Some physicians are reporting that the Medicare payments they've received for their services in 2012 are being reduced for a failure to prescribe enough electronically in 2011, even though the doctors filed waiver requests seeking special hardship exemptions.

By JIM SAUNDERS
THE NEWS SERVICE OF FLORIDA

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THE CAPITAL, TALLAHASSEE, December 4, 2012.........While Florida Republican leaders grapple with carrying out the federal Affordable Care Act, the state's primary-care physicians are poised to get a raise Jan. 1 if they treat Medicaid patients.

Our Third Party Liaison Committee has been notified by a number of Florida ophthalmologists that they have been receiving denials from Medicare for bilateral eyelid procedures since April 1, 2013. Studies by the Government Accounting Office and the Office of Inspector General found that some providers (nationally) were being overpaid for bilateral surgery (modifier 50) procedures.

First Coast Service Options, Inc. (First Coast), the Medicare Administrative Contractor for jurisdiction 9 (MAC J9) which includes Florida, Puerto Rico and the U.S. Virgin Islands, is aware of the issue related to the inappropriate claim denials for certain eye visit services (92012/92014), when the codes are billed with other services performed on the same date of service and appended with modifier 25. A July 2013 NCCI edit has the services 92012 or 92014 bundled into column one CPT/HCPCS codes that describe surgical procedures with a global period of 0, 10, or 90 days.