October 21, 2006

NYSRS HEALTH INSURANCE, COMPENSATION & CAC REPORT 

MEDICARE UPDATE

HOLD MEDICARE PAYMENT 9-22 to 9-30-06*

Congressional mandate to “freeze” all Medicare payments during this period.  'Frozen' funds should have been sent to you on 10/2/06, effectively moving payments from FY2006 to FY2007.

(Part B News, Volume 20, No. 34, September 4, 2006, p. 1)

(Interventional Procedure Coder’s Pink Sheet, Volume 2, No. 8, August, 2006)

AAA SCREENING PAYMENT AFTER 1/1/07*

CMS has authorized payment for screening abdominal aortic aneurysms with ultrasound for NEW MEDICARE PATIENTS IF the examining physician recommends this test on the basis of risk factors (e.g. family history, a 65-75 year old male who has smoked “at least 100 cigarettes in his life”), has several additional criteria and this recommendation is the result of this “Welcome to Medicare” exam and only for a limited period of time following this exam.  Recommended fee is $87 (not finalized).  Use a new “G” code for this.  See references for more detail.

(Part B News, Volume 20, No. 34, September 4, 2006, pp. 5-6)

(Interventional Procedure Coder’s Pink Sheet, Volume 2, No. 10, p 6, October, 2006)

CMS TO AUDIT IN-PATIENT TC BILLING*

CMS will audit Part B billing for the technical component (TC) of inpatients.  The audit will be both prospective and retrospective back to 2002 (CMS estimates about $20 million of overpayments during this period).

(Part B News, Volume 20, No. 36, September 18, 2006, p. 6)

16% ‘HIT” IN 2007 - ESTIMATES DAVID LEVIN, MD*

“Radiology practices could see a 16% hit next year and . . . radiologists will have to learn to operate more efficiently by seeing more patients, extending their hours, and getting new patients onto the scanner more quickly, if they want to remain profitable.”

(Part B News, Volume 20, No. 36, September 18, 2006, p. 8)

MEDICARE BILLING PRIVILEGES - ?REVOCATION*

Medicare billing privileges (for both physicians and non-physicians) are subject to revocation if the provider DOES NOT bill Medicare during a period of 12 consecutive months.

(Part B News, Volume 20, No. 37, September 25, 2006, p. 3)

CPT CHANGES FOR 2007 (i.e.76xxx to 77xxx CODES)*

        Current Code        2007 Code             Definition

        76003                     77002                     Fluoro guidance for central

                                                                      venous access device

        76360                     77012                     Computed tomography

                                                                      guidance of needle placement

(Interventional Procedure Coder’s Pink Sheet, Volume 2, No. 10, p 4, October, 2006)

MANDATORY DISCLOSURE & DATES  RE: NPI*

“. . .if a health care provider to whom you refer patients asks for your National Provider Identifier (NPI), you must disclose it.”  Although NPI can be used beginning on October 1, 2006, it is recommended that you continue to use both your NPI and Medicare PIN.  On May 23, 2007, the NPI “must be reported alone . . .”

(Part B News, Volume 20, No. 38, October 2, 2006, p. 3)

 MAMMOGRAPHY CODES*

 Use “. . . diagnosis codes V76.11 or V76.12 as the primary diagnosis codes on claims for only screening mammography . . . and I-9 codes as secondary codes for secondary diagnoses if the claim includes other services in addition to screening mammography.”

(Part B News, Volume 20, No. 38, October 2, 2006, p. 8)

*For more detailed information, recommend review of the source information, cited above.

Home Page Information:

http://www.ghimedicare.com/

http://www.umd.nycpic.com/

http://www.gao.gov

Coding 

Upstate Medicare - http://www.umd.nycpic.com/billtips.html#ICD-9-CM  and then select, ICD-9-CM Coding for Diagnostic Tests

Respectfully submitted,

Arthur J. Segal, M.D., F.A.C.R.

Chairman, Medical Insurance and Compensation Committee / NYSRS CAC Representative