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Medicare Update
January, 2001
Richard A. Feely, DO, FAAO, FCA
Carrier Advisory Committee for Illinois
Medicare Part B meeting occurred January 24, 2001 in the Chicago Medical
Society building. Our discussion included advanced beneficiary
notification bulletin and it should be used in all cases when the
physician is unsure that a service is covered based upon the patient’s
medical condition or status. If you are certain that Medicare does not
cover a service, then you really do not need an ABN at that time. The
states of Illinois, Michigan, Wisconsin, and Minnesota are consolidating
and will try to have a uniform consistency of Medicare and local policy
throughout the four state areas.
Open public meetings are occurring with
Admina Star Federal Incorporated, which is Medicare Part A carrier
headquartered in Indianapolis, Indiana. Medicare Part B will be having
open public meetings for proposed policy changes for the public, as well
as providers, and manufacturers may comment by WPS.
WPS will have policy changes listed on
their web site and will develop a chat room/bulletin board where the
public can make comments. Medicare B Bulletin published by WPS will have
changes in their descriptive codes that will be less descriptive and
will refer you back to the CPT manual. All national policies will be
published on the WPS website.
Medicare is paying for medical research
trials but all trials must be in approved research and related areas of
listed covered benefits to Medicare beneficiaries.
A list of the number of denial services
from October 1, 1999 to December 31, 1999 was distributed. The most
pressing problem that occurred was improper coding. The top denial was
identifier 50 which lists the service and procedure as a non-covered
service or because it was not medically necessary. It is incumbent upon
physicians to provide the correct codable diagnosis for each lab and
radiological testing procedure to the lab or radiological site. Without
the correct diagnosis code, labs and radiological tests are not
reimbursable.
HCFA has started December 1, 2000, to
change local rules regarding Medicare appeals processing. Illinois has a
successful appeal process, but HCFA that are complex in nature, which is
defined as anything requiring paper, must be written and mailed not
faxed to WPS for administrative level 1 review and appeals.
Regarding ambulances, the OIG and HCFA
are in the process of examining ambulance charges and it is incumbent
upon the physician to write orders for a non-emergency ambulance trip.
Without an order for a non-emergency trip, the ambulance company is
denying payment.
The new fee schedule for Medicare was
published in January 2001. Observation care codes for hospitalization
patients are changing. The initial observation code is used for the
first 8 hours only. Another area that WPS is looking into is to identify
why 90% of cardiac ECHO’s are denied. Dr. Messer the chairman and a
cardiologist for the Care Advisory Committee along with WPS will
investigate this, to identify why ECHO’s are denied at such a high
rate.
Next Carrier Advisory Committee will
meet in April 2001. Policy discussion and three local policies were
presented. They are 1.) bilaminate skin substitute, 2.) anesthesia
services and a teaching facility, 3.) supervising physician, and
teaching settings. The anesthesia services, supervising physician, and
teaching settings are 90% national mandate language. The Illinois
Anesthesia Society found no problems with the anesthesia policy. The
supervising physician and teaching settings has been in existence for a
number of years and was brought up for general discussion.
Sincerely,
Richard A. Feely, D.O., FAAO, FCA |
