E/M Coding Alert - 2007 Issue 16
REIMBURSEMENT: Could Your Practice Survive Wtih 40 Percent Less Cash?
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Article Overview
This article reviews a Practicing Physicians Advisory Council discussion of Medicare payment policy and contractor operations. It focuses on broad reimbursement concerns, claims processing timing, audit and appeal issues, contractor transparency, volunteer and military physician billing questions, and oversight expectations for Medicare Administrative Contractors. It is relevant to physicians, practice managers, coders, and reimbursement staff who follow CMS policy and Medicare operational changes.
Why This Topic Matters
The topics affect Medicare payment stability, claims acceptance, audit burden, and contractor accountability, all of which can influence practice cash flow and administrative workload.
Article Sections
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Medicare payment outlook and physician concern
Discusses concerns about future Medicare payment reductions and the impact on physicians and practice viability. Includes PPAC discussion of the broader reimbursement formula and CMS response.
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PQRI and claims timing
Covers reporting timeliness issues affecting participation in a quality reporting initiative and CMS guidance on claim transmission deadlines.
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Managed-care plan information and payment transparency
Summarizes recommendations for greater disclosure of pricing, fee, claims-processing, and payment policy information by Medicare managed-care plans.
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Recovery Audit Contractors (RACs) and appeal costs
Reviews discussion of audit recovery activities, physician appeal burdens, and proposed offsets related to audit disputes.
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Volunteer physician documentation
Notes clarification provided in a proposed payment rule regarding documentation for volunteer teaching physicians.
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Military physician billing questions
Addresses uncertainty about billing for certain services performed by active-duty physicians and the interagency effort to resolve the issue.
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Medicare Administrative Contractors (MACs) oversight
Discusses expectations for the transition to Medicare Administrative Contractors, including contractor responsiveness, performance measurement, and accountability.
What You Will Learn
- The main Medicare reimbursement and administrative issues discussed by PPAC and CMS.
- Why claims processing timing can affect quality reporting participation.
- What general oversight concerns were raised about Medicare contractors and audit programs.
- Which kinds of policy questions were raised about volunteer and military physician billing.
Who Should Read This
- Physicians
- Medical practice administrators
- Medical coders
- Billing staff
- Revenue cycle professionals
- Compliance teams
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