Part B Insider (Multispecialty) Coding Alert
Regulations Under Development
PDF
The Centers for Medicare & Medicaid Services put another six-month delay on the effective date of a provision in the Jan. 4, 2001, Stark rule, granting another welcome reprieve to teaching hospitals and medical centers that were marking Jan. 7 as the launch of a paperwork nightmare.
The controversy is over a single sentence in the Stark reg that deals with percentage compensation arrangements and the definition of "set in advance." Many of the exceptions to the Stark rule that apply to compensation arrangements can only be invoked if the amount of compensation is set in advance. According to a notice published in the Dec. 24 Federal Register, CMS is trying to decide whether its interpretation of "set in advance" automatically excludes percentage compensation deals from the Stark exceptions - a reading that could leave teaching hospitals, physician practices and medical foundations scrambling to rework thousands of contracts.
This is the fourth time CMS has delayed the rule, which is now effective July 7, 2004. The agency reiterates that the "set in advance" issue will be definitively worked out in the Stark Phase II rule.
To see the notice delaying the rule, go to http://www.access.gpo.gov/su_docs/fedreg/a031224c.html.
Part B Insider (Multispecialty) Coding Alert
- Modifiers:
Use Modifier -51 When Surgeries Share Significant Work
Use modifier -59 when procedures are totally separate
Two procedures, one day. [...] - Ambulatory Surgery Centers:
Keep On-Site ASCs Totally Separate From Offices
Mix your practice with your ASC, and you risk damaging both
It [...] - Biggest Mistakes With Modifiers -51 and -59
Coders mistakenly apply both modifiers -51 (Multiple procedures) and -59 (Distinct procedural service) on multiple [...] - Modifiers:
Examples Illuminate Differences Between Modifiers -51 and -59
Use -59 if procedures are separated by time or by location
Consultant Ken Lobo with Lobo [...] - Regulations Under Development
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Running Behind? Use the .75 Percent Solution
Figure out which patient demand your practice can control
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Physician Practices Can Merge With Hospitals
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