Wachler & Associates Health Law Blog

Published on: February 3, 2010

Region D RAC Approves Anesthesia Services for Review

The RAC for Region D, HealthDataInsights (HDI), recently approved “anesthesia care package” and evaluation and management services for RAC review. Specifically, HDI stated:

Under NCCI Edit rules, the anesthesia care package consists of preoperative evaluation, standard preparation and monitoring services, administration of anesthesia, and post-anesthesia recovery care. Anesthesia CPT codes 00100 to 01999 (except 01996) include Evaluation & Management (E&M) services rendered on the day before anesthesia (pre-operative day), the day of anesthesia and all post-operative days. CPT code 01996 includes E&M services rendered on the same day as the 01996 service only. Physicians can indicate that E&M services rendered during the anesthesia period are unrelated to the anesthesia procedure by submitting modifiers 24, 25, 57 and/or 59, depending on claim specific circumstances, on E&M service. Only critical care E&M services are payable during the anesthesia post-operative period. The post-operative period is defined as the day immediately following the anesthesia service and any subsequent days during the same inpatient hospital admission as for the anesthesia service.

To date, HDI is the only RAC to approve the review of anesthesia care package and E&M services, although other RACs are likely to follow. RAC Region D includes Alaska, Arizona, California, Hawaii, Iowa, Idaho, Kansas, Missouri, Montana, North Dakota, Nebraska, Nevada, Oregon, South Dakota, Utah, Washington, Wyoming, Guam, American Samoa, and Northern Marianas.

Published on: January 26, 2010

U.S District Court Dismisses Lawsuit Regarding Physician Payment Cuts to Medicare Reimbursements

by Wachler & Associates, P.C.

The U.S. District Court for the Southern District of Florida dismissed a lawsuit filed by the American College of Cardiology (ACC) against the Department of Health and Human Services (DHHS). The suit was based on the DHHS’s cuts to Medicare reimbursements for cardiology services. The ACC requested the court to block the cuts and to prevent Medicare from using the Physician Practice Information Survey (PPIS) methodology for calculating payment rates. According to the ACC, PPIS methodology does not provide an accurate picture of physician costs. In its ruling, the court stated that it dismissed the lawsuit because it did not have the authority to review Medicare claims.

This ruling will affect Medicare physicians of all specialties who may face a 21.2% fee cut as a result of the 2010 Physician Fee Schedule. Although the U.S. House of Representatives passed a bill that would prevent this 21.2% physician payment cut in November, the Senate has yet to vote on a permanent solution. For now, the House voted to temporarily suspend the cut for two months.

For more information, visit www.wachler.com or contact one of our attorneys at 248-544-0888.

Published on: January 23, 2010

OIG Fraud Alert to DME Suppliers on Telemarketing Prohibition

by Wachler & Associates, P.C.

On January 13, the Department of Health and Human Services’ Office of Inspector General (OIG) issued a special fraud alert to remind durable medical equipment (DME) suppliers that unsolicited telephone calls to Medicare beneficiaries are prohibited by federal law. The fraud alert referred specifically to instances in which independent marketing firms make unsolicited contact with Medicare beneficiaries to market the DME supplier.

The Social Security Act prohibits such unsolicited contact by a DME supplier, except in three specific situations:

(1) when the beneficiary has given express written permission to the supplier to contact him or her by phone;