Part B Insider (Multispecialty) Coding Alert

Published on Thu Sep 15, 2005 PDF

Find out how to claim extra reimbursement for fasting glucose tests

Did you know: If your physician is already performing the Welcome to Medicare exam on a patient who just turned 65, then you can also bill for diabetes and cardiovascular screening tests.

The Centers for Medicare & Medicaid Services has issued a bunch of educational materials to help you bill for screening tests, according to an Oct. 3. Medlearn Matters article. If your patients have at least one risk factor and two required characteristics, you can bill for fasting blood glucose and post-glucose challenge tests at the same time as the "Welcome" exam.

And for services on or after Jan. 1, 2005, Medicare will reimburse you for three cardiovascular screening blood tests: the total cholesterol test, cholesterol test for high-density lipoproteins and the triglycerides test. The new coverage for these tests applies to beneficiaries who don't have cardiovascular disease but have the risk factors for it.

Refer to: www.cms.hhs.gov/medlearn/preventiveservices.asp.

In other news:

• CMS has created a new Additional Document Request (ADR) form for your carrier to use to ask you for documentation about your claims. The ADR requests documentation "about the patient's condition before and after a specific service to gain a more complete picture of the patient's clinical condition," CMS says in an Oct. 4 Medlearn Matters article. You must respond to an ADR within 30 days. Read the article at www.cms.hhs.gov/medlearn/matters/mmarticles/2005/MM4022.pdf.

• If you're in California's Santa Cruz or Sonoma counties, you could win a reimbursement boost of up to 25 percent. CMS wants to move the two counties out of a low-cost rural area and into a higher-cost urban area. However, the remaining counties in the low-cost area will see a 0.4 percent drop in reimbursement because their expenses won't be averaged with those in Santa Cruz or Sonoma.

• CMS has added some information about Medicare assignment and how to become a participating physician to the Carriers Manual in Transmittal 702, issued Oct. 7.

• CMS has issued a new guide to rural health services for physicians and other providers. You can download it in PDF format by visiting www.cms.hhs.gov/medlearn/MedRuralGuide.pdf. Or, in late November, you'll be able to order a free copy in print or on CD-ROM by going to www.cms.hhs.gov/medlearn/default.asp?link=products.

• CMS is planning a three-pronged strike against fraud in the new prescription drug benefit, it announced Oct. 7. The agency will use innovative techniques including eight new contractors, work with law enforcement and drug plans, and provide tips to help consumers protect themselves.