Urology Coding Alert

Contact your carrier soon to reclaim the money you're owed

If your urologist administered Lupron or Zoladex during 2005, you were likely underpaid for those services for the first two quarters of the year. Experts suggest you contact your carriers personally to seek proper reimbursement -- before the window of opportunity closes.

CMS Won't Make a Mass Adjustment

CMS revised its drug Fee Schedule back to January 2005, according to Transmittal 876 dated Feb. 24, 2006. Based on these changes, your urology practices may have been underpaid for certain services.
 
Caution: Carriers were instructed in Transmittal 876 that "contractors shall not search and adjust claims that have already been processed unless brought to their attention." That means that unless you contact your carrier, you won't have any hope of getting additional reimbursement for claims you submitted under the lower rates last year.
 
"I have looked at the price changes for our Lupron and Zoladex, and it appears that the third and fourth quarters of 2005 will require no adjustments; however, for the first and second quarters of 2005 we were underpaid," says Alice Kater, CPC, coder for Urology Associates of South Bend, Ind. "For us, these shortages amount to a few thousand dollars, which we will be asking for."

You May Have Missed Out on $4 per Unit

The difference in the payments you received in 2005 and the new fee schedule revision are about $1 per unit for the second quarter of the year and about $4 per unit for the first quarter of the year, says Morgan Hause, CCS, CCS-P, privacy and compliance officer for Urology of Indiana LLC, a 31-urologist practice in Indianapolis.
 
Tip: Look at your fee schedules for all quarters of 2005 and compare those to the revisions announced in CMS Transmittal 876, Kater says. You'll see that the actual reimbursement from Jan. 1, 2005, through March 31, 2005, was $189.79 per unit, and the fee schedule revision effective April 1, 2006, changes that to $193.66 per unit.
 
For April 1, 2005, through June 30, 2005, your actual reimbursement was $192.68 per unit, and the fee schedule revision changes that to $193.66 per unit.
 
Best bet: "I would advise readers to call their carriers as soon as possible," Hause says.