Part B Insider (Multispecialty) Coding Alert

Published on Tue Mar 13, 2007 PDF

Medicare 'bounty hunters' coming to your state soon

Make your voice heard: The Physicians Regulatory Issues Team (PRIT) is -actively soliciting complaints from the providers- about the Recovery Audit Contractors (RACs), says William Rogers, the PRIT's head.

Right now, the RACs are operating only in California, New York and Florida, but that will soon change. -We really feel the good habits that we infuse them with now are going to help when they go nationwide,- Rogers says.

The PRIT just received one complaint from an oncology group, which the RAC had audited on its billings of Neupogen, a drug for chemotherapy side effect neutropenia. The RAC was asking for 10 to 12 charts per month every month for five months, despite not finding any problems, Rogers said. -The Baltimore staff that manage the RACs were very responsive,- he adds. Find PRIT online at www.cms.hhs.gov/PRIT/.

- Where the RACs find -large amounts of overpayments,- your carrier or Medicare Administrative Contractor (MAC) should be able to perform a -mass adjustment- on a bunch of your claims, the Centers for Medicare & Medicaid Services (CMS) says in Transmittal 268 (CR 5496). For example, your carrier should be able to adjust all claims with the same CPT code, or a file with -all duplicate claims.-

- Cardiologist Krishnaswami Sriram received an -absurdly light sentence- of five year's probation and $1,258 in repayment after he pleaded guilty to health care fraud and tax fraud, the U.S. Court of Appeals for the Seventh Circuit declared. The court said Sriram received between $5 million and $10 million in fraudulent billings, but he claimed his fraud was limited to two checks he received.

At the same time, the government showed he provided more than 24 hours- worth of services on 401 days and billed for services to patients who were already dead. -On one day when Chicago was paralyzed by a snowstorm, he billed for 28 home visits,- the court added. The court remanded the case for re-sentencing.

- Three quarters of doctors re-ported considering patients- out-of-pocket costs, such as copays and deductibles, when prescribing drugs, according to a survey in the Annals of Internal Medicine. But only 40 percent considered the cost to the patient when prescribing diagnostic tests. So cost-sharing programs that penalize patients for using more expensive care are unlikely to have much effect on doctors- decision-making, the study concluded.

- CMS has now launched Doctor's Office Quality Information Technology (DOQ-IT) University, a free Web-based tool to help small and midsized physician practices to adopt health IT. It's online at http://elearning.qualitynet.org.