HHS targets nonphysician coverage, duplicate billing
The Department of Health and Human Services’ Office of Inspector General (OIG) has recommended that the Centers for Medicare and Medicaid Services (CMS) investigate why it did not detect potential duplicate payments to individual carriers. One report (OEI-03-00-00091) found approximately $2.25 million in potential duplicate payments involving 15 procedure codes. The OIG also recommends that CMS implement corrective edits to detect and reject inappropriate services.
In another report (OEI-02-00-00290), the OIG says carriers do not have sufficient guidance to distinguish which nonphysician practitioner services should be reimbursed by Medicare. It plans to monitor nonphysician practitioner services for both overall trends and for complex services in consideration of additional payment controls.
ASHRM provides help with patient safety standards
The American Hospital Association’s American Society for Healthcare Risk Management is offering hospitals a tool to help them adjust to the Joint Commission on Accreditation of Healthcare Organizations’ new Patient Safety Standards, which took effect July 1. "Perspective on Disclosure of Unanticipated Outcome Information" is meant to educate health care professionals on the many issues surrounding how hospitals disclose outcome information to patients and families. It also helps hospitals develop and implement a policy on disclosure. The paper examines various issues including ethical and legal contexts for withholding information from a patient, the use of bioethics consultations, and the importance of continual communication with patients and family members. For more information, visit the web site www.ashrm.org/asp/highlights/topics.asp.
Medicare covers treatment of sun-induced skin lesions
The Centers for Medicare and Medicaid Services announced that it would expand Medicare coverage nationally for the treatment of common sun-induced skin lesions, known as actinic keratoses, which can develop into skin cancer. The decision establishes a national Medicare coverage policy for removing the lesions without restrictions based on lesion or patient characteristics. Previously, some Medicare claims-processing contractors had established local policies that restricted coverage to specific lesion types (such as those located on specific parts of the body) or in certain patients (such as those with a prior history of skin cancer).
More information on the national coverage decision is available at www.hcfa.gov/coverage/8b3-t.htm.
Medicare expands its preventive services
As of July 1, Medicare began offering expanded coverage for screening tests for breast, cervical, and colorectal cancers. And, starting on Jan. 1, 2002, Medicare will cover an annual glaucoma screening test and medical nutrition therapy by registered dietitians for people with diabetes and renal disease.
The extended coverage results from the Beneficiary Improvements and Protections Act (BIPA) enacted by Congress in December 2000. The legislation calls for the Centers for Medicare and Medicaid Services to phase in specific coverage for certain tests and therapies that can detect diseases early.
The preventive services include:
— effective July 1, 2001, a Pap test and pelvic exam every two years instead of every three for women not at high risk for uterine or vaginal cancers;
— effective July 1, 2001, a screening colonoscopy every 10 years for people not at high risk for colorectal cancer;
— effective Jan. 1, 2002, an annual glaucoma screening for people at high risk, a family history of the disease, or with diabetes;
— effective Jan. 1, 2002, medical nutrition therapy by registered dietitians or other qualified nutrition professionals for people with diabetes, chronic renal disease and post-transplant patients.
Other preventive services now covered by Medicare include:
— four types of colorectal cancer screening tests, including a yearly take-home fecal-occult blood test; a flexible sigmoidoscopy every four years; a colonoscopy every two years for high-risk individuals, or a barium enema as an alternative to the colonoscopy or sigmoidoscopy;
— a baseline mammogram for women with Medicare ages 35 to 39 or an annual mammogram for women with Medicare ages 40 and older;
— bone mass measurements for people at risk for osteoporosis;
— prostate cancer screening exams for men with Medicare aged 50 and older (these exams include a digital rectal exam and a prostate specific antigen test annually);
— a flu shot each season;
— a pneumonia shot if needed;
— a hepatitis B shot for people with medium to high risk for hepatitis.
• Change: The New Constant is the theme of the 11th Annual Conference on Managed Care sponsored by the Healthcare Financial Management Association in Westchester, IL. The conference will be held Sept. 23-25. For more information, visit the Web site www.hfma-mgdcare.org or call (800) 252-4362.