Part B Insider (Multispecialty) Coding Alert

Published on Thu Jun 19, 2008 PDF

Two percent bonus for electronic prescribing looks appealing to many

Despite the fact that many in the healthcare field refer to H.R. 6331 as the -physician pay cut bill,- the legislation offers benefits to thousands of other providers as well.

Not only will practices across the nation continue to collect their rightful Medicare reimbursement thanks to the Medicare Improvements for Patients and Providers Act, but they-ll also have to jump over fewer hoops to collect that money. Following are a few of the new law's winners:

- Therapy: The new legislation reinstated the therapy cap exceptions process, effective retroactive to July 1. -Claims submitted with the therapy cap exception modifier [modifier KX] will be processed as soon as
the payment rates have been activated,- a July 16 CMS memo stated. -Claims submitted without the modifier, and rejected or denied, can be resubmitted with the modifier
for reimbursement.-
 
- Competitive bidding: CMS will delay the Durable Medical Equipment Competitive Bidding Program, which took effect on July 1 in 10 designated competitive bidding areas. Because the program was already in place for two weeks before the new legislation passed, many Medicare patients had already started using their new DME providers. Going forward, -Medicare beneficiaries may use any Medicare-approved supplier,- according to a July 16 CMS fact sheet. -If a beneficiary changed suppliers when this new program started (July 1, 2008), they can either continue to use the new supplier or choose another supplier,- the directive says.

- Labs: Retroactive to July 1, CMS has reinstated the moratorium permitting independent labs to bill the technical component (TC) of physician pathology services administered on behalf of hospital patients. Medicare will continue to pay the TC of the physician's pathology services -when an independent laboratory furnishes this service to an inpatient or outpatient of a covered hospital,- according to a July 16 CMS memo.

- Electronic prescribing: In 2009 and 2010, Medicare will offer a two-percent incentive to -successful electronic prescribers.- That bonus will drop to 1 percent in 2011 and 2012, and just half a percentage point in 2013. By 2014, the bill indicates that you-ll face a -2 percent penalty if you-re eligible to e-prescribe but you don't do so.

To read the legislation in its entirety, visit http://thomas.loc.gov/home/c110query.html and type -HR 6331- in the search box.