|
|
 |
 |
 |
|
|
|||
|
||||
|
||||
FW: [OB/GYN (OB)] RE: Direct Supervision for OBGYNFrom: DuBose, Terry (DuboseTerryJ@uams.edu)Thu Apr 6 08:41:16 2006
Don. Thanks for providing this update. Terry J. DuBose, M.S., RDMS, FSDMS, FAIUM Associate Professor & Director Diagnostic Medical Sonography Program University of Arkansas for Medical Sciences, CHRP 4301 West Markham St. Mail Slot #563 Little Rock, Arkansas, 72205 USA 501-686-6510 DuBoseTerryJ@UAMS.edu http://www.uams.edu/chrp/sonography/ http://www.obgyn.net/us/panel/panel.htm http://www.io.com/~dubose/ ---------------------------------------------------------------
--------------------------------------------------------------- -----Original Message----- --------------------------------------------------------------- From: webmaster@sdms.org [mailto:webmaster@sdms.org] Sent: Wednesday, April 05, 2006 5:12 PM To: forums@sdms.org Subject: [OB/GYN (OB)] RE: Direct Supervision for OBGYN sonography??? There has been a new posting in the SDMS Discussion Forums Written by: dhaydon http://www.sdms.org/members/forums/link.asp?TOPIC_ID=1706 ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ MESSAGE: SDMS Members, This discussion thread related to 'upgraded' supervision level requirements by CMS for a group of recently updated OB codes, resulted in our filing a request with our legal/lobbying counsel in Washington, D.C. for additional information. That response is posted below. Following the response is a brief description of SDMS plans to address the issue. Response from SDMS legal/lobbying firm, Sidley-Austin, Washinton, D.C. Under 42 C.F.R. § 410.32(b), diagnostic tests payable under the physician fee schedule must be furnished under the appropriate level of supervision by a physician. Services furnished without the required level of supervision are unreasonable and unnecessary, 42 C.F.R. § 410.32(b), and, therefore, not covered under Medicare. Transmittal No. B-01-28 Apr. 19, 2001. Therefore, if the diagnostic tests associated with OB codes 76801, 76802, 76811, 76812, and 76817 are furnished without the required level of personal supervision, the tests are considered unreasonable and unnecessary and, consequently, not covered under Medicare. Though possible, it is unlikely that an employed sonographer would be pursued by the government for Medicare fraud for being associated with a service provided under a lesser standard of supervision where the employer made the decision to submit the claim and the sonographer merely provided services under a good faith belief that the service was provided with a medically appropriate level of supervision. We conclude that this is so at least in part based on the information that your members have provided to you and to us suggesting that a personal level of supervision is not medically required and that, therefore, the standard articulated currently by the Medicare program is subject to challenge. We recommend that sonographers openly discuss these issues with their employers and encourage the employers to communicate with CMS regarding their disagreement with the existing policy, their belief that it is ill-founded, and that services will be provided and billed in the interim under a lesser, but medically appropriate level of supervision, pending CMS review of this issue. This level of transparency should both reduce the potential that the government would conclude that any intent to defraud was at work and would assist SDMS in securing a policy change. Although employers face a greater degree of risk than do employed sonographers, we believe that the risk management advice discussed above can meaningfully manage the risks faced by employers, as well. The penalties for Medicare fraud, if it were established, could be quite severe. Where a criminal intent was established, imprisonment is possible. Under the Civil False Claims Act, violations of that statute could lead to damages in the amount of three times the actual loss to the government (the amount claimed on the affected claims), plus up to $11,000 per claim, and potentially exclusion of the individuals or entities involved from the federally funded health care programs. William Sarraille, JD Sidley Austin SDMS will be addressing this issue in an attempt to have the required supervision levels associated with these codes reconsidered. This effort will involve the surveying of the SDMS membership who provide OB services to establish an accurate profile of 'current practice'. Additionally, SDMS will be in contact with CMS regulators to request face-to-face meetings to present our argument.
-- ================================================================================================
|
|
Return to
|
Mail a New Message to the Forum: ultrasound@obgyn.net Forum Administrator: terry.dubose@obgyn.net Report Technical Problems: webmaster@obgyn.net Last Updated: Thu Oct 2 05:20:14 2008 |
The American Medical Association is no longer designating CME hours for AMA Category II CME credit. However, physicians themselves may self designate learning activities as Category II CME credit hours if they feel it is of sufficient educational merit and meets the formal definitions of continuing medical education. OBGYN.net believes these interaction in this forum meets these criteria. For further information see the AMA web site.