With more than 1,500 staff members throughout the United States, the Office of Inspector General (OIG) plans and performs audits, evaluations, investigations, and legal activities pertaining to the Department of Health and Human Services (HHS). With the issuance of the 2010 OIG Work Plan, there are a variety of interesting Medicare issues that they will evaluate pertaining to Medicare physicians and other health-care providers. This may be a good opportunity to evaluate compliance in your practice with respect to the following Part B subjects that are in the work plan. The following is a list of what I think are some of the “hottest” subjects targeted in the plan:
1. Place-of-Services (POS)
The OIG will be reviewing physician coding of POS on claims for service performed in ambulatory surgical centers (ASCs) and hospital outpatient departments. Federal regulations provide for different levels of payments to physicians depending on where their services are performed. Medicare pays the physician a higher amount when the service is performed in a non-facility setting, such as a physician office, than it does when the service is performed in a hospital outpatient department or an ASC. Therefore, the OIG will be evaluating whether physicians properly coded the POS on claims for services provided in these outpatient settings.
2. Physician Billing for Hospice Beneficiaries
The agency will review the extent of Part B billing for physician services provided to Medicare hospice beneficiaries. The Medicare regulations list the physician services that are already covered by Medicare under the Hospice Benefit. Federal regulations provide that for physicians employed by or in an arrangement with a hospice, payments for certain services are reimbursed to the hospice as part of the hospice payment, while other services are paid to the hospice under the Part B Physician Fee Schedule.

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As President Obama’s campaign for health-care reform continues to take center-stage in the news, there has been increased focus on how technology improves overall care. Namely, the administration’s American Recovery and Reinvestment Act encourages greater use of health-information technology through new investments. 
With incentive payments to physicians and hospitals, funding from the Recovery Act will accelerate the adoption of health-information technology and the creation of a nationwide network. Health-insurance reform will then build on this investment by simplifying and streamlining administrative procedures and improving the quality of health care.
Programs designed to reduce erroneous paperwork, improve the accuracy of medical records, and convert hand-written information to electronic data has undoubtedly made its way to the top of the health-care agenda, with positive results supported by the U.S. Department of Health and Human Services.   Nevertheless, despite all the news that information technology is making on the frontlines, what people are not hearing about is how vital automation and streamlining can be on the back-end of operations.   
Redundant administrative complexity is costly in time and money to physicians and by extension, to patients. According to a study performed by the Medical Group Management Association, the estimated annual cost of administrative tasks including billing, payment processing, and credentialing for a 10-physician medical group was almost $250,000 in 2004. There has been an increase in health-care payers, forms and procedures, making practice managers feel added pressure to complete these outmoded, but important, administrative duties more quickly, and leaving an escalated margin for human error.

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There were two cases involving treatment provided to the wrong patient. In the first case, a board-certified internist and nephrologist from Ft. Myers was disciplined after performing on and treating the wrong patient. The doctor was asked to evaluate a patient to determine whether she needed plasmaphoresis. He walked into the room adjacent to the patient’s room, and examined the wrong patient.
The complaint alleges the doctor did not adequately review the patient’s chart before, during or after the examination. He requested a Quinton catheter for the patient, which was inserted, and ordered plamaphoresis for the patient. The following day, a nurse asked about the consultation, and the doctor realized he had examined the wrong patient. He removed the catheter, and cancelled the plasmaphoresis. The doctor was fined $5000, given a letter of concern, and required to complete 50 hours of community service, five hours of CME and a lecture on wrong site surgeries.
In the second case, a physician from St. Petersburg was disciplined after inserting a central venous catheter on the wrong patient. After being asked by a physician to insert a catheter on a patient, the doctor asked a nurse where the patient was. She indicated the patient was on the sixth floor, and the doctor went to that floor, where he found a patient with the same primary care physician. He assumed the name he had been given was incorrect, and did not look at the patient’s chart. The correct patient was on the same floor, but in a different wing of the hospital.
The doctor discussed the procedure with the patient and the patient’s family, and obtained consent for the procedure. Later, a nurse noted the patient had a central venous catheter, although one had not been ordered, and notified the patient’ s physician. The doctor was charged with performing an unnecessary procedure on a patient, as well as failing to comply with the “pause” rule before doing the procedure. He was fined $10,000, given a letter of concern, required to complete 50 hours of community service, five hours of CME, and to give a lecture on wrong procedures.

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Despite a struggling economy, Total Medical Solutions projects continued growth as the privately held company focuses on its core market—handling home care, equipment, and home modification needs for catastrophic workers’ compensation cases—and expanding its private-pay home assessment and modification business.
“It’s been a great niche for us,” said Cara Barde, president of Total Medical Solutions of Sanford. “Even though workers’ compensation accidents in general have been going down, because people are better with their safety, the amount of permanent disabilities, people never going back to work, have been rising the last few years. The big cases are still out there, and those can be millions of dollars for the insurance carrier.”
A July 2009 report from NCCI Holdings indicates that permanent total claims have risen the last four years, likely due to an aging workforce, with more workers age 50 or older. Permanent, total claims comprise less than 1% of lost-time claims but account for approximately 10% of costs.
Inc. magazine named Total Medical Solutions one of the country’s 5,000 fastest growing companies, ranking 2,705th. Annual sales increased 433% from 2003, when Barde’s family purchased the business, until 2008, when revenue exceeded $16.3 million.
Barde anticipates the company will earn $18 million in revenue this year, still growing but not as quickly as in the past. She attributes the growth to a concerted sales effort, expanding services beyond Central Florida, and focusing on patients with complex injuries.

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Although many experts expressed concern last year about the CMS anti-markup regulations, which went into effect in January, the rules seem not to have a major impact on practices.
“It’s had little impact so far on most physician practices,” said attorney Tom Greeson, a partner with Reed Smith in Falls Church, Va., speaking on behalf of the Radiology Business Management Association. “The anti-markup rule will not have significant impact for a couple of years.”
To begin with, the rule only applies to practices that self-refer, such as an orthopaedic practice with a magnetic resonance imaging machine or an oncologist with a PET scanner. The anti-markup provision applies to the technical and professional components of diagnostic tests that are ordered by the billing physician or other supplier, when the technical component is purchased outright, or not performed in the office of the billing physician.
Cardiologist Mark Barrow, MD, of Gainesville, said the anti-markup regulation has not affected his practice, which includes North Florida Imaging, a mobile ultrasound provider. Neither has David Epstein, MD, of Hollywood, speaking for the Florida Radiological Society, heard much feedback about it.

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This past year has been a year of both challenges and change for the ambulatory surgery center (ASC) industry. However, with the impending rebound of the economy and numerous industry developments, the ASC industry is poised to perform well in 2010. This article highlights the most important of these developments and provides some insight into what can be expected in 2010.
2009 At A Glance
On the individual ASC level, in spite of a slight decrease in demand, ASC profits have grown as a result of:
the movement into the ASC of procedures historically required to be performed in the hospital setting (e.g., vascular access and broader array of orthopedic procedures),
an active physician re-syndication market, and
ASC transactions in which the revenue from multiple facilities is consolidated into a single facility.
Even with these enhanced profits, ASCs continue to struggle with physician partnership and physician “deadweight” issues.
With respect to the sale of a significant equity stake to a corporate buyer, a few historical ASC management companies have slowed down their acquisition strategy due at least in part to the credit crunch. New corporate ASC buyers, however, have emerged, including health systems and private equity-backed buyers. Meanwhile, the terms and pricing associated with a sale of a significant equity stake in an ASC have clearly changed.
From a revenue perspective, ASCs and their physician investors are increasingly looking to capture ancillary revenue streams, such as anesthesia, pathology, and imaging. On the other end of the spectrum, payors continue to consider strategies to attack the substantially higher “out-of-network” reimbursement that many ASCs have been receiving for quite some time. And everyone is focused on how the impending overhaul to the health system will impact ASCs.
Sale of Equity Interest to Physicians
Physician re-syndications (i.e., sale of equity interests to physicians) remain very active for a number of reasons. First, ASC companies and physician owners of ASCs often desire to solidify physician utilizers’ relationships to their ASC by having them purchase equity interests. Second, a number of ASCs are reselling equity that was repurchased from prior physician


* For the complete story, call our Circulation Department at 800-327-3736 ext. 137