Part B Insider (Multispecialty) Coding Alert

Published on Fri Sep 07, 2007 PDF

Heads up: More managed-care patients on the way

Now's the time to call your Senator. The Senate Finance Committee is working on legislation that would put a stop to your 10-percent pay cut, slated for Jan. 1. The draft bill would pay for the cuts entirely through cuts to payments for Medicare Advantage plans--which means the bill could run into some pretty stiff opposition from powerful lobbying groups, say Capitol Hill insiders.

MA plans are a favorite target amongst lawmakers after the controversy over unethical marketing by so-called private fee-for-service plans (see next column). But -this is not a slash and burn exercise here on Medicare Advantage,- Democratic committee aide Shawn Bishop said in a statement.

Congress is currently working under continuing resolutions (CRs) that allow the government to operate past the Sept. 30 fiscal year end, although no appropriations bills have been passed. More CRs are likely forthcoming, observers note.

In other news:

- You may notice the number of your patients enrolled in private fee-for-service (PFFS) managed care plans on the rise again.

The Centers for Medicare & Medicaid Services told the seven health plans that halted marketing of PFFS products this summer that they could resume the marketing. -CMS conducted a comprehensive review of these seven sponsors and found vast improvements to their internal controls and oversight processes consistent with regulations and guidance,- acting CMS Administrator Kerry Weems said.

Lawmakers aren't so sure. -Talk is cheap and I look forward to action when PFFS plans are again caught misleading Medicare beneficiaries,- House Ways & Means Health Subcommittee Chair Pete Stark (D-CA) said.

- He's old enough to be a Medicare recipient, but 80-year-old physician Orestes Alvarez-Jacinto took part in a scam that bilked $7 million from Medicare for HIV medications, say prosecutors. Alvarez-Jacinto will serve 18 months in prison for prescribing medications that the HIV patients didn't need and which he knew could harm them.

- Some clearinghouses are still stripping the National Provider Identifiers (NPIs) from claims, and some billing services aren't adding the NPIs even when providers ask them to, CMS warns. This could have a drastic effect on your cash flow, especially as carriers turn on edits to validate NPI/legacy pairs against the NPI crosswalk.

- You can still enroll as a -mass immunizer- with Medicare if you want to offer the flu vaccine to a large number of individuals, CMS says. More information is in MLN Matters article MM5511.