Part B News

TrailBlazer: Our latest review found error rates of 50% to 90% on E/Ms

by: Grant Huang Feb 21, 2011

Can you imagine getting nine out of every 10 established E/M codes wrong -- some d/owncoded, others denied outright? That's the claim -- no pun intended -- being made by TrailBlazer (the Medicare carrier) in its most recent medical review findings. TrailBlazer uncovered average error rates of between 50% and 90% across a total of 200 claims, randomly chosen from multiple practices in all of its covered states.

Obama's proposed 2012 budget includes 2-year pay fix

by: Grant Huang Feb 15, 2011

Just in time for Valentine's Day, President Obama's proposed 2012 budget was unveiled Feb. 14 and includes a two-year physician payment fix that freezes the 25% cut called for by the Sustainable Growth Rate (SGR). The two years are theoretically fully paid for by savings that HHS/CMS expects to reap from Medicare and Medicaid. These expected savings come from two sources: payments recovered by federal fraud and abuse efforts, and better prices on drugs purchased by the Medicare and Medicaid programs.

CMS: MA plans see lower premiums, higher enrollment

by: Grant Huang Feb 14, 2011

Medicare Advantage (MA) plans have actually seen increased enrollment and lower premiums, according to the latest data from CMS. Agency chief Donald Berwick MD touted the news during his Feb. 10 testimony to the House Ways and Means Committee. The data shows that, on average, premiums have fallen 6% while enrollment numbers have increased by 6%, to a total of more than 12 million MA beneficiaries.

Help get rid of burdensome federal regulations

by: Charles Fiegl Feb 10, 2011

Politicians from President Barack Obama to House Republicans want to get rid of burdensome federal regulations. Eliminating regs (including rules about salmon or r ed meat) is a hot topic in Washington.

Lawmakers have solicited input from various stakeholders and groups. The AMA has responded by creating a new survey to funnel physician input on how federal rules impact their practices.

CMS chief gets warm reception at AMA conference

by: Grant Huang Feb 10, 2011

I listened to CMS Administrator Donald Berwick, MD, give a speech on the Medicare physician pay fix and the future of the payment model earlier this week at the AMA's annual advocacy conference in downtown Washington. Before a crowd of physicians, Dr. Berwick -- a former pediatrician -- said he was "committed" to a permanent sustainable growth rate (SGR) fix. While this earned the expected applause, Dr. Berwick spent much more time discussing a dramatic overhaul of the Medicare fee-for-service system, a major change that he painted as being inevitable.

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