News Briefs

HCFA revises CPT critical care codes

The Health Care Financing Administration (HCFA) in Baltimore has issued a program memorandum, B-99-43, that clarifies the interpretation, reporting, and payment of current procedural terminology (CPT) critical care codes 99291 and 99292.

In the American Medical Association’s (AMA’s) 2000 edition of CPT codes, the association had redefined critical care services by removing the term "unstable" from the CPT definition that was previously used to describe critically ill or injured persons. Based on the AMA’s revisions, HCFA has provided definitions to clarify the term "critical care" and has issued guidelines that can be used whenever medical review is performed in relation to critical care services.

In addition, the agency has issued guidance in determining the number of hours and days of critical care that may be billed by a provider. The program memorandum also provides a list of bundled services that are included in the critical care CPT codes. For more information, visit HCFA’s Web site at http://www.hcfa.gov/pub forms/transmit/B994360.htm.


Tool checks background, sanction reports on doctors

As a provider, you should know that an on-line company now offers consumers a means to order a license/sanction report on physicians nationwide.

DoctorDirectory.com, based in Asheville, NC, has joined with SearchPointe in Atlanta to offer this service. Users can learn about a physician’s credentials and educational background and, for less than $10, find out about disciplinary actions and sanctions taken against any medical doctor with an active license. The information offered through SearchPointe’s database of more than 650,000 physicians has been collected from private, professional, and federal agencies, as well as from the medical boards from all 50 states.

Also available to consumers is a convenient alert service that will provide notification via e-mail of any change in the license and/or sanction data on specific doctors when users purchase a sanction report.


OIG releases data for HIPAA project grantees

At the request of the Administration on Aging, the Office of the Inspector General (OIG, has continued to collect performance data for the 18 Health Insurance Portability and Accountability Act-funded (HIPAA) project grantees.

In the first 24 months on the projects, the data reveal:

• The total number of trainers increased from 8,511 to 9,781.

• The total number of beneficiaries educated more than doubled from 10,727 to 25,556.

• The total complaints received increased by half from 6,318 to 9,852.

• The total Medicare funds identified for recoupment was $1,400.

The data were self-reported and were not verified for accuracy. The OIG, however, does request documentation. Both New York and Arizona claimed savings that were not included in the report pending documentation.

For more information, see "24-Month Perfor-mance Data for the HIPAA-Funded Project Grantees" (OEI-02-97-00524) on OIG’s Web site: www.os.dhhs.gov/progrg/oei/whatsnew.html.


Ambulatory surgical centers get small increase

Medicare payments for ambulatory surgical centers will increase by $10 million, or 0.8%, to account for inflation, the Health Care Financing Administration in Baltimore announced in early February.

Services furnished on or after Oct. 1, 1999, will be paid at these rates: Group 1, $317; Group 2, $425; Group 3, $486; Group 4, $600; Group 5, $683; Group 6, $794; Group 7, $949; and Group 8, $934. The 1997 Balanced Budget Act limits inflationary increases to two percentage points below the consumer price index.


On-line program offers health-related discounts

A new on-line service is offering discounts to its members of up to 60% on health-related expenses.

Ehancedbenefits.com, based in Elk Grove Village, IL, has packaged physician visits, dental care, vision care, and prescription services, together with other services such as chiropractic care, vitamins by mail, and cosmetic surgery, into four different plans. Membership fees in the plans — CORE, COREPlus, MedCare, and OPTIMUM — start at $8 a month. A fifth plan for foreign visitors to the United States is also available.

Member discounts average between 20% and 60%, and once enrolled in a plan, members can add optional benefits such as counseling services, extended care, travel, and legal service discounts. At any time, members can log on to the Web site or call a toll-free number and find out the names and addresses of the company’s network of drug stores, eye care centers, physicians, dentists, and other providers in their area.

Anyone is eligible to become a member of ehancedbenefits.com’s program, except residents of California and Washington state. Membership eligibility extends to all family members living at the same address, including any dependents (such as college-age children) living away from home.

For more information, visit the Web site http://www.ehancedbenefits.com or call (877) EHANCED.