Part B Insider (Multispecialty) Coding Alert

Published on Sat Sep 23, 2006 PDF

You gave your carrier high marks for claims processing

The American Medical Association's $1.5 million advertising campaign to stop Medicare pay cuts for doctors may have backfired, the Chicago Tribune reports.

The AMA has angered influential Republicans by running advertisements targeting vulnerable GOP incumbents, at a time when the Republican party is fighting to keep control over Congress, the Tribune says.

Meanwhile, at press time, Congress was scheduled to go into recess at the end of September, with few signs of progress on legislation to halt next year's 5.1-percent cut and with similar cuts scheduled for the next few years. Washington insiders remained skeptical that the AMA and other physician groups could convince Congress to halt the cuts.

The AMA has rejected calls for it to embrace programs to reward doctors for meeting quality goals or sharing information about quality. The AMA wants Congress to restore next year's payments, and then the AMA will consider quality-improvement programs.

In other news:

- You-re satisfied with your Medicare carrier and other contractors, judging from the results of the first Medicare Contractor Provider Satisfaction Survey. Overall provider satisfaction with contractors ranged from 4.4 to 5, out of 6. Providers rated carriers highly based on responses to inquiries, claims processing and medical review.

- Medicare's plan to cap the technical component for imaging procedures at the hospital outpatient payment level will lead to payments below your cost of providing the scans in the office for 126 out of 145 procedures, according to a new survey by the Moran Company. Overall, Medicare only pays 0.6 percent more for imaging scans in the office than in the outpatient setting at the moment, said the survey, which was paid for by the Access to Medical Imaging Coalition.

- Polk County, FL dermatologist Marsha Lynn Hoffman-Vaile faces up to 10 years in prison. She was found guilty of 44 counts of fraud, 44 counts of false claims and one obstruction-of-justice charge. She allegedly billed for higher paying procedures than she actually performed for Medicare patients, according to The Ledger.

- Transmittal 158, dated Sept. 15, updates the reason your carrier can disenroll you from Medicare or deactivate your billing number. Reasons include no billing activity for 12 months or failure to report a change in billing information or ownership. For serious compliance violations, such as a felony conviction, the carrier can revoke your billing number or recommend revocation, without prior approval from the Centers for Medicare & Medicaid Services.

- CMS uploaded the October pricing file for Part B drugs,  according to Transmittal 1059,  dated Sept. 15.