Part B Insider (Multispecialty) Coding Alert

Published on Thu May 22, 2008 PDF

Plus: Fight PTA denials based on expired facility certification

Political posturing in Washington is holding up pending Medicare legislation, leaving physicians on pins and needles.

As Part B providers know all too well, Medicare payments are set to drop by more than 10 percent on July 1, unless lawmakers step in to halt the rate cuts. But finding a bipartisan solution has proven difficult and time-consuming, and practices don't have much time left.

Sen. Max Baucus (D-Mont.) tried to get his bill to the Senate floor for a June 12 vote, but a vote of 54-39 shot down Baucus- plans.

That means that Democrats and Republicans, who broke off negotiations over the bill last month, must come back to the negotiating table as the clock ticks toward the Medicare physician pay cut, but as the date gets closer practices grow more worried by the day.

Baucus has expressed confidence that Congress can pass a Medicare bill averting the pay cut before June 30, but it will mean that both sides of the floor will have to come to an agreement and pass a bill in a remarkably short time.

Keep your eye on the Insider for updates on this issue.
 
In other news ...

-  Medicare shouldn't deny your carotid artery percutaneous transluminal angioplasty (PTA) claims just because the facility is due for recertification.

That's the word from a new MLN Matters article (MM6046), which has an implementation date of July 7.

In short, the article says that carriers have been denying PTA claims when a facility's certification has lapsed or is about to lapse. On the other hand, CMS asserts, -Certifying and recertifying facilities for Medicare payment is solely under CMS jurisdiction.-

Therefore, if a facility appears on an approved list, -it is considered certified by CMS whether or not recertification is in pending status.-

If your carrier denies such a claim, stating that the denial reason was a violation of the expiration date edits, send your payer a copy of the MLN Matters article, which is available online at www.cms.hhs.gov/MLNMattersArticles/downloads/MM6046.pdf.