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Hello,
In
this issue
MGMA
requests your input on payer performance
The
Medical Group Management Association (MGMA) is conducting its second annual
poll to determine group practice professionals' perceptions of interactions
with health insurers. Last year, MGMA used state-specific
findings from the payer study to provide group practices with
comparative payer information and support our advocacy efforts with payers.
This
year’s questionnaire focuses on large payers, as we seek to understand your
views on the national environment. Some insurers have implemented new
programs over the past year, so it’s important to respond in a manner that
reflects your current perception of payer performance.
Participate
in the questionnaire
now.
OIG
audit concludes unqualified professionals provide 21 percent of services
billed as “incident to”
The
Office of Inspector General (OIG) for the Department of Health & Human
Services released a report examining Medicare billing practices when
nonphysician providers seek reimbursement for services incident to a
physician’s care. The report, “Prevalence
and Qualifications of Nonphysicians Who Performed Medicare Physician
Services,” included disturbing findings. Most startling was the
revelation that unqualified nonphysicians provided 21 percent of physician
services — nonphysicians who did not possess the necessary licenses
or certifications, had no verifiable certifications or lacked the training
to perform the service. In addition, 7 percent of invasive services not
performed by physicians were performed by nonphysicians with inappropriate
qualifications.
As a
result of these alarming findings, the OIG made three recommendations to
the Centers for Medicare & Medicaid Services (CMS):
- Seek revisions to the “incident to” rule. It should
require that physicians who do not personally perform the services they
bill to Medicare guarantee that the services are performed only by other
licensed physicians or nonphysicians who have the necessary training,
certification and/or licensure, pursuant to state laws, state regulations
and Medicare regulations working under the direct supervision of a licensed
physician.
- Require physicians who bill services to
Medicare that they do not personally perform to identify the services on
their Medicare claims by using a service code modifier. The modifier would
allow CMS to monitor claims to ensure that physicians bill for services
performed by nonphysicians with appropriate qualifications.
- Take appropriate action to address claims for
services that were billed by physicians and performed by nonphysicians as
incident to services, but that were not by definition incident to services
or were for rehabilitation therapy services performed by nonphysicians who
did not have therapist training. Such actions could include instructions to
Medicare contractors to increase their audits of services that might be
billed as incident to.
To
prepare your practice for compliance with the incident to rules, we
have engaged experts in physician reimbursement to lead a member-focused,
interactive, 90-minute Webinar. Robert
J. Saner II, Esq. and Rebecca L. Burke, Esq. will help you understand these
difficult rules during "OIG
targets ‘incident to’ claims – are you billing correctly?"
Recovery Audit Contractors begin their
work
The
Medicare Recovery Audit Contractors (RACs) have initiated automatic
audits for U.S. regions C and D.
The contractor
for Region C, Connolly
Consulting Associates Inc., is targeting eight issues for Florida and South
Carolina providers in outpatient and physician office settings.
HealthDataInsights
Inc, the contractor for Region D, is conducting automated reviews for
seven issues affecting codes billed since Oct. 1, 2007, by providers in
outpatient and physician office settings. Region D encompasses Alaska,
Arizona, California, South Dakota, North Dakota, Hawaii, Idaho, Iowa, Kansas,
Missouri, Montana, Nebraska, Nevada, Oregon, Utah, Washington and
Wyoming.
Visit
the MGMA Recovery
Audit Contractors (RAC) Resource Center to learn more about the
RACs and when audits begin in your state. View RAC contractor-specific
information, including links to contractors’ Web sites, sample letters
and approved issues.
Prepare
your practice for the RACs by ordering a MGMA on-demand Webinar.
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