Part B Insider (Multispecialty) Coding Alert

Published on Fri Aug 07, 2009 PDF

Plus: Michigan physical therapist faces up to 10 years in prison after pleading guilty to fraudulently billing Medicare for over $1.6 million.

The Government Account Office (GAO) wants to save Medicare a half billion dollars -- and it has discovered a novel proposal that could cost physician practices dearly.

According to a new report entitled "Medicare Physician Payments: Fees Could Better Reflect Efficiencies," the GAO asserts that multiple procedure payment reductions, which apply to surgical and imaging procedures, could be extended to non-surgical, non-imaging services.

"For example," the report notes, "when two services are furnished together, a physician reviews a patient's medical records once, but the time for that activity is generally reflected in fees paid for both services."

The GAO concluded that CMS could save $500 million by expanding the multiple procedure payment reduction (MPPR) "to reflect practice expense efficiencies that occur when nonsurgical, nonimaging services are provided together." In addition, the GAO advises that another $175 million could be saved if the MPPR policy is adjusted "to reflect efficiencies in the physician work component of certain imaging services."

The Dept. of Health and Human Services concurs with the GAO's recommendations, and "plans to review these services," the report indicated.

To read the entire GAO publication, visit www.gao.gov/new.items/d09647.pdf.