Hospital-owned practices may take an unexpected hit in revenue under a new Medicare rule that bundles certain physician service fees into hospital payments. The so-called “payment window” rule (sometimes referred to…
Continue Reading Employed by a Hospital? Beware the New 3-Day Window Rule
Under the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA), all Medicare suppliers of the technical component of advanced imaging services have until by January 1, 2012 to…
Continue Reading Advanced Imaging Suppliers To be Accredited by January 2012
In case you missed it, the Centers for Medicare and Medicaid Services (CMS) eliminated use of the evaluation and management Consultation Codes. Consultations are now to be billed using the…
According to a recent Transmittal from the Centers for Medicare and Medicaid Services, physicians and others are using modifier -PC to designate the "professional component" of diagnostic tests. However, the…
Continue Reading Use the Correct Modifier When Billing for Diagnostic Tests
On November 24, 2009, the U.S. House of Representatives passed the Medicare Physician Payment Reform Act" (H.R. 3961) which would repeal the scheduled 21% fee reduction scheduled for January 2010. The legislation…
Continue Reading Medicare Physician Fee Reform May be on the Way
Despite efforts by Senator Harry Reid to pass legislation which would have effectively frozen Medicare payment rates for physicians, it looks like Congress will once again look to freeze physician…
Continue Reading No Long Term Fix for Medicare Physician Fee Cuts
It is apparent that preventive care will take on greater importance in the "reformed " health care system and while Medicare historically did not cover routine or preventive screening services, the…
Physicians enrolling in the Medicare program should be aware that Medicare recently changed the rules applicable to when a physician’s enrollment is deemed to take effect. Specifically, the FY 2009…
Does your practice bill Medicare for diagnostic tests? If so, you have until January 1, 2009 to make sure your arrangements comply with the now very complicated anti-markup rule.
Continue Reading Changes to Medicare Anti-Markup Rules Effective January 1, 2009
The Office of Inspector General (OIG) of the Dept of Health and Human Services released its FY2009 Workplan yesterday. The Workplan outlines the initiatives and audits that the OIG expects to undertake in the coming fiscal year. Below are some of the key initiatives that the OIG expects to undertake with regard to physicians. If you or your practice is engaged in any of these activities, now would be a great time to review whether you are complying with applicable Medicare rules. If you need assistance reviewing any of your services for compliance with Medicare rules, please contact Todd Rodriguez.
Place of Service Errors
The OIG will review physician coding of place of service on Medicare Part B claims for services performed in ambulatory surgical centers (ASC) and hospital outpatient departments. The OIG will be looking to determine whether physicians properly coded the places of service on claims for services provided in ASCs and hospital outpatient departments.
Evaluation and Management Services During Global Surgery Periods
The OIG will review industry practices related to the number of evaluation and management (E&M) services provided by physicians and reimbursed as part of the global surgery fee. It will be looking determine whether industry practices related to the number of E&M services provided during the global surgery period have changed since the global surgery fee concept was developed in 1992.
Continue Reading The Office of Inspector General (OIG) Releases FY2009 Workplan
