January 18, 2012
Documentation Reviews before Payment
Washington -- High
error rates on claims for certain hospital services has led the Medicare
contractor covering Florida to propose withholding payment for certain
cardiology and orthopedic procedures until the payer has had the chance to
review physician documentation.
The Medicare contractor First Coast Service
Options has targeted 11 cardiology and four orthopedic surgeries for prepayment
review. First Coast singled out procedures that were determined to have high
error rates during postpayment audits. For instance, a sample of claims for
permanent cardiac pacemaker implantation procedures did not meet Medicare
national coverage decision criteria during a recent comprehensive error rate
Discounts Available for February Course in Phoenix! Three
ASIPP is offering three
different courses in one warm, wonderful, and scenic location! Join us on
February 24 at the beautiful Hilton Pointe Squaw Peak Resort in Phoenix,
The course choices are:
Comprehensive Review Course and Cadaver Workshop with basic, intermediate, and
ABIPP preparation (advanced) levels; Coding, Compliance and Practice Management
Comprehensive Review Course (Feb 24-25) Competency Examination - (Feb 26); and
Controlled Substance Management Comprehensive Review Course - (Feb 24-25)
Competency Examination - (Feb 26)
Take this opportunity to
not only break away from the cold but also earn CMEs. Consider comimg early or
staying over. Bring your family and stay and play! Registration and Room Rate
Discounts are available through February 2.
Brochure and Registration for Review Course and Cadaver Workshop
Coding, Complinace, and
Practice Management brochure and registration
Management brochure and registration
|Physicians Can Find
Themselves in the Middle of Medical Guideline Debates
Scenario: How do we
explain conflicting screening guidelines?
The U.S. Preventive
Services Screening Task Force, specialty societies and disease advocacy groups
promulgate guidelines for prevention of illness and disease. Sometimes screening
recommendations from different groups -- for the same condition -- are not in
Consider two patient
questions. The first patient is a 46-year-old woman coming to see you for a
routine visit. Last year she had a mammogram. She has no family history of
breast cancer. Based upon the U.S. Preventive Services Screening Task Force, you
recommend waiting until she turns 50 before starting yearly mammograms.
|Time to Get Informed on
If you missed the live
Coding Webinar it's not to late to purchase the archived version. This is your
opportunity to get informed on your own timeschedule.
Experience the same great
discussion, powerpoint presentation, and printable materials as the webinar
attendees did all on your own time.
Coding is critical to your practice and there
are new changes you need to know about. Once you purchase, you can watch it
anytime, anywhere, as often as you want.
|Small and Midsize Practices
Planning Tablet Computer Buying Spree
At least one survey
indicates that physicians' personal embrace of tablet computers is translating
into a professional embrace -- one that could put small offices at the forefront
in the latest wave of health information technology.
A survey by the market
research firm NPD Group found that 76% of small to medium-sized physician and
dental practices said they plan to buy tablets in the next 12 months and spend
an average of $6,800. The findings were part of a survey of 500 businesses with
fewer than 1,000 employees across all industry sectors.
|Opinion: Possible Side
Effects of Health System Reform
The provisions of the
national health system reform law are only part of the puzzle. Exactly how those
provisions are implemented will affect whether reform is considered a success.
American Medical News has investigated some lesser-known aspects of reform that
might surprise those who think they know how it will roll out.
Health reform after
2014: Not-so-universal coverage
Roughly 30 million people are expected to
gain health coverage under the reform law's provisions, but that would still
leave about 20 million uninsured, whether by choice or by circumstance.
|Physician Employment Up by
32% at Hospitals Over Past Decade
Physician employment has grown by 32 percent
over the past 10 years. Hospitals today are employing roughly 212,000 physicians
- or 20 percent of the practicing physician workforce - according to the AHA
Hospital Statistics 2012 Edition.
Employment varies by region, with 56 percent of
New England physicians reportedly employed or under contract compared to 29
percent in the West South Central Region. This variation is largely due to state
corporate practice of medicine laws, such as those in Texas and California,
which prohibit the employment of physicians.
|CMS Corrects 2012 Medicare
CMS has corrected the
2012 ASC payment rates published in November by the agency, according to an ASCA
The corrections fix
technical errors in how the costs of certain procedures were determined. The
payment rates for some procedures have changed significantly, with a comparison
from ASCA available here. Most of the corrections have little effect on 2012
rates, according to the report.
|Doctors vs. Obamacare: Can
your Physician Simply 'Opt-Out'?
SAN DIEGO, January 17,
2012 -- The destruction of quality in the American medical system will not
result from one isolated event. Neither the 'Affordable Care Act', its
restricted pay to physicians, nor even rationed care will immediately tip the
scales toward a subpar medical system. Rather, the turn for the worse will take
effect as several pieces of the Obamacare puzzle are set into motion over the
next few years.
One piece of this puzzle
likely to work against the success of Obamacare will be the creation of local
managed care 'medical homes' called 'Accountable Care Organizations' or ACOs.
These little fifedoms controlled by local medical community powerbrokers will
pit physician against physician, with only hospital administrators and local
medical society 'leaders' profiting above the fray.
|Small Medical Practices
Greatly at Risk for Data Breaches
Data breach experts are
issuing a warning to small practices -- don't be the vulnerable target that data
thieves assume you are.
Kroll Fraud Solution's Top
Cyber Security Trends for 2012 reported that small practices are more
susceptible to security vulnerabilities because they are "the path of least
resistance." Many rely on outdated technology. Basic security protections, such
as proper use of encryption, often are overlooked as practices focus on meeting
regulatory requirements, such as those related to meaningful use.
|MedPAC Recommends 1% Pay
Hike for Hospitals
The Medicare Payment
Advisory Commission (MedPAC) on Thursday recommended that Congress increase
hospital inpatient and outpatient care payments by 1% in fiscal year (FY)
The panel voted 16-1 to
draft recommendations for the coming fiscal year. In addition, MedPAC voted
14-2 to recommend reducing payments for evaluation and management visits in
hospital outpatient departments to the rate of free-standing physicians' offices
across three years.
"Over time, Medicare needs
to move toward paying the same amount for the same service regardless of the
provider type," said MedPAC Chair Glenn Hackbarth. Hackbarth noted that the
recommendations are not intended to discourage hospital-physician
|States File Brief Opposing
ACA's Medicaid Expansion
WASHINGTON -- The
Affordable Care Act's Medicaid expansion is "coercive" and "transforms the basic
nature" of the insurance program for the poor, according to a brief filed with
the Supreme Court by 26 states.
Requiring states to lower
the eligibility requirements for Medicaid and to ensure that all Medicaid plans
meet certain minimum requirements is an overreach of the federal government's
power, the states argued in the brief filed Tuesday.
|Miami-Area Resident Pleads
Guilty to Participating in $200 Million Medicare Fraud
WASHINGTON - A
Miami-area resident pleaded guilty today in U.S. District Court in Miami for her
role in a Medicare fraud scheme that resulted in the submission of more than
$200 million in fraudulent claims to Medicare, announced the Department of
Justice, the FBI and the Department of Health and Human Services (HHS).
Sandra Jimenez, 38,
admitted to participating in a fraud scheme that was orchestrated by the owners
and operators of American Therapeutic Corporation (ATC); its management company,
Medlink Professional Management Group Inc.; and the American Sleep Institute
(ASI). ATC, Medlink and ASI were all Florida corporations headquartered in
Miami. ATC operated purported partial hospitalization programs (PHPs) - a form
of intensive treatment for severe mental illness - in seven different locations
throughout South Florida and Orlando. ASI purported to provide diagnostic sleep
Jimenez pleaded guilty to
one count of conspiracy to commit health care fraud and one count of conspiracy
to defraud the United States and to pay and receive illegal health care
kickbacks. Jimenez was charged in an indictment unsealed on Feb. 15, 2011, in
the Southern District of Florida.
FSIPP Annual Meeting Dates May 18-20,
The Florida Society of Interventional Pain
Physicians has set the date for their next annual meeting for May 18-20, 2012 at
the Gaylord Palms, Orlando, FL.
Read more about the meeting and other activities
going on in the state of Florida in their newsletter. Click HERE to read latest issue.
For a complete look at the May meeting schedule
and CME information, click HERE
CASIPP Annual Meeting Dates Nov. 9-11,
The California Society of Interventional
Pain Physicians Annual Meeting of the will be Nov. 9 -11, 2012 at the Pelican
Hill Resort in Newport Beach, CA.
Go to www.casipp.com for more information.
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American Society of Interventional Pain Physicians ®
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Phone 270.554.9412, Fax 270.554.5394