During a Medicare Town Hall Meeting, more than 60 Los Angeles County physicians expressed their frustration about Medicare PR 49 denials to officials from the Centers for Medicare and Medicaid Services. The Los Angeles County Medical Association and the California Medical Association sponsored the members-only event at LACMA headquarters on Sept. 28.

Featured panelists included:

* Bruce Quinn, MD, medical director, California Medicare Part B, National Heritage Insurance Co.; 

* Beth Romig, benefit integrity manager, EDS, California Benefit Integrity Support Center (CAL-BISC); and

* Diane Caradeuc, associate regional administrator, Division of Medicare Financial Management, CMS, San Francisco.

Since 2003, physicians nationwide have been complaining that Medicare claims were being denied using the PR 49 code. The code refers to routine patient services that have been deemed medically unnecessary by CMS due to possible fraudulent activity, either by the patient, physician or both, or for purposes of identity theft. Romig showed physicians how they can protect themselves and beneficiaries from Medicare fraud and PR 49 denials.

"As a physician, you are responsible for your Medicare number and the dollars paid to your Medicare number," Romig says. "You must know your biller, know your management company and be leery of 'easy money.' If you suspect someone is abusing your Medicare provider number, call CMS or NHIC, deactivate your number, and protect yourself. If you think your claims are being denied incorrectly, appeal the claims and follow the normal procedures. Also, ask CAL-BISC to review your billing practices."

LACMA physicians and staff in attendance included Arthur E. Auer, LACMA CEO; David Aizuss, MD, LACMA president-elect; and Catalina Jovane, director of economic advocacy services. Frank Navarro, associate director for the CMA Center for Economic Services, was the moderator for the three-hour meeting.

In closing, CMS officials agreed to conduct individual audits of physician provider numbers. Nearly 10 percent of the attendees signed up for the service.