Part B Insider (Multispecialty) Coding Alert

Published on Fri Nov 16, 2007 PDF

You-ll collect about half of the cost price of Bexxar and Zevalin in 2008

Starting in January, if you treat patients with Bexxar or Zevalin, Medicare could be shorting you about $14,000.

That's because Medicare will slash payment for these drugs to approximately $16,000, despite the fact that the medications cost nearly $30,000 a piece, according to a Dec. 7 New York Times article.

Medicare officials responded to the outcry over the drug price cuts by saying that $16,000 is a -fair price,- the Times article noted.

In other news:

- At its meeting last week, The Medicare Payment Advisory Co-mmission (MedPAC) proposed a 1.2 percent payment increase to physicians in 2009, along with a 1-percent boost for dialysis facilities. MedPAC will deliver its recommendations to Con-gress by March 2008, although the current proposal wording may change.

MedPAC is also mulling a recommendation that Congress should require CMS to confidentially monitor the resources that physicians use in de-livering care. This way, the Commission could eliminate inefficient care.

- If you-re billing Medicare for neurobehavioral status exams via a telecommunications system, you may need a modifier.

Empire Medicare recently announced that practices reporting 96116 for services performed via a telecommunications device must append modifiers GT (Via interactive audio and video telecommunications system) or GQ (Via asynchronous telecommunications system) to claims for these procedures. Empire also requires that the originating site of these services must be a physician or practitioner's office, a hospital, a critical access hospital (CAH), rural health clinic or federally qualified health center.

To read Empire's article, visit www.empiremedicare.com/news/nynews07/ngs_120707telehealth.htm.

- Four ASCs submitted inflated claims to New York's Empire Plan after they inappropriately waived out-of-pocket costs for state and local government employees, costing taxpayers $8 million, according to audits released last week by New York State Comptroller Thomas P. DiNapoli.

New York auditors will most likely intensify their efforts following this news. The news release from DiNapoli states, -The systemic abuse revealed by these audits suggests that questionable if not fraudulent billing practices are much more prevalent than previously thought. It underscores the necessity for increased audit activity to ensure that taxpayer dollars are not wasted.-

To read the audit report, visit http://www.osc.state.ny.us/press/releases/dec07/120307.htm.