Part B Insider (Multispecialty) Coding Alert
Trying to Save Medicare Money? Be Careful When Sharing Savings
PDF
New advisory opinion reiterates the OIG's
A new advisory opinion, which is the latest in a long line of similar opinions, indicates that physicians should be careful when trying to collect money from hospitals as a reward for saving money on surgical procedures. In many cases, this practice is illegal, so you've got to navigate the regulatory minefield carefully if you're trying to get a cut of the savings.
The scenario: A neurosurgery group and an orthopedic group made an agreement with a local medical center. Under the agreement, the hospital would pay the physicians a share of the cost savings that they generated by making changes to their operating room practices.
For example: The surgeons ag-reed to limit the use of bone morpho-genic protein (BMP) to an "as-needed basis," based on specific patient criteria. Plus, the physicians decided to standardize the spine fusion devices and supplies that they used.
In return, the hospital agreed to pay the medical practices 50 percent of the cost savings attributable to the techniques that the surgeons implemented to save money for one year.
The problem: The OIG studied the case and said that several aspects of the arrangement violated the Civil Monetary Penalties (CMP) law.
Here's why: The law specifically notes that the government can impose a civil monetary penalty against any hospital that pays a physician as an inducement to reduce services to Medicare patients, says David C. Harlow, Esq., with The Harlow Group in Newton, Mass.
The OIG noted its concern that the arrangement "could be used to disguise remuneration from the medical center to reward or induce referrals" from the physicians, the advisory opinion indicated.
"If the physician is being paid to choose a cheaper implant or forego the use of BMP, the government wants to be sure the choice is clinically appropriate," Harlow says.
No penalties: The OIG chose not to crack down on the parties involved in the arrangement, noting, "Although we believe the arrangement might have resulted in illegal remuneration if the requisite intent to induce referrals were present, we will not impose sanctions in the particular circumstances presented here," according to the advisory.
To read the full opinion, go online to http://www.oig.hhs.gov/fraud/docs/advisoryopinions/2008/AdvOpn08-09B.pdf.
Part B Insider (Multispecialty) Coding Alert
- Modifier Errors:
Don't Let Modifier 59 Misuse Take A Bite Out of Your Reimbursement
One carrier reminds practices to heed the rules when using modifier 59 to separate CCI [...] - Compliance:
Trying to Save Medicare Money? Be Careful When Sharing Savings
New advisory opinion reiterates the OIG'sYou've cut back on your surgical costs, saving Medicare and [...] - Part B Payment:
CMS Halts Payment for Some Post-Op Infections, Failure to Control Blood Sugar
Expansion of Medicare's list of "never events" worries practices nationwide that treat conditions such as postoperative [...] - Modifier Decision Tree:
Go With the Flow to Make Your Modifier 59 Decisions Easier
This handy chart can help you decide whether modifier 59 applies to your claimYour physician [...] - Reader Question:
No Patient Present? Don't Expect Payment From Medicare
CMS' face-to-face E/M billing requirement could nip payment in the bud when you meet with [...] - Submit Clean Epidural Steroid Injection Claims Every Time -- Including the Fluoro
Payer policies reveal which conditions indicate medical necessity You need to get up to speed [...] - Physician Notes:
Medicare Launches Pilot Program to Put Personal Health Information in Beneficiaries' Hands
Plus: New ICD-9 codes formally released, including several new diagnosis codes that CMS hadn't previously announcedMedicare [...]