Any updates on MUE status?

[elperro]

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This excerpt is from the Dark report:

R. Lewis Dark: Coding Edits Are a Potential Hammerblow to Pathology

DURING THE NEXT SIX MONTHS, WE WILL WITNESS an intense debate between the pathology profession and the Medicare/Medicaid bureaucracy. This battle will center around the proposed MUEs (Medically Unbelievable Edits) which place restrictions on the units of service per patient per day on key CPT codes widely used in laboratory medicine.

As you will read in our lead story on pages 2-3, news of this proposal only surfaced in mid-December, just as the holiday season kept folks from paying close attention to business issues and government proposals. It is still a matter “under wraps,” because confidentiality agreements cover the information about proposed restrictions on service that was distributed by a Medicare contractor to the American Medical Association and medical specialty associations. It is why neither the Medicare program nor recipients of this information have made it public.

What caught the attention of pathologists was the proposal to restrict use of CPT code 88305 to two units of service per patient per day. But that is not the limit of the bad news. The Medicare contractor proposes to place restrictions on approximately 1,200 CPT codes involving anatomic pathology and clinical laboratory services. By itself, the 88305 restriction is a potential hammerblow to pathology because it covers a procedure that makes up as much as 50% of the services performed by some individual pathologists.

As the laboratory industry responds to this ill-conceived Medicare coding initiative, there are no guarantees that the final decisions affecting 88305 and other laboratory CPTs will be satisfactory to the pathology and laboratory community. This will be a major story of 2006 and you can expect to read more about it in the pages of THE DARK REPORT.

For my part, I believe the very fact that Medicare launched a contractor on a project to propose restrictions on service, based on MUE standards, across all medical specialties, represents a more serious threat. Regardless of whether this round of CPT code edits originated because of incompetence, ignorance, or intent to restrain utilization (thereby reducing costs), the fact that some Medicare officials wanted to go down this road is a sign of the growing pressure they face to control spending—and their lack of creativity in how to solve that problem.

Long time lurker here who really appreciates everyones posts.

Anybody have any more information on the status of the MUE proposal? I still love pathology, and will probably still go into it despite trying very hard to convince myself that radiology would be better, considering the current state of things. Alas, I've been unsuccessful, and ultimately, I am more interested in Path. I have been following this issue closely.

Anyone know of any other sources of information, besides the CAP website?

 

[LADoc00]

I need a link to this.
thanks.

(starts cleaning guns.....)

 

[elperro]

I need a link to this.
thanks.

(starts cleaning guns.....)

http://www.darkreport.com/dark/current.htm

 

[Pathmonster]

Bush said he wants to cut 40,000,000,000 from medicare spending in the near future. All of that money will come from the MDs. Like someone said before, it is always acceptable to reduce the salaries of physicians.

 

[tsj]

This excerpt is from the Dark report:



Long time lurker here who really appreciates everyones posts.

Anybody have any more information on the status of the MUE proposal? I still love pathology, and will probably still go into it despite trying very hard to convince myself that radiology would be better, considering the current state of things. Alas, I've been unsuccessful, and ultimately, I am more interested in Path. I have been following this issue closely.

Anyone know of any other sources of information, besides the CAP website?

I would seriously reconsider. For the last few years Path has been one of the best compensated specialties just behind stuff like Urology, Rads, Cards, ENT, but still it has been 2-3 times as good as FP, IM, Peds. It looks like Path is destined to move more towards Peds and FP, like in the 100-200K range. THat sounds like a lot of money, but when you think that the best you could only buy a 300-500K dollar house with that salary, and then think of what houses pricing are, you are seriously screwed in most markets unless you have a wife/husband that's bringing home 200K or more also.

Rads is certainly a more lucrative profession than Path, but they are under the gun too. EVery surgical subspecialty is opening up their own surgical center with their own MRI/CT scanner. Plus a lot of outpatient radiology is sent out to the lowest bidder whether in the US or abroad.

I would serious consider urology/ent/optho/anesth/cards/gi. That is where the money will be the next 20 years. Rads will likely do OK, but they are feeling the heat. Anesth isn't the most lucrative, but you and for easily make 350+ and only work 40 hours a week, and anesth groups are so big that you only take call once or twice a month.

Of course, in the perfect world, you should go into what interests you the most. However, when you can earn 5 times in Uro or GI what you can in path (if this MUE thing goes through), you need to be pragmatic also.

 

[yaah]

They didn't mention this at all during the USCAP, and there are some pretty strong lobbyists within the CAP, so I wouldn't panic just yet.

The increased money in Uro and GI is probably not going to last either. The current situation often does not indicate what things will be like in 5-10 years. Part of the reason GI, for example, makes a lot of money is that they skirt around some of the medicare regulations and are able to charge differently for things. That may change too. The advice, as always, is to do what you want to do and you will be far less likely to be disappointed.

 

[DrBloodmoney]

That seems like a nice little site at darkreports. I'll have to peruse there some more. This whole restricting the 88305 is complete nonsense. I'll have to go on a killing rampage if this **** goes down. I drop 88305's like a mutha.

[Then again I work for the Army and we only code for ****s and giggles.]

 

[tsj]

They didn't mention this at all during the USCAP, and there are some pretty strong lobbyists within the CAP, so I wouldn't panic just yet.

The increased money in Uro and GI is probably not going to last either. The current situation often does not indicate what things will be like in 5-10 years. Part of the reason GI, for example, makes a lot of money is that they skirt around some of the medicare regulations and are able to charge differently for things. That may change too. The advice, as always, is to do what you want to do and you will be far less likely to be disappointed.

And even if it does go through, it might be premature to panic. Medicare's 2006 6% cut in physician payments was recently reversed narrowly by Congress. On top of that it was retroactively reversed meaning all docs will get that money back for their work in Jan and Feb. So there is always that route if MUEs get approved.

 

[tsj]

Heard today that not only is the MUE thing being tabled (as was reported a week ago) but that is is permanently dead. And CMS is going to try to implement a proposal to address the real issue which is errors/dishonesty in billing.

 

[tsj]

Here is the announcement

The CMS announced today that the MUE proposal will only focus on identifying "obvious mistakes in billing" and are intended to "prevent the payment of obviously erroneous Medicare claims submissions." CMS plans to post an official notification of this development on its website shortly. The CAP has obtained an advanced copy of this notification.

The CMS notice further states "the medically unbelievable edits are not meant as Medicare payment policy." CMS states they will develop a plan for implementing these edits no earlier than January 1, 2007, and will continue to "work closely with the provider community to insure that these requirements are in line with current medical practices and are used only as intended, to detect errors in claims submission."

CMS also announced it is scrapping the March 20th deadline for comment and is extending the deadline at least another 60 days. CMS will provide additional guidance on the MUEs as well as notification of the actual deadline for comments by March 17th.

Pressure on CMS has continued to mount over this issue, the latest being from Rep. Nancy Johnson, Chair of the Ways and Means Health Subcommittee, who weighed in with CMS Administrator Mark McClellan last Friday, calling on CMS to withdraw the proposal and scale back to address its original purpose. She further urges CMS to utilize the formal rule making process to seek comments on any revised proposal.

Click here for a copy of Rep. Johnson's letter

That follows a unanimous vote last week by the Practicing Physicians Advisory Council (PPAC) calling upon the agency to withdraw the MUE proposal and revise it using formal rulemaking authority. At that meeting, CMS official Herb Kuhn said following the recommendation that "this process was essentially underway."

Over the past few months, the College has organized a coalition of national and state pathology organizations to oppose the current MUE proposal. The coalition includes:

American Association of Neuropathologists
American Pathology Foundation
American Society for Clinical Pathology
American Society of Cytopathology
Arthur Purdy Stout Society of Surgical Pathologists
Association of Directors of Anatomic and Surgical Pathology
Association of Pathology Chairs
Association for Molecular Pathology
National Association of Medical Examiners
United States and Canadian Academy of Pathology
50 State Pathology Socieities
The College and its coalition partners have pressed CMS to withdraw the MUE proposal and have argued that the agency should be required to utilize the formal rulemaking process to develop sweeping unit of service limits for all pathology and clinical laboratory services. The College has also asked the agency to provide the rationale and methodology utilized to develop the MUE proposal.

 

[elperro]

Thanks for the post tsj, nice to see that got stopped.