Medicare Compliance & Reimbursement

Plus:  CPT 2007 has new codes for Moh's surgery.

Medicare's detailed reviews of fee-for-service (FFS) claims aren't likely to cease.

The Centers for Medicare & Medicaid Services (CMS) continues to triumph from its intense scrutiny of Medicare FFS claims and has reduced improper payments by $1.3 billion--just in the past year. In 2005, Medicare's error rate for paying improper FFS claims was 5.2 percent, but that rate decreased to 4.4 percent in 2006, according to a recent CMS announcement.

CMS pays more than one billion FFS claims each year and has reduced the amount of improper payments by $11 billion in just the last two years, the agency reports.

"We have been increasing our efforts to reduce improper Medicare claims payments, and for the second year in a row, it's paying off," CMS administrator Mark McClellan said in the announcement. "Because we are able to measure the accuracy of payments more closely now, we are able to target our efforts more effectively with Medicare contractors and providers."

The agency releases its Medicare FFS improper-payment findings every November and posts the report on its Web site at www.cms.hhs.gov/cert. Don't Lose Reimbursement By Overlooking New Moh's Surgery Codes Dermatologists need to prepare now for a big change in how they code Moh's micrographic surgery.

CPT 2007 deletes existing Moh's codes 17304-17310 and replaces them with five new codes (17311-17315). The new codes break the procedure down into two categories: for head, neck, hands, feet and genitalia, or for trunk, arms and legs. Where the old codes talked about "specimens," the new codes talk about "blocks."

The old Moh's surgery codes divided the add-on codes into second stage, third stage and each additional stage. But the new codes simply include one add-on code for each additional stage after the first. For Moh's surgery of the trunk, arms or legs, you also have an add-on code for each additional block after the first five blocks. New CPT 2007 Codes Taking The Medical Billing World By Storm The following is a list of new codes and coding changes, courtesy of CPT 2007, that you'll need to know:

· You'll have a new code for ablation therapy for reduction or eradication of one or more pulmonary tumors (32998).

· There's also a new code for placement of fiducial markers, dosimeters or other devices in the prostate for radiation therapy guidance (55876).

· And you'll have a new code for revision (including removal) of a prosthetic vaginal graft through an open abdominal approach.

· There are two new codes for resection (tumor debulking) of recurrent malignant ovarian, tubal, primary peritoneal or uterine tumors. One code includes omentectomy (58957) and one includes omentectomy plus pelvic lymphadenectomy and limited para-aortic lymphadenectomy (58958).

· In [...]