Part B Insider (Multispecialty) Coding Alert

Published on Wed Jan 16, 2008 PDF

If you have more Stark questions than answers, CMS has a resource for you. Thanks to a new Q&A section on the CMS Web site, you can peruse 16 questions related to the physician self-referral law, with CMS- answers on everything from how a -physician practice- is defined under the -physician organization- umbrella (a medical practice with two or more physicians organized to provide patient care services) to examples of providers that don't qualify as physician organizations (for example, federally-qualified health centers).

CMS will continually update the Stark Q&A page as new answers are posted. You can visit the CMS Web page online at www.cms.hhs.gov/PhysicianSelfReferral/05a_FAQs.asp#TopOfPage, and click on -All Physician Self-Referral FAQs.-

In other news -
 
- Florida physicians aren't waiting around for the government to fix Medicare. Instead, they-ve decided to take matters into their own hands.

After President Bush announced his proposed budget, which would cut $183 billion from the Medicare program, approximately 30 Florida physicians met with U.S. Rep. Vern Buchanan (R-Sarasota), according to the Feb. 6 Bradenton Herald.

Their mission? To let the congressman know that they are working twice as hard as ever for half as much money, and asking for Bu-chanan's help in instituting Medi-care reform. Using the rationale that -Medicare reforms would be more realistic if approached as pilot projects on a state level, particularly if they were based in Florida, which has a large Medicare population,- the physicians and Buchanan vowed to get Medicare reform on the table as a point of discussion.

- New York Attorney General Andrew M. Cuomo has had it with insurers- billing practices and plans to get to the bottom of what he sees as a discrepancy in how insurers determine patient balances.

Cuomo is investigating -whether health insurance companies have systematically forced patients to pay more than they should when using doctors and hospitals outside their insurer's networks,- according to a Feb. 14 New York Times article outlining Cuomo's plans.

Key to the investigation is Cuomo's plan to sue insurer United Health Group, to find out how the insurer determines which portion of a physician's bill it will pay if the patient sees the physician under the payer's -out of network- benefit.