Medicare Compliance & Reimbursement

Plus: Fight PTA denials based on expired facility certification. Political posturing in Washington is holding up pending Medicare legislation. Medicare payments are set to drop by more than 10 percent on July 1, unless lawmakers step in to halt the rate cuts. But finding a bipartisan solution has proven difficult and time-consuming. Sen. Max Baucus (D-MT) tried to get his bill to the Senate floor for a June 12 vote, but a vote of 54-39 shot down Baucus' plans. That means that Democrats and Republicans, who broke off negotiations over the bill last month, must come back to the negotiating table as the clock ticks toward the Medicare physician pay cut, but as the date gets closer practices grow more worried by the day. Baucus has expressed confidence that Congress can pass a Medicare bill averting the pay cut before June 30, but it will mean that both sides of the floor will have to come to an agreement and pass a bill in a remarkably short time. In Other News ... • Medicare shouldn't deny your carotid artery percutaneous transluminal angioplasty (PTA) claims just because the facility is due for recertification. That's the word from a new MLN Matters article (MM6046), which has an implementation date of July 7. In short, the article says that carriers have been denying PTA claims when a facility's certification has lapsed or is about to lapse. On the other hand, CMS asserts, "Certifying and recertifying facilities for Medicare payment is solely under CMS jurisdiction." Therefore, if a facility appears on an approved list, "it is considered certified by CMS whether or not recertification is in pending status." If your carrier denies such a claim, stating that the denial reason was a violation of the expiration date edits, send your payer a copy of the MLN Matters article, which is available online at http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM6046.pdf. • Suppliers of durable medical equipment may get a breather on bidding, but it will come at a high price. On June 12, legislators in the House introduced a bipartisan bill to delay DME competitive bidding for 18 to 24 months. Senators introduced a companion bill on June 17. The bill "will help prevent many small home-medical- equipment suppliers from going out of business," says Senate Finance ranking member Charles Grassley (R-IA) in a release. "That's especially important in states such as Iowa that are reeling from floods and tornadoes." The bills call for a 9.5 percent reduction to Medicare payment rates for bid items to pay for the delay.