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Archive for March, 2010
|Overpayment Recovery Effort
Wednesday, March 31st, 2010
Recent data analysis, conducted by National Government Services’ Operational Units, identified Medicare overpayments were made to provider and supplier organizations in prior years. National Government Services began notifying all impacted providers/suppliers in November 2009. The provider/supplier notification provides demand letter(s) for any debts owed to the Medicare program, pursuant to the Medicare requirements of participation and rules regarding Medicare overpayment guidelines as described in the Centers for Medicare & Medicaid Services (CMS) Internet-Only Manual (IOM) Publication 100-06, Medicare Financial Management Manual, Chapter 3, Overpayments. 
(890 KB)
If your organization receives an overpayment recovery demand letter from National Government Services, please be prepared to respond accordingly. Please be aware that if you have more than one overpayment, you may receive more than one demand letter in an envelope. If you have questions, please contact the National Government Services Provider Contact Center.
Due to the nature of these overpayments, an extended repayment plan (ERP) may be a viable option for you. If you believe you meet this criteria, please submit the required documentation outlined in the Extended Repayment Plan Request Form. 
This document provides you all necessary mailing information.
As with other Medicare overpayments, you have the option to remit your payment:
- to the address in the overpayment demand letter you receive; or
- complete the Overpayment Recovery Unit Part B Carrier Offset Request Form to begin immediate offset of the debt.
If you elect the immediate offset option, remember that outstanding claim payments due you will be withheld until the total overpayment balance including interest has been satisfied.
If you disagree with the overpayment determination you receive, you may request an appeal.
Posted in MEDICARE UPDATES | No Comments »
The Patient Protection and Affordable Care Act (PPACA)
Tuesday, March 30th, 2010
On March 23, 2010, President Obama signed into law the Patient Protection and Affordable Care Act (PPACA). The Centers for Medicare & Medicaid Services (CMS) is working hard to expeditiously implement the new law. The law’s Medicare fee-for-service provisions have varying effective dates and our first priority is to address provisions with the earliest effective dates. CMS is committed to assuring Medicare providers are well informed as early as possible. For that reason, CMS is urging you to be on the alert for notices and instructions from CMS and from your Medicare fiscal intermediary, carrier, or Medicare Administrative Contractor, on forthcoming policy and operational changes as we implement the PPACA.
Posted in NATIONAL HEALTHCARE NEWS | No Comments »
Enhanced LCD Access in NGS Medical Policy Center
Monday, March 29th, 2010
National Government Services has enhanced the Medical Policy Center (MPC) page on the NGSMedicare.com Web site, offering a powerful new way to search for local coverage determinations (LCDs).
The MPC page offers coverage-related information to help providers and beneficiaries research Medicare coverage and submit correctly-coded claims. It includes access to LCD information hosted in the Medicare Coverage Database (MCD) in the Centers for Medicare & Medicaid Services (CMS) Web site. It also includes access to coverage articles and supplemental instructions articles (SIAs) linked to each LCD.
LCD Search Capability
The MPC is the only place within NGSMedicare.com that provides LCD information and that links directly to the CMS MCD. The key enhancement to the page is the addition of two search fields for LCDs and articles:
§ One field enables searches by LCD title, keywords, procedure names, HCPCS, or CPT codes.
§ The other field enables LCD searches by the CMS Identifier Number (i.e., LXXXXX or AXXXXX).
The new feature enables tightly-targeted searches and sharply reduces the number of LCDs returned with each query, which allows you to find coverage and coding information more efficiently.
Reorganized Links
In addition, National Government Services has reorganized the links to all coverage-related information on the MPC page. The revamped links are more recognizable and readable, making searches faster and easier. Each link is identified by a double-arrow bullet and an icon indicating the content type and whether or not the content is hosted on the National Government Services Web site.
Improved Instructional Guides
Finally, each section of the MPC page includes a Need Help button leading to improved instructions for using the various sections of the MPC.
Thank you,
National Government Services, Inc.
Corporate Communications
Posted in MEDICARE UPDATES | No Comments »
Holding of April Claims for Services Paid Under the 2010 Medicare Physician Fee Schedule
Monday, March 29th, 2010
Information Regarding the Holding of April Claims for Services Paid Under the 2010 Medicare Physician Fee Schedule (3-26-2010)
The Centers for Medicare & Medicaid Services (CMS) is working with Congress, health care providers, and the beneficiary community to avoid disruption in the delivery of health care services and payment of claims for physicians, non-physician practitioners, and other providers of services paid under the Medicare Physician Fee Schedule (MPFS). As you are aware, the Temporary Extension Act of 2010, enacted on March 2, 2010, extended the zero percent (0%) update to the 2010 MPFS through March 31, 2010.
CMS believes Congress is working to avert the negative update that will take effect April 1. Consequently, CMS has instructed its contractors to hold claims containing services paid under the MPFS (including anesthesia services) for the first 10 business days of April. This hold will only affect claims with dates of service April 1, 2010, and forward. In addition, the hold should have minimum impact on provider cash flow because, under the current law, clean electronic claims are not paid any sooner than 14 calendar days (29 for paper claims) after the date of receipt.
Be on the alert for more information about the 2010 Medicare Physician Fee Schedule Update.
Posted in MEDICARE UPDATES | No Comments »
Congress Fails to Prevent April 1 cut in Medicare Physician Payments
Friday, March 26th, 2010
Last night, the Senate held floor debate on a bill, H.R. 4851, that would extend a number of expiring programs through April. That bill, which had already passed the House, includes a 30-day extension of current Medicare physician payment rates, postponing once again the 21.3 percent cut scheduled to take effect in 2010. It also addressed a number of other programs such as extensions of COBRA benefits and unemployment insurance benefits for Americans who have lost their jobs. In a replay of the standoff that occurred a month ago, this time it was Senator Tom Coburn (R-OK) who objected to the bill’s consideration, on the basis that it should not be considered emergency spending that would be exempt from budgetary offsets. As a result, Congress will adjourn for its two-week spring recess without taking action to stop these programs from expiring. We are told that the Senate plans to hold a cloture vote after the recess which, if supported by 60 Senators, will allow a vote to occur on the legislation. That vote could occur as early as April 12.
Congress failed to act yet again and, as a result, the 21.3 percent Medicare physician payment cut will take effect on April 1. We have contacted the Centers for Medicare and Medicaid Services (CMS) and they will be making an announcement shortly about their plans for handling the situation. Judging from past experience, CMS will not be forced to process claims at the reduced payment rates for 10 business days.
This repeated game of brinksmanship is wreaking havoc with physician practices, and is causing both physicians and patients to lose confidence in the Medicare program. It illustrates in stark terms why medicine can no longer support short-term “fixes” to a formula that we knew would not work at the time Congress created it.
The Federation is urged to track down their Representatives and Senators during their spring break and hold them accountable for their inability to do what they know is right for patients and their physicians. Forty-five million Americans count on Medicare, and physicians simply cannot run viable practices in an environment with such extreme financial uncertainty. Medicine knew when Congress created the sustainable growth rate (SGR) formula that it would not work, and this point has been proven every year for nearly a decade. Congress must stop playing games with physicians and patients and do what they know must be done: Repeal the SGR formula once and for all.
Jen Lee Wagner Field Representative
Posted in NATIONAL HEALTHCARE NEWS | No Comments »
Final Rule with Request for Comments – Drug Enforcement Administration (DEA), Electronic Prescribing of Controlled Substances.
Friday, March 26th, 2010
Attached please find the Interim Final Rule with Request for Comments from the Drug Enforcement Administration (DEA), Department of Justice on Electronic Prescribing of Controlled Substances.
The Interim Final Rule specifies the rules that health care providers will need to follow in order to electronically prescribe controlled substances in accordance with the law. Since DEA published the Notice of Proposed Rulemaking for electronic prescribing of controlled substance, ONC, CMS, AHRQ and other HHS staff have worked closely with DEA to develop the policies in the Interim Final Rule. The Interim Final Rule is expected to be published in the Federal Register on Wednesday, March 31 and will include a 60 day comment period. If the federal Register is published on 3/31, you should have until May 30, 2010 to submit any comments you might have regarding this Interim Final Rule.
Comments may be sent to DEA by sending an electronic message to dea.diversion.policy@usdoj.gov . Comments may also be sent electronically through http://www.regulations.gov <http://www.regulations.gov/> using the electronic comment form provided on that site. To ensure proper handling of comments, please reference “Docket No.DEA-218″ on all written and electronic correspondence.
To view the federal Register go to: http://www.federalregister.gov/OFRUpload/OFRData/2010-06687_PI.pdf
Posted in Uncategorized | No Comments »
CERT Alert: Dual-Chamber Cardiac Pacemaker Insertion Denial
Friday, March 26th, 2010
Attention Facilities and Providers who bill Noninvasive Vascular Studies
Summary: National Government Services has a local coverage determination (LCD) L27355 and supplemental instruction article (SIA) A47394 to assist providers in determining medically necessary services and how they should be supported in documentation. All providers who bill Medicare for Noninvasive Vascular services should be familiar with the LCD and SIA. Claims will begin editing based on the current LCD in the next 30 to 60 days. Prevent unnecessary denials or returns by adhering to the policy guidelines.
For more information please read the article titled, “Dollars at Risk for Local Coverage Determination L27355: Noninvasive Vascular Studies Edit.”
Providers Who Bill for Scanning Computerized Ophthalmic Diagnostic Imaging (SCODI) National Government Services has a local coverage determination (LCD) L28488 and supplemental instruction article (SIA) A48003 to assist providers in determining medically necessary services and how they should be supported in documentation. All providers who bill Medicare for SCODI services should be familiar with the LCD and SIA. Claims will begin editing based on the current LCD in the next 30 to 60 days. Prevent unnecessary denials or returns by adhering to the policy guidelines.
For more information please read the article titled, “Dollars at Risk for Local Coverage Determination Scanning Computerized Ophthalmic Diagnostic Imaging L28488 Edit
Posted in MEDICARE UPDATES | No Comments »
Physicians Urged to Support Managed Care Reform in State Budget
Monday, March 15th, 2010
Posted in NEWS FROM THE NYS LEGISLATURE | No Comments »
Change is Coming…National Government Services to Consolidate Mail & Distribution Hubs
Thursday, March 11th, 2010
Over the next three months, National Government Services will consolidate its mail and distribution function from the current two mail hubs in Indianapolis, IN and Syracuse, NY, to a single facility in Indianapolis.
Mail will be forwarded from Syracuse to Indianapolis as workload is shifted. Providers will be notified in April of the new P.O. Box numbers they are to use.
The Mail & Distribution Hub consolidation should be transparent to providers as mail will be forwarded immediately as each operational segment of mail operations is transferred from Syracuse to Indianapolis.
Please watch for future Listserv notices and bulletin articles for the new P.O. Boxes and other information.
Thank you,
National Government Services, Inc.
Corporate Communications
Posted in Uncategorized | No Comments »
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