Specialty groups affected by the recent and continuing cuts for dual-energy X-ray absorptiometry (DEXA) services are mounting an intense advocacy campaign to convince Congress to restore payment rates, Part B News has learned. There are already two bills in Congress that would return DEXA payment rates to their 2006 levels, when the primary DEXA code was paid approximately $140 on average, about 60% more than the $53 it will be in 2010, says Andrew Laster MD, president of the International Society for Clinical Densitometry (ISCD) and a practicing rheumatologist.

With the permanent recovery audit contractor (RAC) program on the verge of kicking off, you can keep the attentions of your regional RAC away from your practice by voluntarily handing overpayments directly to your carrier. This strategy will also reduce your compliance risk from recent legislation, experts say. Voluntary repayment to your carrier will preempt a RAC audit for that missing money that could include time-consuming medical record requests and other administrative hassles, a health care attorney tells Part B News.  

You've probably heard the phrase "patient-centered medical home" before. It's a key part of health care reform legislation because experts say it will improve quality of care and save money (PBN 5/18/09). Implementing a patient-centered medical home will mean changes to how your practice manages patients and the flow of health information. In the next three issues, Part B News will review specific areas - management, process or workflow, and roles and responsibilities - you must address in order to accomplish a successful transition to a medical home environment.

Don't give out your account information in response to a fax you receive that purports to be from your carrier or Medicare Administrative Contractor (MAC). As this issue of Part B News goes to press, we received a warning from CMS that scammers are sending these faxes to physician practices trying to get account information.

Your practice needs to know five key takeaways from CMS's "never events" additions to its Medicare National Coverage Determinations (NCD) Manual. Three relate to a recent transmittal ordering your carrier to deny you payment for never events and two are for when CMS will pay. The agency finalized three NCDs for never events - wrong surgery performed on a patient, a surgery performed on the wrong body part and a surgery on the wrong patient - in January (PBN 2/2/09). You are required to submit claims for these instances, but you won't get paid for the service.

Our carrier's Web site states there must be at least 15 minutes of critical care time spent before we can add another 99292 ($114.69) at the end of the claim. I can't find this documented in CMS' Internet-only Manual (IOM) or a Local Coverage Determination. What should I do?

You're likely to continue having to answer patient questions and concerns regarding the spread of the H1N1 influenza virus, or swine flu. The flu virus strain is showing no sign of slowing down as the World Health Organization (WHO) raised its pandemic alert to the highest level June 11.

Last week we examined Medicare spending growth broken down by broad type-of-service categories such as imaging services and office visits (PBN 6/8/09). This chart gets more specific by looking at spending changes for E/M services. Like last week's Benchmark, all data comes from an April 2009 report by the AMA called "Estimated change in SGR spending from 2007 to 2008."

You wouldn't see the 21% cut to your Medicare payments set to take effect Jan. 1 under a House of Representatives health care reform bill that eliminates the "flawed Sustainable Growth Rate (SGR) formula." The bill, released June 9, came out of the House Ways and Means, Energy and Commerce and Education and Labor committees, who promised to pass major health care reform by August. The Tri-Committee Health Reform proposal would replace the SGR formula used to calculate Medicare payments.

You will need to check with your carrier's local coverage determinations (LCDs) for coverage instructions regarding four inhaler drug codes. The July 2009 update to the physician fee schedule includes this change and introduces three new Q codes.