Part B Insider (Multispecialty) Coding Alert

Published on Mon Jun 19, 2006 PDF

Fixing physician payment mess top priority, Congressman insists

Now that you've finally been rescued from the 4.4 percent cut to your Medicare payments for 2006, Washington is turning its attention to the roughly 5 percent cut that awaits you in 2007.

Congress should make fixing the broken physician payment formula a top priority this year, House Energy and Commerce Committee Chair Joe Barton (R-TX) asserted in a Feb. 15 committee hearing on the White House's health spending priorities. Barton said he wants to work with the White House "on ways to reform Medicare reimbursement, and particularly focus on physician payment reform."

But once again, Barton and Health and Human Services Secretary Michael Leavitt focused on rewarding your physicians for improving quality. Barton said he wants to provide "incentives" for physicians "to continue providing quality health care."

In other news:

• Starting Jan. 1, 2007, your doctor won't need to fill out Certificates of Medical Necessity for home oxygen therapy, hospital beds and support surfaces among other durable medical equipment items. For infusion pumps and enteral parenteral nutrition, your doctor will have new forms to fill out to prove medical necessity, according to Centers for Medicare & Medicaid Services Transmittal 138.

• You won't receive payment for new code G0372 for supplying documentation to support power wheelchair and scooter claims until April 1. Congress directed CMS to wait until April 1 to implement a rule which would pay physicians $21.60 for providing supporting documentation for power mobility device claims. Until then you can either hold those claims, or bill for G0372 now and receive payment in April, CMS told a recent open door forum for home health care.

• CMS is pulling back on its Open Door Forum schedule due to budget constraints, the agency says in a notice to providers. CMS now will hold physician forums every six weeks instead of every month.

• HHS published its final rule on enforcement of the Health Insurance Portability and Accountability Act (HIPAA) in the Feb. 16 Federal Register. The rule deals with the fines and penalties that you could owe if you fail to safeguard your patient's health information privacy.

• If your practice employs an occupational or physical therapist, he or she may be able to obtain an exception to the caps on therapy services in certain circumstances, as explained in Transmittal 47, dated Feb. 15.

• CMS announced it would work with the National Oncologic PET Registry to obtain data to help manage patients with various forms of cancer.