Part B Insider (Multispecialty) Coding Alert

Published on Sun May 14, 2006 PDF

Medicare will freeze your payments this fall

Brace yourself for nine lean days in late September.

The Centers for Medicare & Medicaid Services (CMS) has once again said it will put a hold on all your payments from Sept. 22 to Oct. 1, the last nine days of Medicare's fiscal year. That means those payments will be pushed into the next fiscal year--and it also means you could have a cash flow problem in late September.

CMS issued detailed instructions to the carriers on how to implement the nine-day freeze in Transmittal 940, dated May 5.

In other news:

• Kentucky's "Any Willing Provider" (AWP) law doesn't govern Healthspan, an Ohio insurer that does business in Ohio and Kentucky, because physicians agreed to be governed by Ohio law when they signed Healthspan's provider agreement, the U.S. District Court for the Southern District of Ohio ruled in Florence Urgent Care vs. Healthspan (CV-00177). The court dismissed the AWP suit but allowed the physician's claims of racial discrimination to go forward.

• If you operate an ambulatory surgery center (ASC) and you want to supply durable medical equipment (DME), then you should read Transmittal 942, dated May 5. Your ASC should become licensed as a DME supplier with the National Supplier Clearinghouse, the transmittal says. For items not on the ASC list, the physician must bill the carrier separately.

• Medicare has the capability to process National Provider Identifier (NPI) applications via Electronic File Interchange as of May 1. This allows an organization to submit many health care providers' NPI applications in a single file in a Medicare-specified format. After you submit a file, you'll receive a downloadable file with the NPIs of all the providers that applied. You can find out more information by going to www.cms.hhs.gov/NationalProvIdentStand/.  To register as an EFI Organization, download the Certification Statement from https://nppes.cms.hhs.gov.

• Oncologists may soon be removing their specialties from their shingles, according to a new study at Washington University School of Medicine in St. Louis, MO. Therapy based on a tumor's anatomical location may soon be obsolete, according to the paper in the Journal of Pathology, "Expression of drug pathway proteins is independent of tumor type."

Researchers found that the location of a tumor, such as a breast, lung or colon tumor, didn't affect how the cancer interacted with a standard anti-cancer drug. Current cancer therapies set up different drugs for brain, prostate or ovarian cancer, but future therapies could select the drug based on the tumor's pharmacologic profile.