Medicare Compliance & Reimbursement

Plus: Don't let a CMS edit keep you from appealing radiology claims

Cancer practices are doing fine, insists the HHS Office of Inspector General in the latest of a long line of reports on oncology drugs.

The OIG surveyed a dozen oncology practices and found that nine of them could buy 15 cancer drugs at the Medicare rate or cheaper. The other three practices, however, had to pay more than the Medicare rate for at least half of those drugs.

Unfortunately, 11 out of 12 practices didn't have any way to track the costs of providing the drugs, apart from the drugs themselves.

That means the OIG was unable to tell whether the Medicare payments were enough to cover all the other costs that go along with providing the drugs.

Bottom line: The newest report "provides additional evidence of the adequacy of Medicare payment for Part B drugs used in cancer treatment," commented the Centers for Medicare & Medicaid Services (CMS).

Don't Stand For X-Ray Denials On Admission Dates

Start appealing those denied radiology Technical Component (TC) claims now, CMS officials urged.

CMS imposed an edit last April, saying that Medicare wouldn't pay for the TC of radiology services, if they happened on the same date as a patient's hospital admission or discharge.

Example: A provider calling into the Aug. 14 physician Open Door Forum said patients sometimes come into the office and receive X-rays. Then the doctor decides to admit the patient to the hospital the same day.

Medicare will deny the TC payment for those X-rays because they're on the same day as the hospital admission.

The edit which is causing these denials will disappear on Oct. 1, according to Transmittal 1295 (Change Request 5675).

"CMS has determined that some imaging services performed on the admission and discharge dates are being denied," CMS said in the Transmittal.

Medicare should pay for imaging and pathology services on the admission and discharge dates, as long as someone other than the hospital provides them.

So if you've received denials based on this edit since April, you should "bring them to the attention of the contractor," one CMS official advised. "An appeal is one way to do that." In Other News...

• Electronic Medical Records (EMRs) could aid in preventing fraud if they included 14 safeguards, according to a new report from RTI International in Research Triangle Park, NC. These include audit functions, provider identification, user access authorization, and safeguards for evaluation & management coding.

Most doctors don't commit fraud and shouldn't be burdened by safeguards aimed at the few who do, notes the RTI report, prepared for the HHS Office of the National Coordinator for Health Information Technology. So any fraud protections in EMRs should also benefit every [...]