moran Company which shows total reimbursement for imaging in physician offices and imaging centers will fall 18 to 19 percent below actual reimbursement in hospital outpatient departments.

- The HHS Office of Inspector General continues to beat the drums in favor of more cuts to drugs that you administer in your office. Medicare could save $761 million a year by paying for 24 drugs at the prices you pay, the OIG told a March 8 hearing of the House Ways & Means Subcommittees on Health and Oversight.