Part B Insider (Multispecialty) Coding Alert
Radiologist-Hospital JV Clears Anti-Kickback Hurdles
The fact that radiologists don't typically order the tests they perform allowed an otherwise potentially risky business deal between a medical group and a hospital to win the HHS Office of Inspector General's blessing.
In its latest advisory opinion (No. 03-12), the OIG says a hospital-radiology group joint venture to operate an open magnetic resonance imaging facility won't be subject to kickback enforcement, despite the fact that it doesn't meet the watchdog agency's small entity investment safe harbor requirements.
The deal - under which a medical center and the six-person physician practice would own 51 percent and 49 percent, respectively, of the MRI facility - has a number of features that minimize the risk of fraud and abuse, the opinion says.
First and foremost, "Unlike most hospital-physician joint ventures, the physician investors are not referral sources for the Facility or the Medical Center." That's so because, in general, treating physicians, not radiologists themselves, order radiological tests.
Other safeguards that helped win a green light from the OIG
include:
referral volume.
To see the opinion, go to http://oig.hhs.gov/fraud/docs/advisoryopinions/2003/ao0312.pdf.
The research, which appears in the latest Journal of the American Medical Association, notes heightened risk of developing dementia in a study of women 65 and older taking Prempro, a form of estrogen-plus-progestin hormone therapy.
Federal Bureau of Investigation agents on May 1 arrested the medical director of a Houston-area physical therapy clinic based on charges that he signed off on physician's evaluations for patients he never examined. According to U.S. Attorney Michael Shelby's office, Dr. Anant Mauskar allegedly signed off on paperwork prepared by an unlicensed foreign medical student, who also performed the exams.
Mauskar faces up to five years in prison and a $250,000 fine on each of nine counts of fraud and conspiracy brought against him.
Part B Insider (Multispecialty) Coding Alert
- Physician Payments:
Congressmen Call For Drug-Free Physician Growth Rate
Physicians are getting shafted because drug expenses make their payments look as if they're growing [...] - MEDICARE OVERHAUL:
Physicians, Brace Yourselves for Medicare Reform
A Medicare reform plan could pass as soon as this summer, but you're not likely [...] - Medicare Prescription Drugs:
SENATE FINANCE PRODUCES BIPARTISAN Rx PLAN
Senate Finance Committee Chairman Chuck Grassley (R-Iowa) and ranking Democrat Max Baucus (D-Mont.) unveiled a [...] - Medicare Private Plans:
Nudging Patients Into Private Health Plans
Physicians may still have to deal with preferred provider organizations, but it won't be in [...] - Payment Revisions:
Eye Surgeons Win Boost as CMS Reviews RVUs
Good news for physicians billing for voice prosthetics and eye surgery codes.
The quarterly housekeeping [...] - Drugs:
Jan. 1 Could Be D-Day for Drug Payments
Oncologists and others who dispense medications under Medicare could be under the gun in a [...] - OIG Excludes 200 per Month
Heads up, physicians. The HHS Office of Inspector General is out for blood.
In its [...] - Studies & Surveys:
Emergency Care Costs Doctors $4.2 Billion a Year
Think it's just emergency department physicians who suffer from unreimbursed emergency care? You're off your [...] - Coverage:
ICD COVERAGE EXPANDS - BUT ONLY SLIGHTLY
Healthcare providers will soon be able to bill Medicare for implantable cardioverter defibrillators in more [...] - REIMBURSEMENT:
New Guidelines Mean Broader Application of Deep Brain Stimulation Codes
New guidelines from the Centers for Medicare & Medicaid Services have allowed for broader use [...] - Don't Forget to Charge for Programming
Following implantation of a DBS unit, the surgeon (or a neurologist) must test the device [...] - Coding:
Add Prolonged Services to Applicable E/M Only
If you're billing for prolonged service codes 99354-99357, you should be careful to avoid adding [...] - Legislation:
SENATORS AGREE ON GENERIC DRUG BILL
A bipartisan compromise announced June 5 means the Senate is again likely to pass legislation [...] - Coverage:
Beneficiary Rage Leads to Likely Coverage
Taking the Centers for Medicare & Medicaid Services to court proved a worthwhile strategy for [...] - Reimbursement:
An ED Visit and a Hospital Admission on the Same Day? Earn Proper Payment
How can you code for optimal reimbursement if the surgeon sees a patient in the [...] - Coding:
Can't Decide Between -51 and -59? Here's How to Choose
Physicians, coders and payers alike often have trouble distinguishing between modifiers -59 (Distinct procedural service) [...] - Physician Notes:
Radiologist-Hospital JV Clears Anti-Kickback Hurdles
The fact that radiologists don't typically order the tests they perform allowed an otherwise potentially [...]
