Industry News

MGMA issued a letter dated February 1 to HHS outlining a dozen 5010 transition issues that are clogging claims processing.

Eligible professionals (like anesthesiologists) worried about being hit by a penalty for non-participation with the Medicare e-prescribing program, take note: you may qualify for one of the new exemptions created by CMS.

The Office of Inspector General warned you and your peers on May 18 about some features of electronic health records (EHRs) that could endanger your business and lead to False Claims Act violations......

Blue Care Network announced that effective April 4, 2011, prior authorization would be required for cervical or lumbar epidural injections or facet joint injections..........

With all the conversation about ACO's and how they may impact so many aspects of medical practice, the Medical Group Managers Association (MGMA) asked the law firm of Powers, Pyles, Sutter and Verville, P.C. to prepare an analysis of the proposed ACO rules. This analysis is essential reading for anyone interested in this subject.

This article provides a brief summary of their analysis.

Some procedures, when performed with additional services or conditions, can yield from 1 to 5 additional base units.

On Friday, the Senate passed legislation via a unanimous consent agreement blocking the 21.3 percent cut to Medicare physician payments until Nov 30.  The House of Representatives must also vote on the matter and is expected to do so this week.  If this bill becomes law, medical practices will receive a 2.2 percent increase to Medicare physician payment for claims with dates of service of from June 1 through Nov. 30.

Several clients have recently asked us to clarify the documentation requirements for post-op pain. Since there seems to be some confusion in this area, we thought it would be appropriate to refresh everyone’s understanding.

In order to be reimbursed for postoperative pain management services the following must be documented in the patient’s medical record/chart by the anesthesia provider:

Per the Medicare Claims Processing Manual [Pub 100-4, Chapter 12, Section 30.6.1 (B)] the selection of the level of evaluation and management service is based upon the content of the service.   There are now new codes to represent this interpretation.

On December 11, 2009, CMS issued final revisions to the hospital interpretive guidelines that pertain to anesthesia services. While ASA is concerned that these changes may not have followed provisions in the Administrative Procedures Act and will address this issue as well as other concerns in regards to the revisions with CMS, it is important that you understand the key changes and implications.

As we work through the year it is all too easy to forget some of the basic things we know about documentation. This can be particularly costly when failing to document one or two items can have a significant impact on your reimbursement. We have put together a short “refresher” to help remind you of some of those procedures where a word or two more on your anesthesia record can yield big improvements to your bottom line.

In addition to adding an anesthesia measure (#193: Perioperative Temperature Management), CMS has introduced the concept of clusters and groups. Professional coders will know which way to code them however there are some considerations that may impact which measures you choose to report.

The Wall Street Journal today devotes an entire section (section R) to “Innovations in Delivering Health Care”. There are a number of interesting articles discussing both technology-based and process-based changes currently underway.

• Aetna: No Payment for ‘Never Events’ and Certain Other Medical Errors
• Joint Commission Alert: Effective Leadership Critical to Preventing Medical Errors
• Hospital Financial Metrics Improving: Industry Report
• HHS Issues Rule Requiring Notification of Health Information Breaches 

We asked The Health Law Partners (www.thehlp.com) to provide an overview of the RAC Program for our clients. Following is their summary:

Per Section 302 of the Tax Relief and Health Care Act of 2006, CMS’ Recovery Audit Contractor (RAC) Program was made permanent and was expanded nationwide.  This program was recently rolled out and will mean a significant increase in Medicare auditing activity for health care providers.

The Senate Health, Education, Labor and Pensions (HELP) Committee has released a comprehensive health reform bill: the “Affordable Health Choices Act.”  Committee leadership has indicated that they will begin marking up the bill next Tuesday, June 16.

From the FTC Website: ?The Federal Trade Commission will delay enforcement of the new ?Red Flags Rule? until August 1, 2009, to give creditors and financial institutions more time to develop and implement written identity theft prevention programs.

The Medical Group Management Association (MGMA) surveyed provider groups in all 50 states to determine their level of satisfaction with the 5 major carriers in their state plus Medicare.