The Office of Inspector General (OIG) for the Department of Health & Human Services released a report examining the services of non-physician providers that are billed "incident to" a physician's care. The report found that "unqualified" non-physicians provided 21 percent of physician services, meaning that the non-physicians lacked necessary licenses or certifications, had no verifiable certifications or lacked the training to perform the service. In addition, OIG found that 7 percent of invasive services not performed by physicians were performed by non-physicians with inappropriate qualifications.

You should be aware that OIG and CMS are closely examining "incident to" services and that billing for them must fall within current Medicare requirements.

To read OIG's report, refer to: Prevalence and Qualifications of Nonphysicians Who Performed Medicare Physician Services.

Beginning January 1, 2010, CMS has eliminated the use of all consultation codes (inpatient and office/outpatient codes for various places of service except for telehealth consultation G-codes).

In an effort to calm providers on the elimination of consults, CMS has increased the work RVUs for
new and established office visits, initial hospital and initial nursing facility visits, and have made adjustments for the increased use of these codes into the practice expense and malpractice RVU calculations.

MedPro has prepared a summary of these changes in an easy-to-follow format. Find out how these changes are going to affect your bottom-line by emailing us at mpm@medpromanagement.com.

If you are interested to find out more about any of the topics mentioned, please do not hesitate to send us an email at mpm@medpromanagement.com or call us at (888) 549-1713.

 

Sincerely,

 

Razmik Sarkisian, M.S.H.A.
Chief Operating Officer
Med-Pro Management, Inc.