A key physician advisory panel wants CMS to prevent Recovery Audit Contractors (RACs) from reviewing your E/M claims and urged the agency to take steps to further limit RACs during a March 9 meeting in Washington.  

Part B News brief

This week's question is answered by Sean Weiss, vice president of DecisionHealth Professional Services.

Q. Where can I find the regulations you use to make recommendations on what a provider must include in his dictations pertaining to consults?

You need to check, double-check and triple-check claims with modifier 79 (unrelated procedure or service by the same physician during the postoperative period) because your carrier is on the look out for inappropriate use of this modifier. 

An analyst warned Congress that expanding or creating another government-funded insurance plan to cover the uninsured could put a tremendous financial burden on providers.

The creation of a public health plan to widen coverage and the changing of physician payment top the list of controversial issues that must be tackled for health reform to happen, lawmakers and experts said at an AMA conference in Washington. A slew of high-profile speakers discussed various ideas for payment reform, delivery system changes and the prospects for compromise and bipartisanship in Congress. The conclusion? Things probably won't go as planned, but some kind of reform is likely.

This chart shows the regions with the highest Medicare denial rates in 2007 and compares it with their 2006 rates. The regions are geographic practice cost index (GPCI) locations; GPCIs that billed less than 1 million claims annually were excluded from analysis. The percentage figures above the bars indicate the percent change in denial rates from 2006 to 2007. The overall trend is alarming: 80% of these GPCI regions, which already had high denial rates in 2006, saw increased denials in 2007.

Attached to your e-mailed version of Part B News is a diagnostic testing request form created by Sean Weiss CPC of DecisionHealth Professional Services. Use this form to provide medically necessary reasons that support diagnostic testing interpretations performed by your practice. 

Congress should give you and your peers a 1.1% payment update instead of the 21% pay cut, according to the latest report from the Medicare Payment Advisory Commission (MedPAC). In its March report to Congress, MedPAC also recommends that all medical drug, device and supply manufacturers be required to disclose their financial relationships with physicians and hospitals.