Practice Management Alert

You can look forward to more fair and reasonable treatment in the coming year, thanks to provisions within the new Medicare legislation.

The Medicare reform bill signed into law on Dec. 8, 2003, is likely to change the relationship between Medicare and healthcare providers, says Wayne J. Miller, attorney with the Compliance Law Group in Los Angeles.

Under the new law, Medicare has to give advance notice to a provider that is billing incorrectly before putting it on prepayment review, says attorney Lester Perling with Broad & Cassel in Ft. Lauderdale, Fla. This law will attempt to impose an educational and correctional approach to Medicare's dealings with providers, rather than a punitive approach, Miller says. Practices will now have the opportunity to explain themselves and correct their billing conduct without feeling that their status with Medicare is immediately threatened.

Another provision may allow some providers to have an independent reviewer handle low-level appeals if they wish, Miller says. The reason for the provision is to guard against unfair bias by Medicare employees reviewing appeals.

The Medicare bill is effective immediately, but it's now a matter of implementation - maybe three to six months - before you'll start seeing these changes in action, Miller says.