Dear Clients,

As you know, Congress has overridden the President’s veto of H.R. 6331, the Medicare improvements for Patients and Providers Act. While much of the public and media attention was focused on the provisions rescinding the July 1, 2008 reduction in physician fee schedule payments, there were many other things in the bill that should be of interest to our clients.

Below is a brief summary of the major provisions in the bill:

Physician Services

Blocks pending cuts scheduled under the sustainable growth rate (SGR) formula through December 31, 2009; provides a 1.1% update for 2009; extends the physician quality reporting initiative (PQRI) through December 31, 2010; increases the PQRI bonus to 2.0% for 2009 and 2010. The law requires the Secretary of Health and Human Services (HHS) to provide confidential feedback to physicians regarding their resource use. Further requires the Secretary to submit a plan to Congress by May 1, 2010 regarding transition to a value-based purchasing program for physicians.

Preventive services.

Authorizes the Secretary of Health and Human Services to cover preventive services recommended by the U.S. Preventive Services Task Force. Authorizes the waiving of the beneficiary co-pay and deductible for the “Welcome to Medicare” visit. The new law also extends coverage of the Welcome to Medicare visit from the first 6 months after enrollment in Medicare to the first year after enrollment.

Equalization of co-payment rates for Medicare outpatient mental health services.

Reduces Medicare beneficiaries’ coinsurance for mental health services to the same level applied to other outpatient medical care. Transitions from current 50-50 (Medicare-patient split) to 80-20 (Medicare patient split) over a six year period. Transition begins in 2009.

Incentives for electronic prescribing

The law provides incentives for practitioners who use a qualified e-prescribing system in 2009 through 2013. The new law requires practitioners to use a qualified e-prescribing system beginning in 2011. Once the mandate is in effect, providers who fail to use an e-prescribing system will have payments reduced by up to 2%. The new law prohibits application of financial incentives and penalties to those who write prescriptions infrequently, and the new law permits the Secretary of HHS to establish a hardship exception to providers who are unable to use a qualified e-prescribing system.

Imaging Standards

The new law requires accreditation of providers of the technical component for advanced diagnostic imaging services by January 1, 2012. After 1/1/12, Medicare will not pay for advanced diagnostic imaging services unless it is provided in a accredited facility. A voluntary “demonstration program” to test the appropriateness of imaging standards is to be in place by January 1, 2010. Advanced diagnostic imaging is defined as – CT, MRI, Nuclear Medicine and PET. The legislation specifically excludes Xray, ultrasound and fluoroscopy from the definition of “advanced diagnostic imaging”. In addition, the General Accounting Office is charged with conducting a study.

Coverage for patients with chronic obstructive pulmonary disease and other conditions

Includes coverage of intensive cardiac rehabilitation programs to the Medicare program and repeals the transfer of ownership of oxygen equipment.

With the expected democrat control of the White House and Capital Hill, we can anticipate much more Medicare legislation in 2009.

Sincerely,

John Zulaski

Medical Records Fees

Illinois Sets The Maximum Fees

Fees that can be charged in Illinois for processing medical records requests are set by Illinois law. The 2008 maximum fees for records are listed below. They are set by state law and can be viewed at:

http://www.ioc.state.il.us./office/fees.cfm

When you receive a request with an appropriate authorization from the patient or guardian, we recommend that you notify the requestor of the fee and collect that fee before delivering the records. A form letter indicating the need for payment in advance (specify amount), with the patient’s name listed can be faxed back to the requestor. This fax method seems to reduce the need for time consuming telephone calls.

Flu Season Around The Corner

How Do I Code Flu Vaccinations?

The simple answer is that two codes are used to bill a flu shot for ages 3 and up, they are 90658 and G0008.

Questions and confusion about flu vaccine coding come up every fall. The reason we get so many inquiries about coding flu shots is that the procedure coding system itself is very confusing. There are currently two codes that are valid for the administration portion, 90471 and G0008. The G0008 code, however, is the more descriptive of the two codes, it is specifically for the administration of flu vaccine. HIPAA requires all payers to recognize both Level I (mostly number codes) and Level II (start with a letter) CPT codes. Additionally, our experience has been that G0008 pays the same or higher than the less descriptive 90471.

When it comes to coding, HIPAA mandates have eliminated the need for treating Medicare differently than all other plans.

Duplicate Explanations of Benefits

Why am I Getting These? Is Something Wrong?

From time to time, you may notice an increase in the number of explanations of benefits (EOB’s) that indicate “duplicate” and are not accompanied by payment. This is a normal part of the billing process. The primary cause of duplicate EOB’s is Practice Management’s approach to minimizing your aging claims. Our goal is to secure payment for you as quickly as possible. We would rather generate a few duplicates than to have any delay in your reimbursement. We use a multi-layered approach to addressing claims that have not been paid within the statutory payment deadlines. While we follow-up on individual claims, at the same time, we also re-file claims that have not been paid. This approach does generate some extra mail but it consistently increases cash in your hands. Duplicates can also be caused by the payers and clearinghouse. Both payers and clearinghouses have been known to accidentally run a claim file twice (or more), this generates additional electronic and paper mail. The “duplicate” EOB from a payer can also be valuable to us in the follow-up process. If we never received a paper or electronic EOB, the duplicate tells us that the claim has already been processed. We then research the original claim adjudication.

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