Part B Insider (Multispecialty) Coding Alert

Published on Mon May 01, 2006 PDF

Fill out 855 forms online to save time in future

Congress should expand national coverage for off-label uses of cancer drugs, the American Society of Clinical Oncology argues in the July 1 Journal of Clinical Oncology. Congress should require Medicare contractors to consider peer-reviewed literature as they make coverage decisions about off-label cancer drugs, ASCO says. Non-Medicare insurers should follow Medicare rules on off-label cancer drug use, ASCO adds.

In other news:

• CMS is offering pdf files of the 855 enrollment form, it says. The forms "can be filled out online and saved for future reference or to notify CMS of any future changes," a CMS spokesperson says. "This presents a significant savings in terms of time and energy for the practitioner."

Download the forms at www.cms.hhs.gov/CMSForms/CMSForms/list.asp. Search for "855."

• A lawsuit by House Democrats that seeks to nullify the Deficit Reduction Act should be dismissed, the U.S. Justice Department says. The lawsuit rests on the fact that one provision affecting durable medical equipment was different in the House and Senate versions of the bill.

• A federal judge dismissed doctors' class action suit against a variety of managed care insurers. All of the defendants except Coventry Healthcare and United HealthCare had already paid large amounts to settle the suit, which accused the insurers of using claims processing software to delay, reduce and deny physicians' payments.

• Prosecutors accused the owners of Leonza Health Management Group Clinic of billing Medicare for injected drugs that they didn't administer, administered in smaller quantities than billed, or administered in return for kickbacks. They billed $7.5 million for the injections, prosecutors say.

• Dearborn, MI physician Ali Makki allegedly overbilled $500,000 for unnecessary medical tests, faked medical records in response to a Medicare audit, and provided false medical records for more than 500 green-card applicants. He allegedly gave two immigrants who had syphilis "negative" test results prescribed controlled substances without a medical purpose.

• Non-physician practitioners can't sign a home health plan of care, but they can bill for home health care plan oversight (CPO) services, CMS says in Transmittal 993, dated June 23.

• Lumbar artificial disk replacement (LADR) with the Charite lumbar artificial disk is non-covered for Medicare patients over 60, CMS said in Transmittal 60, dated June 23.