Part B Insider (Multispecialty) Coding Alert

Published on Sat Jan 13, 2007 PDF

Tell CMS what you really think of your carrier's performance

The Centers for Medicare & Medicaid Services expects contractors to be able to handle paying claims at the correct 2007 rates from the start of this month, with no delays or problems, the agency said in a -backgrounder- on the legislation that did away with this year's 5-percent cut.

But payments won't be the same as in 2006 because of the boost to work RVUs for evaluation & management codes and the 5-percent cut to other codes- work RVUs to compensate. Because of the revised payment rates, your doctor has until Feb. 14 to decide whether to be enrolled in Medicare as a participating physician, according to Transmittal 1131 (CR 5448).

In other news:

- CMS patted itself on the back for slowing down spending on physician services. The country spent $421.2 billion on doctor services in 2005, 7.0 percent more than in 2004.

Medicare physician spending still grew a whopping 9.5 percent in 2005, compared to an even faster 10.4-percent growth rate in 2004. Medicaid spending slowed down more, thanks to -cost-containment efforts,- including payment freezes and cuts.

In general, U.S. health care spending grew 6.9 percent, compared to 7.2 percent in 2004 and 8.1 percent in 2003, according to a CMS report published in Health Affairs. This is the slowest growth rate since 1999, but total spending reached nearly $2 trillion.

- Miami Beach physician Clark Mitchell, already in prison for defrauding Medicaid, pleaded guilty to a health care fraud that cheated investors out of almost $1 billion, the Miami Herald reports. Mitchell and others promised investors that AIDS patients had a short life-expectancy so those investors would buy out patients- life-insurance policies. Mitchell also pleaded guilty to submitting false claims for treating AIDS patients.

- Now's your chance to sound off on your carrier's or Medicare Administrative Contractor's performance. CMS is mailing out surveys for this year's Annual Medicare Contractor Provider Satisfaction Survey. More details are at www.cms.hhs.gov/MCPSS.

- Pay-for-performance (P4P) programs now affect 20.2 percent of doctors, up from 17.6 percent in 2000-2001. But a whopping 70 percent of doctors receive financial rewards for productivity, according to an -issue brief- from the Center for Studying Health System Change.

- The law that reversed the 5-percent cut to 2007 Medicare payments will cost the government an extra $5 billion in 2007-2010, the Congressional Budget Office predicts.