Part B Insider (Multispecialty) Coding Alert

Published on Tue Mar 28, 2006 PDF

Watch out for confusion between beneficiary's home and mailing addresses

You can still bill for a Health Professional Shortage Area (HPSA) bonus if your physician provides services in the patient's home, the Centers for Medicare & Medicaid Services clarified.

Before now, carriers weren't paying the HPSA bonuses to some physicians who cared for patients in the home because the carriers were using the address they have on file for the beneficiary to determine eligibility. But sometimes the carrier has a "representative payee address" or mailing address that doesn't reflect the patient's true location, CMS says.

So from now on, when carriers receive a HPSA claim with the place of service as "home" and they believe the beneficiary isn't eligible, CMS wants them to investigate where the physician actually provided the service. Soon, CMS will require physicians to write the actual location of the service, instead of just "home."

In other news:

• CMS clarified the rules for billing ultrasound stimulation (CPT Codes 20979) for nonunion fracture healing in Transmittal 816, dated Jan. 20. You should use the "KF" modifier when billing for these devices because they are Food and Drug Administration Class III devices.

• CMS has posted a file that will help physicians figure out which drugs are covered under Part B and which are included in Part D, at www.cms.hhs.gov/Pharmacy/Downloads/partsbdcoverageissues.pdf. In general, any drug which a physician administers "incident to" a physician's services is a Part B drug.

• Senator Charles Schumer (D-NY) has introduced legislation to make tissue transplants as heavily regulated as organ transplants. Schumer had written to the FDA about a case in which a Brooklyn funeral home, without obtaining consent, sold body parts to a company that then sold them to five other tissue banks. The FDA "didn't give a hoot," Schumer complains.

• CMS is setting up a new Open Door Forum for its Medicare beneficiary ombudsman. If any of your patients have problems with Medicare, encourage them to call in and air their complaints. You can sign up for the announcement list by going to www.cms.hhs.gov/apps/mailinglists/default.asp?audience=4.

• A U.S. District Court convicted Cleveland, OH pain doctor Jorge Martinez of billing Medicare and other plans $60 million in fraudulent claims. Martinez faces up to 20 years in prison. Two patients died under his care. He allegedly prescribed drugs such as OxyContin, Zoloft and Valium to drug addicts, but refused to write prescriptions until patients agreed to receive injections.