Part B Insider (Multispecialty) Coding Alert

Published on Fri Aug 24, 2007 PDF

Medicare -bounty hunters- will soon be in your back yard

Bad news: The chances of averting a 15 percent Medicare cut (spread across 2008 and 2009) just got a lot slimmer.

The House of Representatives agreed to drop Medicare provisions from its children's health bill in order to agree on a consensus bill with the Senate, according to Capitol Hill insiders.

The upshot: You-ll have to hope Congress can get its act together before the end of the year to pass a separate Medicare bill that prevents the 10-percent cut scheduled for 2008. The legislative calendar is fast running out. And if Congress doesn't address this year the additional 5 percent cut scheduled for 2009, you can't count on Congress passing a fix in 2008, an election year.

The American College of Physicians sent letters to Congres-sional leaders expressing -deep concern and disappointment- that Congress had dropped Medicare fixes from the children's health bill. ACP President David Dale urged Senate leaders to work with the House to -reach prompt agreement on Medicare legislation to preserve and improve access to care for America's seniors.-

The American Medical Association (AMA) issued a statement saying it was -deeply disappointed that congressional leaders have decided to defer action to stop Medicare cuts to physicians.-

-Doctors want to continue caring for Medicare patients, but many are between a rock and a hard place,- the AMA statement added.

In other news:

- Don't hold your breath for new critical care codes for doctors who monitor their patients remotely.

Some physician groups have argued in favor of new codes to cover telemedicine critical care, where doctors use audio, video and other devices to monitor crisis patients in another location. But nobody can agree on how to word these codes in a way that might be acceptable to payors, says a source on the CPT panel.

- The Recovery Audit Contractors, which receive a bonus every time they recoup your Medicare payments, will soon be spreading nationwide. So far, there have been a few isolated problems with the RACs, says William Rogers at the Centers for Medicare & Medicaid Services.

The RACs have requested -unreasonable amounts of paperwork for unreasonable amounts of claims,- or else requested paperwork for claims where the time limit has already expired, Rogers notes. But CMS has been working hard to create policies to minimize the impact of the RACs on doctors. Every RAC will have a medical director, for example.

CMS is also working on rules which will make the RAC program -a lot less burdensome,- Rogers says.