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Monday, 01 March 2010 |
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As we reported in Physician Practice Bulletin 2009-07, published on December 18, 2009, on October 5, 2009, the Centers for Medicare and Medicaid Services (CMS) expanded claim editing to include verification that the ordering/referring physician on a claim is eligible to order/refer under the Medicare program and is enrolled in Medicare. Phase 2 of this process has been further delayed until January 3, 2011. The description of the edits follows: Read full article.
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Saturday, 21 November 2009 |
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On October 1, 2009, the Office of Inspector General (OIG) released its yearly Work Plan of initiatives for federal fiscal year 2010 which began on October 1, 2009. Areas of particular interest to Physician Practices are:
1) Physician Billing for Medicare Hospice Beneficiaries: The OIG will review the extent of Part B billing for physician services provided to Medicare hospice beneficiaries. They wish to ensure that services that are covered under the Medicare hospice benefit and included in the hospice payment are not being reimbursed separately by Part B.
Read full article.
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Wednesday, 07 October 2009 |
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Different Medicare provider types are reimbursed under different payment methods. This bulletin applies to physicians and qualified non-physician practitioners submitting claims to Carriers/AB MACs.
For a seasonal flu or pneumococcal vaccination, there is an administration component and vaccine component to be billed to Medicare Part B. The administration is billed using diagnosis code V04.81 for influenza, V03.82 for pneumococcal, or V06.6 for both influenza and pneumococcal, and HCPCS Code G0008 for influenza administration and HCPCS Code G0009 for pneumococcal administration. Reimbursement is based on the Medicare Physician Fee Schedule amounts and is subject to the lower of the fee schedule amount or billed charges. If the charges are less than the fee schedule amount below, then reimbursement will be at the lower charged amount. Read full article.
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Thursday, 10 September 2009 |
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The latest regulations for physician self-referral, also known as the Stark Law, will be effective October 1, 2009. The regulations change the way office space or equipment can be rented. The law also expands the definition of “entity” in which the physician has an ownership or investment interest under Stark Law in a way that may prohibit many current "under arrangements" relationships. Read full article.
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Saturday, 25 July 2009 |
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As expected, legal action has finally come to the home care industry. A federal grand jury indicted the owners and operators of eight home health agencies in Michigan for their part in a Medicare kickback for referral scheme. With the government’s increasing vigilance in the areas of fraud and abuse, we can expect to see more such cases in the future. Read full article.
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Physician Practice 
