Physicians hold talks with HCFA over payment issues
Providers want to clarify standards on CCU claims
Physicians from several critical care organizations are involved in long-range talks with Medicare officials over ways of bringing more consistency to Medicare reimbursements for the care of critically ill patients enrolled in the federal program.
While the discussions focus specifically on physicians’ fees, whatever resolutions arise from the talks could have implications on Medicare reimbursements for technical, nursing, and other components of hospital-based care.
A panel of physicians representing several professional societies, including the Society of Critical Care Medicine (SCCM) in Anaheim, CA, has been meeting with officials of Bethesda, MD-based Health Care Financing Administration.
The groups are trying to address some of the problems physicians say they have experienced when billing their Medicare carriers for services delivered in hospital critical care units. The providers assert that the carriers are applying varying standards when interpreting claims, which have resulted in some claims being denied or reduced in level of intensity.
Critical care claims are being denied, reduced
Phil Dellinger, MD, a critical care physician and spokesman for The Critical Care Working Group, a coalition of providers, declined to go into details about physicians’ complaints out of concern, he states, for the status of the deliberations. But Dellinger indicated the problem has centered on "inconsistencies in the way the Medicare carriers are viewing critical care claims for payment."
"The group is trying to recommend to HCFA that it clarify its policy on what is or isn’t critical care and on what the carriers will and won’t allow for payment," Dellinger tells Critical Care Management.
However, he declines to comment on the status of the talks, which have been going on since last October, saying only that the discussions are "polite and collegial."
He hinted that the group expects a draft of specific policy clarifications or guidelines to be issued to the Medicare carriers, and that one may already be under way.
In addition to SCCM, the coalition consists of members from the American College of Chest Physicians, Northbrook, IL; the American Thoracic Society, New York City; the National Association for the Medical Direction of Respiratory Care, Chevy Chase, MD; the American Association for the Surgery of Trauma, Louisville, KY; and the American Society of Critical Care Anesthesiology, Free Union, VA.
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