American College of Physicians: Internal Medicine — Doctors for Adults ®


Medicare and Medicaid

Documentation and coding: College policies | Drug Card Program | Fraud and abuse | Fraud and abuse: College policies | Medicaid news | Medicare news | Medicare and Medicaid: College policies | Medicare+Choice | Medicare HMOs: College policies | Part D | Provider-sponsored organizations | Reimbursement | Reimbursement: College policies

Documentation and coding: College policies


Medicare clarifies, updates several claims payment issues

The Centers for Medicare and Medicaid Services has released statements regarding claims payment issues that it will be correcting in the near future, including enforcing coding conventions and restructuring system edits. More

Lessen the burdens of Medicare's home health requirements

Home health care now requires face-to-face certification of eligibility based on the patient's current condition, a burden that doesn't have to be one. A few simple tips can ensure that the patient's needs and Medicare's paperwork are both satisfied. More

Updates to Medicare program change telehealth codes, PQRS

The second of a two-part series outlines changes to telehealth codes for diabetes and the Physician Quality Reporting System. More

Claims coding edits target improper payments, errors

Knowing the ins and outs of claims coding edits speeds reimbursement, but they are tricky even for experienced office staffers. Learn how to do them properly, and what resources exist to help. More

Follow the changes to Medicare coding edits for early 2009
CMS will publish some previously unreleased medically unlikely edits, which had made it nearly impossible for physicians to know whether the billed number of services resulted in denied charges without a specific reason. More

College opposes new hepatitis B codes (November 2002)

College warns HHS about new inpatient coding system (November 2002)

ACP-ASIM asks for review of immunization policies (February 2002)

Changes in payment, coding will boost immunizations (November 2001)

College says E/M guidelines still flawed, too complex (September 2001)


See also Billing and coding Q&A


Drug Card Program


Drug card program turns spotlight on seniors' costs
Physicians help steer patients to resources that can save them money on prescription drugs. (December 2004)


Fraud and abuse


Clinicians crucial to avoiding coding errors

Beware believing that coding isn’t an important part of an internist’s job. What gets overlooked could cost a significant amount if errors go unchecked, especially in the era of Recovery Audit Contractors. More

OIG warns physicians about joint ventures. (June 2003)

What internists need to know about the new Stark law
Final rules clarify when you can refer a patient for Medicare services and steer clear of anti-kickback problems (January 2002)

Is your waived lab compliant? Try these four tips
To avoid problems, know the limits of a waiver certificate and document well (September 2001)

Medicare auditors focusing on medical necessity
If a service is medically unnecessary, no amount of documentation or E/M codes will persuade Medicare to pay you for the visit (June 2000)

OIG's new rules on how to steer clear of kickbacks
New rules explain how internists can conduct specialty referrals and invest in joint ventures and ambulatory surgical centers (April 2000)

How to steer clear of a Medicare billing audit
Tips to help avoid coding and billing practices that can put you on the wrong side of the law (September 1999)



Fraud and abuse: College policies


College asks for oversight on Rx data sales, deceptive practices of some DME suppliers. (November 2003)

ACP-ASIM: Medicare needs to change its definition of 'improper payments' (July-August 2001)

Engaging the federal government on Medicare's antifraud program
How the College worked with to represent internists in the OIG's efforts to find fraud and abuse (November 2000)

New fraud statistics from OIG help separate fact from fiction
Only 1% of calls to the OIG's hotline resulted in a physician-related complaint, and of those, only a handful resulted in a fraud investigation (September 1999)

Doctors object to enlisting patients in war on fraud
Physicians believe it will lead to tensions between providers and Medicare beneficiaries (April 1999)

Allies or adversaries? The OIG's real fraud and abuse agenda
Recent events give credence to internists' concerns that the government's real intentions may go beyond the requirements of the law (April 1999)



Medicaid news


CMS demo aims to help seniors stay healthy, independent
CMS is partnering with private companies to address multiple health risk factors that contribute to senior's chronic diseases. More (October 2008)

ACP calls on Senate to reject Medicaid cuts. (April 2004)

Trying to provide care that's different, not second class
A conversation with Helen Smits, MACP, about the challenges of heading up a Medicaid HMO (April 1998)

Lessons in improving care for Medicaid HMO patients
One internist's efforts led to better care and access for the city's poor—and an award from ACP (March 1997)

Medicaid: Can HMOs do better?
To cut costs and expand access for Medicaid, managed care could be a solution (July/August 1995)


Medicare news


Research at SGIM meeting targets prevention

From smoking to weight loss to vaccination, much of the research at the Society for General Internal Medicine annual meeting focused on preventive medicine. Researchers from around the country shared data on their efforts to keep patients healthy. More

CMS releases 2007 fees. (December 2006)

CMS program gives doctors a glimpse of P4P future
While it lacks financial incentives, the program gives volunteers a trial run in reporting performance data. (May 2006)

Part D hopes and hassles begin to play out
Prior authorization tops list of headaches as internists navigate the system. (May 2006)

Medicare ramps up coverage of power mobility devices
The Centers for Medicare and Medicaid has made several changes, including removing the physician specialty requirement for prescribing power-operated scooters. (November 2005)

Getting yourself ready for Medicare Rx
Internists can expect lots of patient questions and confusion—but help is available. (October 2005)

The new ICD-9 codes that every internist should know
Changes to the International Classification of Diseases take effect next month. (September 2005)

New Medicare demonstration project will reward doctors for quality. (March 2005)

College comments on 2004 Medicare payment changes. (April 2004)

ACP provides fee schedule recommendations. (April 2004)

What will new Medicare legislation mean for reimbursement, practice hassles, patient care?
The new Medicare law rules out physician pay cuts for two years, but there are long-term concerns. (January-February 2004)

Medicare to put coding information on Web for free. (July-August 2003)

Medicare must now explain some denials to patients. (June 2003)

Better communication from Medicare carriers is coming soon. (June 2003)

New Medicare fee schedule: mixed news—and confusion
Delays in publication give physicians more time to fight Medicare cuts and to opt out of the program (February 2003)

Medicare cuts forcing some hard choices
Cash-strapped practices are dropping Medicare patients and leaving the program (January 2003)

Changing your Medicare status? Here are some issues to consider
Each category of Medicare participation has benefits and drawbacks (December 2002)

Six Medicare myths that internists shouldn't fear
While government rules can be complex, you can use the following tips to make the system work for you (May 2002)

Medicare audit changes are good news for physicians
Audits now take place after claims are paid, greatly reducing paperwork hassles for physicians (March 2002)



Medicare and Medicaid: College policies


College supports Senate action on changing fee update formula. (April 2004)

Medicare reforms must address medical liability, physician pay
ACP calls on legislators to deal with key issues to improve Medicare. (July-August 2003)

Tighter budget for Medicare carriers could hamper physician pay. (July-August 2003)

Bill would boost efforts to bring doctors to underserved areas (March 2003)

CMS needs to improve communication between doctors, Medicare carriers (December 2002)

Senate failure to pass drug benefit should not derail other reforms (September 2002)

How ACP-ASIM is helping to reduce regulatory burdens
College works with Physicians' Regulatory Issues Team to improve Medicare. (September 2002)

The effort to reduce the regulatory burden of Medicare (Web Only)





The trouble with Medicare HMOs
Health plans say money is the key, but critics see bigger problems (December 2000)

The next phase in Medicare+Choice: private fee for service
New companies explore the managed care potential of Medicare (December 2000)

Tough times as Medicare HMOs fold
Physicians, patients weigh their options as the market shakes out (February 1999)

Making sense of Medicare+Choice
HCFA's new managed care options confusing patients and doctors (October 1998)



Medicare HMOs: College policies


Medicare+Choice program final rule (October 2000)

Patients, not Medicare HMOs should choose hospitalists (April 2000)

HCFA to risk-adjust pay for Medicare HMOs (February 1999)

New initiative to help Medicare patients dropped by HMOs (November 1998)


Part D


Readers respond to Observer coverage of Medicare Part D and outsourcing trends. (July-August 2006)


Provider-sponsored organizations


IPAs down—but not out—with doctors Despite a rash of recent failures, physicians may have few other options (September 2001)

Prospects dimming for expanded private contracting (June 1998)

ACP raises concerns about private contracting in Senate testimony (April 1998)





Medicare clarifies, updates several claims payment issues

The Centers for Medicare and Medicaid Services has released statements regarding claims payment issues that it will be correcting in the near future, including enforcing coding conventions and restructuring system edits. More

ACP disputes federal valuation of primary care observation codes

ACP disputes the relative values assigned to observation care codes, believing that they do not fully account for the physician work involved in providing the services. ACP advocacy and members' input are critical to helping improve internal medicine physicians' recognition for the care they provide. More

Debt deal could hurt programs crucial to internal medicine

Legislative wrangling over the debt ceiling threatens health care spending on government programs that train primary care physicians, as well as the oversight capabilities of the Centers for Disease Control and Prevention and the Food and Drug Administration, and could even trigger across-the-board cuts to Medicare payments. More

Well visits not just for kids any more

Medicare now reimburses for annual physical exams, so prepare your office, your patients and yourself for the best way to accommodate this into your practice. More

Assess your ability to comply with version 5010 requirements

The pressure is on to switch to version 5010, and the process will require identifying changes, testing transactions and minimizing disruptions. Also available are resources to help with preparation. More

Coding made easy for annual wellness visits

Health care reform now reimburses for annual exams under Medicare. Now, physicians have to reform their practices and prepare patients for them, as well. More

Help ACP determine Medicare’s physician service payments

ACP will invite randomly selected members to provide feedback that could influence Medicare reimbursement on services common to internal medicine. More

CMS dramatically changes CPT consultation billing for 2010

CMS no longer recognizes CPT consultation codes 99241-99255 for consultations. ACP’s practice management staff explain how to bill for outpatient and inpatient visit codes. More

Countdown is on to get National Provider Identifier. (January-February 2007)

CMS releases 2007 fees. (December 2006)

Medicare changes its rules on consult requirements
CPT code revisions and new policies mean consultation documenting and reporting changes for internists. (March 2006)

College issues FAQs on 2006 payment and claims process. (March 2006)

Congress expected to restore 2005 payment cuts
While legislators passed bills to avert pay cuts, last-minute changes have allowed cuts to take effect. (January-February 2006)

The new ICD-9 codes that every internist should know
Changes to the International Classification of Diseases take effect next month. (September 2005)

Medicare coverage changes that will affect internists
The CMS will now reimburse you for ordering some important screening tests and administering vaccines. (April 2005)

How to fill for the new "Welcome to Medicare" exam
Billing tips and covered benefits for the new Medicare initial preventive physical exam. (January-February 2005)

Counseling diabetic patients? Here's how you should bill
With the number of patients with diabetes on the rise, internists are placing a growing emphasis on preventive and counseling services for diabetic patients. (November 2004)

Medicare's new office-drug payment policy has oncologists concerned about access
Because of reduced fees, physicians say office infusion services may be at risk. (April 2004)

ACP criticizes report on incorrect payment rates as "preliminary." (January-February 2004)

Medicare now pays for enoxaparin administered in outpatient settings (March 2003)

New Medicare fee schedule: mixed news—and confusion
Delays in publication give physicians more time to fight Medicare cuts and to opt out of the program (February 2003)

Diagnosing—and curing—Medicare's maladies
Congress needs to strengthen Medicare's foundation by halting payment cuts, replacing the flawed formula for updating payments and reducing excessive red tape. (March 2002)

After 10 years, has RBRVS helped your bottom line?
While RBRVS has not increased internists' Medicare pay as much as hoped, spending on cognitive services has increased significantly (January 2002)



Reimbursement: College policies


College asks CMS to revise aspects of Medicare fee schedule
Certain aspects of physician pay need fine-tuning. (May 2003)

ACP pushes Medicare to cover screenings before colonoscopy (April 2003)

Will Congress redeem its legacy of inexcusable inaction?
Congress' failure to reverse Medicare pay cuts was not a result of physicians' lack of effort to pressure legislators to act (December 2002)

College continues fight to restore Medicare cuts (December 2002)

Can Congress redeem its record of failure on health care?
Congress has little time to right a big wrong by reversing cuts in Medicare payments for physician services (Novemer 2002)

College: Medicare must reverse 'severe' reimbursement cuts (October 2002)



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