This article pertains to Change Request (CR) 6740, which alerts physicians and non-physician practitioners that effective January 1, 2010, the Current Procedural Terminology (CPT) consultation codes (ranges 99241-99245 and 99251-99255) are no longer recognized for Medicare Part B payment. Effective for services furnished on or after January 1, 2010, physicians and non-physician practitioners should code
Medicare & Reimbursement
CMS Revises Claims Processing Manual to Eliminate Consultation Codes
By Michael Cassidy on
Posted in Medicare & Reimbursement
Effective January 1, 2010, CPT Consultation Codes ranges 99241-99245 and 99251-99255 will no longer be recognized for Medicare Part B Payment. For services furnished after January 1, 2010, physicians and non-physician practitioners should code patient evaluation and management visits with E/M codes that represent where the visit occurs and identifies the complexity. CMS has published MLN Matters…
CMS Finalizes Supervision Requirements For Hospital Outpatient Services
By Michael Cassidy on
Posted in Medicare & Reimbursement
CMS Finalizes Supervision Requirements For Hospital Outpatient Services
By Joan L. Lowes, Lori A. Wink, and Regan E. Tankersley, Hall Render Killian Heath & Lyman
The waiting is over for hospitals that have been anticipating further word from the Centers for Medicare and Medicaid Services (CMS) on the direct supervision requirements applicable to outpatient
…
Reporting Purchased Services
By Michael Cassidy on
Posted in Medicare & Reimbursement
CMS has issued MAC instructions for processing purchased services. Denials are keyed to the answer to question 20 on CMS-1500 (or ANSI X12 837P – line level PS1), which is the question regarding “Outside Lab.”
CMS 2010 Physician Fee Schedule Final Rule
By Michael Cassidy on
Posted in Medicare & Reimbursement
CMS has issued the final rule for the 2010 Physician Fee Schedule. Among other items, it implements the 21.5% reduction (pending Congressional intervention of course) and eliminates consult billing while enhancing E&M WRVUs. Link to text below. http://www.cms.hhs.gov/apps/media/press/release.asp?Counter=3539&intNumPerPage=10&checkDate=&checkKey=&srchType=1&numDays=3500&srchOpt=0&srchData=&keywordType=All&chkNewsType=1%2C+2%2C+3%2C+4%2C+5&intPage=&showAll=&pYear=&year=&desc=&cboOrder=date
Healthcare Reform: Physician Transparency and Disclosure
By Michael Cassidy on
Posted in Medicare & Reimbursement
At this point, there are three comprehensive healthcare reform bills passed by key United States Congressional Committees, i.e. the Senate Finance Committee, the Senate Health, Education, Labor and Pensions (HELP) Committee, and a consortium of House committees, referred to as the House Tri-Committee, consisting of the Energy and Commerce, Ways and Means, and Education and…
AMA Medicare Action Kit – States Where Medicare Cuts Will Decrease Physician Participation
By Michael Cassidy on
Posted in Medicare & Reimbursement
The AMA has predicted that the proposed Medicare SGR (sustainable growth rate) physician fee schedule decrease will reduce physician Medicare participation in 22 states. Log onto the Medicare Payment Action Kit and see the predicted impact in your state.
Click here for the Medicare Payment Action Kit.
AMA & MGMA Lobby for Support to Reverse the SGR Medicare Physician Cut
By Michael Cassidy on
Posted in Medicare & Reimbursement
Urgent: Call your senators and urge support of legislation repealing SGR
The Senate is scheduled to begin consideration of S. 1776, the “Medicare Physicians Fairness Act of 2009,” on Monday afternoon, Oct. 19. This just-introduced legislation eliminates the 21.5 percent cut in Medicare physician reimbursement for 2010 and repeals the sustainable growth rate (SGR)…
New Medicare Recoupment Rules Protect Providers
By Michael Cassidy on
Posted in Medicare & Reimbursement
Prior to passage of the Medicare Modernization Act of 2003 (MMA), CMS was not restricted in recouping overpayments, despite the provider’s ongoing appeal rights.
Finally, as of November 16, 2009, CMS will implement new rules required by MMA to restrict immediate recoupment. Section 1892(f) of the Social Security Act prohibits recoupment of overpayment during a supplier…
October 1, 2009: Effective Date of New Stark Rules
By Michael Cassidy on
Posted in Fraud - Stark, Medicare & Reimbursement
This is just a reminder of the effective date for certain new Stark Rules:
1. CMS prohibits percentage formulae conjunction with space on equipment leases, fair market value exception transactions and indirect compensation effective October 1, 2009.
2. Per click leases are prohibited effective October 1, 2009.
3. "Under arrangement" relationships have been changed because…