Part B Insider (Multispecialty) Coding Alert

Published on Sat Oct 14, 2006 PDF

Current system doesn't account for drug discounts you never see

If you took away all the mistakes that the Centers for Medicare & Medicaid Services (CMS) had made over the years in calculating the annual updates to physician payment rates--you-d still be in for a cut of around 2.4-percent to 4-percent per year, says one influential body.

But if you only based each year's update on comparing last year's spending with a target, doctors could receive an annual pay boost of up to 3-percent, according to a presentation at the Oct. 9 meeting of the Medicare Payment Advisory Commission (MedPAC).

The commissioners considered options that would allow for small cuts, or updates that just ranged from zero percent to a measure of inflation. MedPAC has until next March to report to Congress on options for reforming the current system, which results in steep cuts every year.

Meanwhile, drug wholesalers may be receiving bulk discounts on Part B drugs that they don't pass on to you, MedPAC commissioners said. Those discounts could have the effect of slashing the amount CMS pays for your drugs. Also, CMS doesn't account properly for the difference between the amount your wholesaler pays and what the wholesaler charges you, the commissioners speculated.

The sharp cuts in drug payments have forced many patients to receive drugs in the hospital instead of the doctor's office, MedPAC staff said.

Also, MedPAC criticizes CMS for sticking with this year's 25-percent reduction on imaging scans on contiguous body parts, instead of going up to a 50-percent reduction, as CMS had planned. In its written comments on the physician fee schedule proposed rule, MedPAC supports CMS- policies restricting -condo labs- or -pod labs.-

In other news:

- A Florida doctor who scarred and, in some cases, disfigured his patients received a 22-year sentence. Michael Rosin falsely diagnosed dozens of people with cancer and performed Moh's microsurgery on them. The more layers of tissue he removed from patients, the more Medicare paid him. Even Rosin's own staff started to wonder after a while why 100 percent of the biopsies he reviewed were cancerous, the St. Petersburg Times reports.

In one case, Rosin based his diagnosis on a slide sample that was chewing gum, not human tissue. In another instance, he examined a slide that contained plastic foam and decided the patient had a very aggressive cancer, requiring immediate surgery.

Rosin also must repay $3.7 million and pay a $25,000 fine.