Local, State, Federal

The Bill Box
ACR Requests Changes to 2008 MPFS
Teaming Up for Better Coding and Compliance

The Bill Box

House Sustains Veto of SCHIP Expansion Legislation
The US House of Representatives voted to sustain President Bush’s veto of legislation that would have provided for the reauthorization and expansion of the State Children’s Health Insurance Program (SCHIP). Supporters of the bill were 13 votes shy of the two-thirds majority needed to override the executive veto.

With additional funding paid for by a 61-cent-per-pack increase in the tobacco tax, legislation would have given an additional $35 billion in funding for the program over the next 5 years and increased total SCHIP spending to $60 billion.

After the override vote, Rep Tom Feeney (R-Fla) and Sen Mel Martinez (R-Fla) introduced legislation that would reauthorize the program and increase spending by $11.5 billion over 5 years, making way for coverage for an additional 1.5 million lower-income children. Tax credits, worth as much as $1,400 annually per child, would be offered to families who possess annual incomes between 200% and 300% of the federal poverty level.

—Elaine Sanchez

What Does the Defense Authorization Bill Have to Do with Imaging?
The American College of Radiology (ACR), Reston, Va, is calling for members to speak up in support of an amendment to the Defense Authorization Bill.

Sen Ted Kennedy (D-Mass) has proposed an amendment to prevent the elimination of the Armed Forces Institute of Pathology (AFIP) of the Walter Reed Army Medical Center, which the Department of Defense recommended to the Base Realignment and Closure Commission (BRAC). An amendment to the BRAC will allow for the continuation of AFIP’s functions after Walter Reed closes, but without Kennedy’s amendment to the Defense Authorization Bill, the DOD can still shut down AFIP at its discretion.

During a typical year, the ACR notes, AFIP consults on more than 92,000 cases, and provides for the radiology-pathology correlation required by the Accreditation Council for Graduate Medical Education for almost all US radiology residents. The loss of AFIP, the ACR says, could “eliminate robustness in our capacity to respond to potential bioterrorism threats such as the recent anthrax and SARS situations.”

Additionally, a recent Bearing Point report commissioned by the Office of the Army Surgeon General noted that dismantling AFIP “may result in the loss of immediate response capability to medical threats that could impact combat effectiveness or operational forces.”

—Cat Vasko

Maine Senator Focuses on At-Home Care Costs
Sen Susan Collins (R-Me) has introduced legislation that would prevent a scheduled $6.2 billion reduction in Medicare reimbursements for home health care services over the next 4 years.

The cuts, which translate to a loss of about $30 million in Maine, are part of a CMS restructuring plan that increases funding for clinically intensive home care but restricts payment on routine home health care services, as reported by the Bangor Daily News.

Slated to take effect January 1, the plan also calls for an increase in payments to agencies that provide quality-of-care data.

In Maine, where Medicare accounts for between 70% and 80% of all home health revenues, there are 32 home health agencies that provide services to about 21,500 Medicare enrollees each year.

Collins said payment reductions would make it impossible for agencies to cover the cost of at-home care, resulting in the loss of essential services for many Americans.

The Senate bill is titled the Home Health Care Access Protection Act, and it is cosponsored by Sens Robert Casey (D-Pa), Maria Cantwell (D-Wash), and Christopher Bond (R-Mo). A similar measure will be introduced in the House.

—E. Sanchez

ACR Requests Changes to 2008 MPFS

The American College of Radiology (ACR), Reston, Va, recently submitted comments to the Centers for Medicare and Medicaid Services (CMS) on the proposed 2008 Medicare Physician Fee Schedule (MPFS). Addressing such issues as malpractice values, practice expense per hour, independent diagnostic testing facility (IDTF) requirements, changes to reassignment and self-referral rules, and more, the ACR’s letter to CMS attempts to effect changes to the final rule, set to be published this month.

A sampling of the ACR’s comments:

Regarding malpractice issues: “. . .the ACR does not believe that the malpractice values in the technical component should be zero. The ACR is aware that CMS is requiring independent diagnostic testing facilities to purchase a certain level of liability insurance. CMS is, therefore, acknowledging that some liability costs do exist in the TC and the ACR supports CMS’comments on this issue in past final rules. Also, other clinical staff such as radiology technologists and medical physicists purchase professional liability insurance and are represented in the TC.”

On budget neutrality: “The ACR is again disappointed that the CMS decided to apply the budget neutrality adjustment by way of a physician work adjustment factor as a result of the increase in anesthesia physician work under the third five year review. . . . The vast majority of professional societies whose members treat Medicare beneficiaries recommended that the budget neutrality adjustment be made to the conversion factor and not to the physician work values. . . The ACR again strongly recommends that CMS reconsider applying the budget neutrality adjustment to the conversion factor and not to the physician work RVU.”

Pertaining to IDTF issues: “The ACR supports the requirement for an IDTF to have comprehensive liability insurance but is concerned that requiring a Medicare contractor to be listed as a Certificate Holder will create reluctance of insurance underwriters to issue such policies, since listing a Medicare carrier as a Certificate Holder could, theoretically, provide the government with contractual rights to indemnification or payment that it would not otherwise have.”

On self-referral rules: “The ACR strongly supports CMS revisiting and changing the in-office ancillary exception. . . . Additionally, the ACR recommends that CMS require that physicians provide in-office ancillary services within one hour after a patient’s scheduled office visit. We also recommend that CMS modify the definition of a ‘centralized building’ to a location within five miles of the building where a physician or medical group furnishes designated health services. . . . Finally, the ACR recommends that non-specialist physicians should not be able to use the in-office ancillary exemption to refer patients for specialized services involving the use of equipment owned, leased, or controlled through a joint venture by the referring physician unless the equipment provides the simple and truly ‘ancillary’ services that Congress originally intended in this exception.”

On MedPAC wording: “The ACR supports including the MedPAC recommendation to expand the definition of physician ownership in the current CMS proposal on services furnished ‘under arrangements.’ Additionally, we would recommend changing the language of the MedPAC recommendation to state ‘. . . an entity that derives a substantial proportion of its revenue from a provider of designated health services or from the business of providing designated health services.’ We would also recommend that, for this purpose, a ‘substantial’ portion of revenue should constitute 50% or greater.”

The full set of recommendations is available on the ACR Web site.

—Cat Vasko

Teaming Up for Better Coding and Compliance

New partners Medical Learning Inc (MedLearn of St Paul, Minn) and A-Life Medical, in San Diego, have created a unique relationship to deliver a broader range of services to their clients. A-Life is the developer of LifeCode, a patented technology for computerized coding and coder management solutions. MedLearn offers experts and knowledge to provide education in coding, compliance, and reimbursement. The partnership will leverage these strengths to offer a suite of value-added services unavailable elsewhere.

“We will provide A-Life’s clients with consulting, auditing, and other value-added services. Our experts can assist with an audit or chart review and help to keep the customer in compliance,” said Suzanne Lappen, director of corporate development at MedLearn. The company also offers newsletters, publications, audio conferences, webinars, and seminars.

These services will supplement A-Life’s technology, which automates the coding process. Based on LifeCode, the company’s Natural Language Processing (NLP) technology, the software reads and understands text as a human coder through the use of proprietary “knowledge-bases” holding more than 10 million facts. “Customers often see productivity gains of 300% after installation,” said David Byrd, vice president sales and marketing for A-Life. He attributes the savings to the elimination of manual steps in the billing cycle.

The company’s technology solutions include ICD-9 and CPT coding and a Windows-based billing system released earlier this year. Alacer features document management, real-time NLP coding, billing, collections, denials management, and auditing tools. LifeCode technology has been applied to a variety of medical specialties, such as radiology, emergency medicine, and pathology. New releases are in development.

One of these will be an expansion of Actus (Automated Coding Capabilities) to interventional radiology. The two companies have collaborated on the solution to broaden its capabilities. For instance, MedLearn’s images and anatomical graphs are embedded into the A-Life interventional radiology module to provide a visual map of the interventional radiology procedure for coding. “You can access our anatomical drawings, move your mouse through a vein to the leg, and the system will code it along the way,” said Lappen. Color-coded charts are another useful tool. Eighteen images will be included in this year’s release and 25 next year.

Such unique services will mark the companies’ collaboration as they move forward. Each organization will remain its own entity, but the process will be seamless for customers. The partnership permits both organizations to offer the market a cohesive solution for coding, billing, auditing, and compliance.

—Renee DiIulio