Part B Insider (Multispecialty) Coding Alert

Published on Fri May 12, 2006 PDF

Congress should provide more money to reward physicians for quality

Primary care physicians are falling apart because of a messed-up health care reimbursement system, warns the American College of Physicians in a Jan. 30 report.

The ACP makes a number of recommendations for reform, including encouraging physician practices to transform into a new model, known as the "Advanced Medical Home," geared towards treating patients with multiple chronic conditions. Practices certified as Advanced Medical Homes would receive "new models of reimbursement" based on their added value.

Policymakers should redress the balance between evaluation & management services and surgical procedures under Medicare, the ACP urges. Congress and the Centers for Medicare & Medicaid Services should provide enough money to reward physicians properly for improving their quality. And Congress should replace the broken Sustainable Growth Rate, which keeps calling for 5-percent cuts every year, with a truly sustainable system, ACP says.

In other news:

• Washington, DC HIV specialist Larry Bruni faces up to 10 years in prison for charges that he submitted fake Medicare claims and used the money to pay his rent, according to the Washington Times. The U.S. Attorney's Office for D.C. charged Bruni with health care fraud, saying he billed Medicare for a blood-thinner, Reteplase, which is usually administered within a few years after a heart attack. He billed for administering Reteplase 185 times to a single patient.

• More than 100,000 Medicare beneficiaries are now enrolled in Medicare Health Support (MHS) programs, which manage their chronic illnesses, CMS announced. The eight MHS contractors have been operating since 2004.

• You'll no longer have to bill separately for the professional component (PC) and technical component (TC) of services in order to receive the Health Professional Shortage Area (HPSA) or Physician Scarcity Area (PSA) bonuses. Transmittal 834, issued Feb. 3, instructs the carriers to allow physicians to bill globally for services and calculate the bonus based on the professional component payment.

• You should start including data elements required by the Health Insurance Portability and Accountability Act (HIPAA) on your claims for mass vaccinations using bill types 12X and 22X, according to Transmittal 829, issued Feb. 2. These include admission date, admission type, diagnosis, patient's status code and admission source code.

• CMS updated the list of codes for radiopharmaceutical imaging agents that you can use with PET scans to include new codes A9552 , which replaces C1775 and A9555, which replaces Q3000. See Transmittal 822, issued Feb. 1, for more details.