Medicare Updates

CONVERSION FACTOR INCREASE
(posted 12/04)

Physicians will see an increase of 1% percent from Medicare which will bring the anesthesia conversion factor up to $17.7594 from this year’s $17.4969.

Adjustments to the relative value of many pain codes will result in average 4% increase for services performed in a facility and for services performed in a physicans office an 8% increase.

CLICK HERE for 2005 Anesthesia Conversion Factors throughout the U.S.

2004 MEDICARE UPDATES & CHANGES
(posted 5/04)

On July 1, 2004, changes will be made to the Medicare Physician Fee Schedule files to correct payment mistakes made in the November 7, 2003 and January 7, 2004 Final Rules. See the related article for the corresponding fee changes. Click here for complete update.

Also, on July 1 changes will be made to correct mistakes in the payment files that were made based on the November 7, 2003 and January 7, 2004 Final Rules. The following fee changes will be effective for dates of service on and after January 1, 2004: Click here for complete update.

Check our updated online listing of State Medicare Web Sites for policy changes in your state.
Also, check out the latest Medicare & Medicaid Program Transmittals now available online.

STATE UPDATES

Maryland
The owner of an Annapolis, MD company that provided healthcare services to patients suffering from brain injuries pleaded guilty in March and face a maximum penalty of 10 years in prison and a $250,000 fine or double damages. According to US Attorney General, in 1999 and 2000 weekly billing sheets were falsely recorded – by date and amount of care provided – physical therapy services purportedly provided to supported living patients who resided in CNR facilities. These sheets were use to fraudulently bill Medicare for more than $150,000. Remember providers need to make certain that all claim submitted are backed up by valid documentation.

Lesson – Providers need to ensure that every claim they submit is backed up with legitimate documentation.
(posted 4/03)

Texas
It was announced on February 18th, 2003 that a clinic in Texas pled guilty to conspiracy and healthcare fraud, that involved kickbacks for referring Medicare and Medicaid patients.

Patients were referred for physical therapy services that were never provided over a two-year period. More than $11 million in false and fraudulent claims were filed and the clinic received more than $5 million for the programs for services. The trial is scheduled to start at the end of March 2003.
(posted 3/03)

Missouri
Six co-defendants that were involved in a scheme that kickbacks for patient referrals, were sentenced to 20 months in federal prison without parole and ordered to payback $156,471 in restitution . A nurse also involved was sentenced to 30 months and ordered to pay $122,386.
(posted 3/03)

Florida
Criminal indictments were issued against seven individuals involved in a multi-million dollar Medicare scheme. The indictment alleges that deliveries of wheelchairs were staged to beneficiaries. Also included were forged certificates of medical necessity. Claims totaled over $5 million dollars.
(posted 3/03)

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