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In this issue
House
postpones 21.2 percent cut, passes 60 day freeze
The House
of Representatives has postponed the 21.2 percent reduction to Medicare
physician payments that was scheduled to take effect Jan.1. The House
included an amendment to the 2010 Defense Department appropriations bill,
HR. 3326 that freezes Medicare payments at their current levels until Feb.
28, 2010. The bill passed by a vote of 395-34. The legislation now goes to
the Senate, where Republicans are expected to filibuster it, forcing Senate
Majority Leader Harry Reid, D- Nev, to obtain 60 votes before the bill can
be considered. This procedural hurdle will likely delay consideration of
the bill until Friday or Saturday.
In addition to this short term “bridge” mechanism, it is extremely
important to send an email
and remind your senators to immediately address the Medicare physician
payment issue.
CMS
delays instruction on date of service for diagnostic tests;
place-of-service instruction effective Jan. 1
In response
to concerns brought by the Medical Group Management Association (MGMA), the
Radiology Business Management Association and others, the Centers for
Medicare & Medicaid Services (CMS) has delayed instructions to its
contractors on the date of service (DOS) to be used for diagnostic tests.
As
reported in the Dec.
2 MGMA Washington Connexion, CMS released instructions to its
contractors on the DOS and place of service (POS) for the professional
component or interpretation (PC) and technical component (TC) of diagnostic
tests. The instructions direct CMS contractors to require the actual DOS
that the PC of a test is performed on the claim, instead of the current
policy of having the DOS of the TC serve as the date for both the PC and TC
of the test. CMS also instructs contractors to require the ZIP code of the
location where the PC was performed and provides clarifying information for
the use of various POS codes, including "home,"
"office," "ambulatory surgery center," "hospital
outpatient," "temporary lodging" and "other."
After
discussions with the agency, CMS agreed to delay the DOS instruction until
July 1. The POS instruction was not delayed and will become effective on
Jan. 4. MGMA will work with the agency on this issue to obtain the best
resolution for members. The transmittal with the updated effective date
will be available on the CMS
Web site.
CMS
eliminates consultation codes – FAQs, crosswalk and guidance available
In the final 2010
physician fee schedule, the Centers for Medicare & Medicaid
Services (CMS) eliminated the use of all consultation codes (inpatient and
office/outpatient codes for various places of service except for telehealth
consultation G-codes) on a budget-neutral basis. Instead, CMS increased the
work relative value units (RVUs) for new and established office visits, as
well as initial hospital and initial nursing facility visits.
Recently, CMS released Transmittal
1875 and MLN
Matters 6740 which provides guidance to practices on how to bill
for services for Medicare Part B patients now that consultation codes have
been eliminated. CMS announced that the modifier to distinguish the
admitting physician from other physicians who may furnish care is “-AI.”
The admitting physician should append the “-AI” modifier along with initial
visit codes to their claims while other physicians who perform initial
evaluations should only bill the appropriate evaluation and management
(E/M) code. CMS instructs providers to select the appropriate E/M codes
based on the content of services provided and not the level of documentation.
According to agency, documentation should merely support the level of
services provided. CMS advises practices to take time and/or controlling
factors into consideration when determining the level of service provided.
In this transmittal, CMS also clarifies billing procedures for:
- Observation
services;
- Inpatient
hospital care;
- Emergency
departments; and
- Nursing
facility services
Nancy
Enos, FACMPE, CPC-I, MGMA consultant, has designed a frequently asked questions
list and crosswalk pertaining to the elimination of consultation codes to
help practices implement these changes for 2010.
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Dec. 16, 2009
Member Resources
Healthcare Reform Resource
Center
Medicare Provider
Enrollment Toolkit
Red Flags Rule
Resource Center
Recovery Audit
Contractors Resource Center
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