Medicare may start profiling physicians as soon as mid 2008. The Government Accountability Office (GAO) recommended that the Centers for Medicare & Medicaid Services (CMS) develop a profiling system to identify physicians with inefficient practice patterns. At a House Ways and Means Subcommittee on Health hearing, Herbert Kuhn, acting deputy administrator of the CMS, said that identifying inefficient physicians, or “profiling,” would involve comparing the number of tests ordered by a physician for certain types of patients with the number ordered by colleagues in cases with the same outcome.
Contact Congress Today about Medicare Reimbursement
Changing the Medicare physician reimbursement formula so that it more accurately mirrors the cost of care is a top legislative concern for the ACR this year. The reimbursement scale is currently calculated using the sustainable growth rate (SGR), which is based on the gross domestic product and is irrelevant to medical care. The formula has steadily decreased physician reimbursement since its inception.
Medicare Quality Movement Reaches Clinicians
Physician Quality Reporting Initiative offers bonuses for clinicians and health professionals
Coding Corner Answer
May’s Coding Answer
Prior Authorization Struggle Continues
Many Medicare Part D plans continue to request prior authorizations for several drugs commonly prescribed by rheumatologists. The ACR has been working diligently with Robert Bennett of the Physician Regulatory Issues Team (PRIT) to avoid the same problems many physicians had last year. PRIT advises all physicians to write “for Part D” along with the diagnosis on the prescription, to verify that the drugs are for Part D diagnoses and should not be paid under Part B. This way the administrators of the prescription drug plans (PDPs) can waive the need for a new prior authorization—saving time and money for physicians, pharmacists, and the PDPs.
Maximize Reimbursement by Managing Denials
Could you use an additional $50,000 to $80,000 in revenue each year? If you are like most clinicians, you have superbills and well-trained office staff but you still receive frequent denials. Though some denials are appropriate, many can be corrected and the lost revenue recovered.
Medicare Switch to ASP Pricing Reduces Part B Spending
The Medicare Payment Advisory Commission (MedPAC) reported to Congress in January that Medicare’s switch to a payment method known as ASP, or Average Sale Price, has reduced spending on drugs in the Medicare Part B program. This system reflects actual market spending, rather than wholesale prices.
National Provider Identifier System Becomes Mandatory Next Month
On May 23 it will be mandatory to use your National Provider Identifier (NPI) number when billing the Centers for Medicare & Medicaid Services (CMS). Currently, you can use your PIN alone, your PIN and the new NPI, or the NPI alone—but as of May 23, only the NPI number will be accepted.
Coding Changes for 2007
Note these CPT and Healthcare Common Procedure Coding System (HCPCS) code changes…
Keep ACR at the Table
Without your help, ACR will lose its clout at the AMA