Are Your Medical Practices Compliant With the “Rules”?

We are reaching out to all our readers in the medical field to alert them about the impending May 1st, 2009 deadline associated with the “Red Flags” Rule enforced by the Federal Trade Commission (FTC), as well as compliance with the Fair and Accurate Credit Transactions Act (FACTA). You may know that in order to fight identity theft (the fastest-growing crime in the U.S.), Congress added new sections to the federal Fair Credit Reporting Act (FCRA) when it passed FACTA in 2003 – in which privacy, limits on information sharing, new consumer rights to disclosure and accuracy are all addressed.

While the American Medical Association (AMA) has sought exemption from compliance for physicians and medical organizations, the FTC recently made it very clear that industry-based exclusions are not allowed. These new provisions have created serious new responsibilities for our physician clients as well as potential liabilities (financial and legal).

What does this mean for our industry? By May 1st, you need to have formal, written procedures in place outlining how you plan to protect the identity of both your own employees and those of your patients.

If you need more information about meeting compliance with these procedures contact us, and we’ll help you out. We can also put you in contact with some of the experts we have been working with to address identity theft protection for own employees.

The V Coding Trap

We believe there are many flaws in the coding arena and want to discuss one in particular we believe is a trap. Don’t fall into it.

Be aware when using the chemotherapy V Codes (V58.11 or V58.12) or you may not get reimbursed properly for what you are really owed.

Cancer patients have lots of problems, and their treatment if often complex. We firmly believe that “there is no such thing as a routine chemotherapy”. Therefore, oncologists/ hematologists need to assess patients when they arrive for their chemotherapy – to be sure they are stable enough to have their treatment that day. Typically, this assessment would constitute a Level IV or Level V visit. We find this to be true with 90% of the patients in the practices we work with across the country.

Unfortunately, by reporting the V code as a primary diagnosis as required by some local coverage determinations, you are essentially saying the only reason for the encounter was to administer chemotherapy, thereby indicating the evaluation and management service was not necessary and should not be paid. In essence, you’re telling them “Don’t’ pay me” when you do this.

So, how do you get paid for your physician assessment and the chemotherapy? We bill cancer diagnosis as the primary code plus the V code as the secondary, and our clients are getting paid. We’ve not had denials doing it this way. If you use the V code as the primary code, you risk not getting reimbursed for your assessment.