Posts Tagged ‘reimbursement’

Health insurers will soon have a new, independent database to use for determining out-of-network payment rates for physicians. Not-for-profit company FAIR Health Inc. and an Upstate New York research network headquartered at Syracuse University are charged with the task of developing the new database. Read more »

Confused about the Evaluation and Management Consultation codes in CPT® 2010 (99241-99255)?  Didn’t Medicare just say that, save for HCPCS Level II codes for telehealth consultation, they were out the window? (See “2010 MPFS Final Rule Still Holds Surprises,” EdgeBlast No. 136.) So why are they in the official CPT® code book? Is it a mistake, and if not, does that mean commercial payers are reimbursing for them?

It’s no mistake, says Sheri Bernard, CPC, CPC-H, CPC-P, vice president, clinical coding communications, AAPC. “The codes remain in CPT® 2010 with expanded official guidelines that iden­tify scenarios that in the past would not have been consid­ered consultations,” according to Bernard. 

Check with payers to whom you report these codes to find out if they are reimbursing them and for what services specifically. Unfortunately, at this point no one really knows what all the payers will think of these codes now.

AAPC former NAB member Barbara Cobuzzi, MBA, CPC, CENTC, CPC-H, CPC-P, CPC-I, CHCC, is asking colleagues to contact her with what payers in their states say they will accept come Jan. 1, 2010. She will compile the data into a spreadsheet and make it available via the AAPC Web site.

If you’d like to contribute information to this project, and help Cobuzzi clear the confusion with her grass-roots project, send what you’ve learned about payers in your area to her in an e-mail (b.cobuzzi@att.net).

The Centers for Medicare & Medicaid Services (CMS) began accepting bids for the Round One Rebid of the Medicare Competitive Bidding Program for durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) on Oct. 21. Qualified DME suppliers in nine areas have until Dec. 21 to submit bids.

Registration to participate in the Round One Rebid is nearing an end. Suppliers that wish to submit bids must be registered by Nov. 4, 9 p.m. EST.

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If, in fact, Medicare rates for physician services are inaccurate, how might the system be improved? The Medicare Payment Advisory Commission (MedPAC) met earlier this month to answer that very question. In November, the Centers for Medicare & Medicaid Services (CMS) will look at how relative values units (RVUs) are determined during a key process known as the five-year review, which will include a public comment period.

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The Centers for Medicare & Medicaid Services (CMS) issued, Oct. 7, a correction document to the 2010 Inpatient Prospective Payment System (IPPS) for acute care hospitals and Long Term Care Hospital Prospective Payment System (LTCH PPS) final rule. Make hospital billing staff aware of these corrections, which include changes to important compliance dates and payment rates. Read more »

It is important to make sure you are getting reimbursed appropriately for your colonoscopy services. This article by the AAPC’s Sheri Poe Bernard, CPC, CPC-H, CPC-P, provides tips and documentation suggestions for ensuring proper reimbursement for colonoscopy services.

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The AAPC is learning more about how the American Recovery and Reinvestment Act signed by President Barak Obama Tuesday will affect your workplace and your job. Under the $787 billion economic stimulus bill, health care providers will receive financial incentives beginning 2011 for implementing qualified electronic health records systems (EHRs).

Physicians, facilities, and other providers will receive money through Medicare or Medicaid programs for their “meaningful use” of EHRs. Payments are structured to encourage early adoption and penalties discourage procrastination.

“Meaningful use” is not specifically defined in the bill, but it gives the Secretary of Health and Human Services (HHS) — still to be named — advisory guidance regarding how to determine this. HHS is required to develop and publish universal standards for EHR systems by the end of 2010. EHR vendors will seek certification for meeting these standards, and any provider using a certified EHR system will be eligible for incentive payments. Read more »

Some argue that peripheral nerve blocks (PNBs) have too many setbacks to make them a viable option for post-operative pain management. Others disagree. Brian Williams, MD, and Steven Orebaugh, MD, take a stab at “Dispelling 8 Peripheral Nerve Block Myths,” in the January 2009 online edition of Outpatient Surgery magazine. The article refers to another informative article, “The Economics of Peripheral Nerve Blocks,” featured in the March 2008 online edition of Outpatient Surgery.

Many physicians battle with how to remain devoted and compassionate to patients when faced with HMO paperwork, long days, and receiving less money for services. Some primary care physicians are opting into early retirement and switching to specialized care due to poor reimbursement, increased regulations, time constraints, and low morale in the primary care setting.

A recent survey shows why many doctors are looking to other professions. Listen to Dr. Sidney Spiesel and surveyed physicians talk about their frustrations and coping mechanisms on NPR Audio News Clip.

Providers and suppliers of ambulance services can expect a 5 percent inflation adjustment in their 2009 Medicare reimbursements, compared to 2.7 percent in 2008.

You only have until Dec. 31, however, to collect the 25 percent per mile bonus payment for ground ambulance trips 51 miles or greater. Medicare has paid the 25 percent increase in addition to the existing per mile reimbursement rate since July 1, 2004, but the party ends on New Year’s Eve.

For more information about the ground ambulance base rate, go to the Centers for Medicare & Medicaid Services’ (CMS) Web site and read transmittal R1607CP or MLN Matters article MM6113.