Current Issues the Third Party Reimbursement Committee is Actively Researching & Lobbying - SPRING 2008 • Verification that Coronary Interventions can be performed in freestanding cath labs outside of FL. The preliminary findings are no, they cannot. • Recovery Audit Contractors. Representatives have been working with the Medical Director at FCSO to clarify that some of the RAC audits should not be occurring. • The committee has been following the status required by United Healthcare of all providers rendering certain diagnostic test. The current target date is the third quarter 2008. • There are concerns about select payers requiring prior authorization to perform test. The committee is working in this area gathering data to present to ACC National for a joint effort. 2008 Medicare Payment for Cardiac Cath Services in Non-Hospital Settings UPDATE This issue underscores the need for fundamental reform of Medicare’s payment systems. The FCACC and the ACC are working to ensure that any reforms support cardiologists in their mission to provide high quality cardiovascular care to Medicare beneficiaries. The bottom line is that Medicare payments for many non-hospital cardiac catheterization services will be cut over the next three years – in the example shown here ( Click Here to see full ACC report), by nearly 30 percent. The example shown above is independent of the 10 percent cut to the Medicare Conversion Factor that is scheduled to go into effect on January 1. However, by working together through the established regulatory process, the cardiology community was able to significantly reduce the magnitude of the payment cuts. Note the proposed cut would have been 67% in 2010 based on CMS’s original proposal– not the 29% projected now. Any cut significantly effects practices and could hurt access to care - the need for fundamental reform of the Medicare payment system is needed. The Florida Chapter realizes the importance working with third party payers and identifying solutions to improve members' daily practice operations through dialogue and resolution of billing and coding issues. The Chapter's Third Party Payer Committee, chaired by Jerold, Saef, MD, routinely identifies and tracks trends among health plans and government payers and helps chapter members resolve medical policy and reimbursement disputes. The NPI is here. The NPI is now. Are you using it? Social Security Numbers (SSNs) Should Not Be Reported in FOIA-disclosable NPPES Fields As CMS has mentioned in previous outreach messages and on the CMS NPI website, some health care providers have reported their Social Security Numbers (SSNs), or the SSNs of other health care providers, in their NPPES records in fields that the Freedom of Information Act (FOIA) requires that CMS make publicly available. For example, there are instances where SSNs are reported in the "Other Provider Identification Numbers," "License Number," and "Employer Identification Number (EIN)" fields in providers’ NPPES records. The information that providers report in these (and certain other) fields is fully disclosable by CMS to the public and, therefore, SSNs should never be reported in any of these fields. Because SSNs are 9-digit numbers, CMS has been suppressing all 9-digit numbers found in any FOIA-disclosable field except for ZIP code and telephone/fax number fields. This means that these 9-digit numbers—whether or not they are SSNs--are not displayed in the NPI Registry and cannot be found in the monthly NPPES downloadable file. If these 9-digit numbers are legitimate EINs, "Other Provider Identification Numbers," or “License Numbers,” health plans and others who are using the NPI Registry and the downloadable file are not able to see them, which means that they cannot see all of the NPPES data they may need in order to accurately match providers in NPPES to the providers in their own files, thus making it more difficult to link NPIs to legacy identifiers. In some cases, this may adversely affect payments to providers by health plans. It is imperative that providers immediately look at their NPPES records to ensure that they did not inadvertently report their, or someone else’s, SSN in a FOIA-disclosable field; if they did, they need to delete that SSN immediately and, if appropriate, replace it with the correct information (e.g., an EIN).