CMS to correct PET overpayments

The U.S. Centers for Medicare and Medicaid Services (CMS) on July 6 will begin to correct for recent reimbursement overpayments for certain PET procedures and applications.

According to SNM of Reston, VA, CMS officials in early June confirmed with the organization that recent files submitted to Medicare were incorrect and that a corrected file would be sent to the payors for the July 6 Medicare Physician Fee Schedule update.

SNM noted that in late May a number of its members reported a sudden increase in Medicare technical and global payments for PET studies, specifically for CPT codes 78811-78816, 78608, 78459, 78491, and 78492 paid in the physician fee schedule.

The CPT codes apply to PET imaging of tumors, myocardial imaging at rest and stress, and the use of PET radiopharmaceuticals.

The CPT codes did not contain the CMS capped rate, resulting in overpayments beginning May 24. A temporary fix was implemented by CMS on June 3 to avoid additional overpayments on claims received between June 4 and July 5.

CMS plans to correct the physician fee schedule file with the July release, beginning July 6. Once all the claims have completed processing, CMS will begin to recoup the overpayments.

Related Reading

CMS proposes 6.1% cut in 2011 Medicare payments, June 29, 2010

CMS proposes change to PET restriction, May 7, 2010

CMS proposes 2011 inpatient payment rates, April 20, 2010

CMS offers reprieve to SGR rate cuts, March 31, 2010

CMS delays PECOS implementation until 2011, February 18, 2010

Copyright © 2010 AuntMinnie.com

Page 1 of 435
Next Page