Written by Chuck Buck   

Medicare payments for Part B services and evaluation and management services both increased by more than 40 percent during the first decade of the new millennium, according to a study coordinated by the U.S. Department of Health and Human Services Office of Inspector General (HHS OIG).

Medicare payments for Part B goods increased by 43 percent, from $77 billion to $110 billion, from 2001 through 2010, the report indicated. Payments for evaluation and management (E/M) services spiked by 48 percent - from $22.7 billion to $33.5 billion - during that time.

E/M services traditionally have been vulnerable to fraud and abuse; two healthcare entities paid more than $10 million apiece in 2009 alone to settle allegations that they fraudulently billed Medicare for E/M services. But the Centers for Medicare & Medicaid Services (CMS) found evidence that went beyond the anecdotal, determining that certain types of E/M services were tied to more improper payments than any other type of Medicare Part B service type in 2008.

The HHS OIG described the results of the study as the first in a series of evaluations of E/M services. Subsequent evaluations will determine the appropriateness of Medicare payments for E/M services and the extent of documentation vulnerabilities in E/M services.

The study was conducted using the Part B Analytics Reporting System, through which the HHS OIG scrutinized E/M services provided to beneficiaries to determine coding trends. Using Part B Medicare claims data, physicians' E/M claims were analyze to identify physicians who consistently billed higher-level (more complex and more expensive) E/M codes in 2010 (the study did not determine whether the E/M claims from these physicians were inappropriate).

The study ultimately revealed that, from 2001 to 2010, physicians increased their billing of higher-level E/M codes for all types of E/M services. Approximately 1,700 physicians, practicing in nearly all states and representing similar areas of specialty, were identified as consistently billing higher-level E/M codes. Those physicians also treated beneficiaries of similar ages and with similar diagnoses as those treated by other physicians.

CMS concurred with the HHS OIG's recommendations to continue to educate physicians on proper billing for E/M services and to encourage its contractors to review physicians' billing for E/M services. CMS partially concurred with a third recommendation as well: to review physicians who bill higher level E/M codes for appropriate action.

BY KYLE GRABOWSKI

DENVER BUSINESS JOURNAL

America's approximately 10,000 oncologists rely on Medicare payments for 50 to 60 percent of their Income, more than most other specialists.  Jim Musslewhite, president and CEO of Oncology Convergence in Lakewood, runs one of the few companies In the nation that provides help to oncologists in dealing with the unique challenges they face In giving care to cancer patients. Oncology Convergence helps physicians get reimbursed by Insurance companies, telling them which treatments are covered.  “We take the burden of getting paid off their table”, Musslewhite said.  The company also provides consulting services to help oncologists be more efficient in their billing and Insurance-claim submission processes.

Musslewhite bought Oncology Convergence In 2006.  At the time it provided only billing services and was called PK Medical Administrative Services Inc.  Oncology Convergence was doing "OK" financially then, Musslewhite said, but "struggled with technology.”  

The company was running on an antiquated billing platform and was behind In IT Infrastructure, so Musslewhite focused on refurbishing it, adding encrypted email and using software that can access hospitals’ information securely. "You have to have an IT platform that can protect clients' Information," Musslewhite said.  Musslewhite’s company uses patent pending software that it developed, which helps oncology and radiology practices manage changing reimbursement rates, identify where procedures are going unbilled and control re-billing practices. 

 Four years ago, Musslewhite merged his company with Mark Maynard's consulting firm, Trimanus Consulting, to create Oncology Convergence; Maynard Is chief operating officer.  Oncology Convergence's revenue has increased by 400 percent in the six years that Musslewhite has owned the company, going from the low seven figures to mid-seven figures.  During the last three years, the company's client base has increased by more than 500 percent.

 When Musslewhite bought the company, it served clients only In Colorado. Now it has clients In Colorado, Kansas and Arizona, and does consulting work "from coast to coast," according to Musslewhite.

 The company's largest and most recognizable client is the University of New Mexico Cancer Center, which became a client of Oncology Convergence In 2009.  Oncology Convergence has offices in both Lakewood and Tempe, Arizona.  Musslewhite’s primary focus is on helping oncologists. "The federal government dictates how a medical oncologist is paid more than any other specialist," he said.  They just want to treat their patients. Oncology is a small subspecialty, and their voice isn't loud enough because there aren't a lot of them."

Outside the office, Musslewhite writes articles on reimbursement topics for the Hematology Oncology News and Issues, which is designed to help physicians make the best decisions for their practices and patients.

Nevada's federal stimulus-funded quest to switch to paperless health care records continues with a bill to authorize the project.

The Senate Health and Human Services Committee on Thursday combed through SB43, a bill creating a structure to implement a $6.1 million electronic health records grant from the American Recovery and Reinvestment Act.

Electronic health care records, a priority of President Barack Obama's administration, would allow doctors and hospitals to easily share records rather than storing large archives of paper documents. Officials say the digital format will allow electronic prescriptions, reduce human error arising from transferring the records or illegible handwriting, and reduce potentially costly and harmful duplication of tests.

Nevada officials also say transferring medical records to an electronic format will also bring jobs.

Nevada's federal stimulus-funded quest to switch to paperless health care records continues with a bill to authorize the project.

The Senate Health and Human Services Committee on Thursday combed through SB43, a bill creating a structure to implement a $6.1 million electronic health records grant from the American Recovery and Reinvestment Act.

Electronic health care records, a priority of President Barack Obama's administration, would allow doctors and hospitals to easily share records rather than storing large archives of paper documents. Officials say the digital format will allow electronic prescriptions, reduce human error arising from transferring the records or illegible handwriting, and reduce potentially costly and harmful duplication of tests.

Nevada officials also say transferring medical records to an electronic format will also bring jobs.

Are you interested in speaking to someone from Oncology Convergence (OCI) in person about the challenges you are facing in your facility or practice?

Representatives from OCI will be in the Exhibit Hall at the ACCC National Meeting in Washington, DC March 24-26th.

Stop in and see how Oncology Convergence can help you with Revenue Management, Recovery/Compliance Audits, EHR Implementation, Installations and Enhancements, or Strategic Planning/Advisory Assistance.

From the Richmond Times Dispatch

Patients don't want to hear that they're dying, and doctors don't want to tell them. But new guidance for the nation's cancer specialists says they should be upfront and do it far sooner.

The American Society of Clinical Oncology says too often, patients aren't told about options such as comfort care or even that their chemo has become futile.

To help families broach the topic, too, the group developed an easy-to-read booklet about those choices, from standard care to symptom relief, and advice about what to ask to maximize remaining time.

"This is not a 15-minute conversation, and it should not happen in the back of the ambulance on the way to the ICU at 3 in the morning," says society chief executive Allen Lichter. "When everyone is well and has their wits about them, it's time to start the process."

The guidance and booklet — available at www.cancer.net — mark an unusually strong push for planning end-of-life care, in a profession that earns more from attacking tumors than from long emotional discussions about when it's time to stop.

"This is a clarion call for oncologists to take the lead in curtailing the use of ineffective therapy and ensuring a focus on palliative care and relief of symptoms throughout the course of illness," the guidance stresses.

But it's part of a slowly growing movement to deal with a subject so taboo that Congress' attempt to give such planning a nudge in 2009 degenerated into charges of "death panels."

"Patients want more information than they often get. … The great majority of people and families want to know what they have, what can be done about it and what's going to happen to them," said Thomas J. Smith, professor of Medicine and Palliative Care Research at Virginia Commonwealth University Massey Cancer Center.

"That includes what's going to happen even towards the end of life. Will I die from this? How soon? Can you make some predictions? What are my options? Doctors routinely don't like to give that information, for at least several reasons.

"One, it's hard to tell people that medical science doesn't have a cure for their disease. The second is doctors are afraid of taking away hope, but all the available studies, including one done here at VCU Massey Cancer Center, say that the more honest you are, the more hope is maintained. The third reason is that doctors worry about making people depressed.

"With the death-panels issue, there has been a concern that somehow planning for a good death might make it happen or hasten it," Smith said.

"In medical facts, the exact opposite is true. People who use hospice actually live longer than those who don't. If you use palliative care alongside your usual oncology care you live at least as long if not up to three months longer."

Smith co-authored one of the background papers on which the new guidelines are based and helped design the patient booklet.

"People are afraid of uncontrolled symptoms," said Esther Desimini, vice president of oncology services at HCA Inc. Virginia.

March 24-26 in DC -- Visit Oncology Convergence in the Exhibit Hall!

Learn how Oncology Convergence can assist your facility or practice.

Free Webinar at 1:00 PM EST/10:00 AM PST on February 2nd

Contact Craig Schwamm at (561) 289-6183 or by e-mail at craig@oncologyconvergence.com for call-in/log-in information

The following four EHRs have been approved for Meaningful Use:

ECareSoft eCS as an inpatient Complete EHR, by the Drummond Group;

 MacPractice MD 4.1 as an ambulatory Complete EHR, by the Certification Commission for Health Information Technology;

Meditech 6.0 Health Care Information System as an inpatient Complete EHR, by the Drummond Group; and

LSS Data Systems Client/Server Medical and Practice Management v5.6.4 as an ambulatory Complete EHR, by the Drummond Group.