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Archive for April, 2010
|MEMORANDUM IN OPPOSITION to 9.63% HCRA SURCHARGE
Thursday, April 29th, 2010
ESTABLISHMENT OF A 9.63% HCRA SURCHARGE ON OFFICE-BASED SURGICAL AND RADIOLOGICAL PROCEDURES
As contained in the Governor’s Health Budget Art. VII bill (A.9708/S.6608)
This measure contained within the Health and Mental Hygiene Article VII bill would extend the 9.63% HCRA surcharge to services billed as surgery or radiology services which have been provided in physician offices or in urgent care facilities. The Medical Society of the State of New York opposes this provision and urges that that it be removed from the State Budget.
We agree that health insurance companies, which have made extraordinary profits over the last several years, must re-invest these profits back into the healthcare system. They cannot continue to extract from the healthcare delivery system the equity in that system which is essential to its future growth. In this regard, MSSNY supports the proposal contained in the proposed State Budget that would restore the authority of the State Insurance Department (SID) to approve proposed increases in health insurance premium rates, as well as increasing to 85% the minimum medical loss ratio for the nearly 2 million individuals enrolled in small group and individual health insurance policies.
However, while this surcharge would be imposed on the health insurer, not the physician, we are very concerned with the potential that this surcharge will simply be passed through to the physicians who are providing this care through substantial payment reductions and/or to their patients through imposition of higher cost-sharing obligations. Simply put, individual physicians and even group practices lack sufficient leverage now enjoyed by much of the hospital sector to forestall or prevent a possible 9.63% cut in their payment which might be imposed by health insurers to offset the surcharge imposed on them.
Many physician practices today are barely solvent. There are a number of reasons for this, including rapidly escalating practice costs led by the extraordinary cost of medical liability insurance. At the same time, physicians are confronted with declining practice revenue. Radiologists in particular will suffer significant Medicare cuts as a result of the federal health care reform bill. Already in every region of New York State, we are experiencing a significant shortage of critically needed physicians in a number of specialties. The impact of this one proposal, if the proper protections are not established preventing health insurers from passing on these costs, could cause an even larger number of physicians to retire early, alter their practices, or relocate their practices outside of New York State. Access to need surgical and radiological care must be protected.
Based upon the foregoing, your medical society opposes this component of the Governor’s Budget and urges that it be removed.
Posted in NEWS FROM THE NYS LEGISLATURE | No Comments »
CMS APPROVES NEW YORK MEDICAID ELECTRONIC PRESCRIPTION PROGRAM: BEGINS MAY 1ST
Monday, April 26th, 2010
It is important to note that the Medicaid e-prescribing incentive program applies only to an electronic transmission For the purposes of the incentive program, an electronic prescription (e-prescription) is defined as: a prescription created electronically and transmitted via encrypted, interoperable computer-to-computer electronic data interchange in machine-readable (non-facsimile) format that is compliant with Medicare Part D data standards and requirements and New York State Pharmacy Regulations.
The e-prescription must originate from the prescriber’s computer system (an electronic health record, electronic medical record, or stand-alone e-prescribing software) and must be transmitted to the retail pharmacy’s computer system. It is permissible to employ the services of an intermediary or e-prescribing network to transmit the e-prescription. The incentive will not apply to prescriptions transmitted electronically by facsimile.
To be eligible to participate in this incentive program, physicians must be enrolled in the Medicaid FFS program and have an individual National Provider Identifier (NPI) number. Moreover, the e-prescription must be compliant with Medicare Part D standards. Medicare currently requires the use of the National Council for Prescription Drug Programs (NCPDP) Prescriber/Pharmacist Interface SCRIPT standard Version 8.1. Additionally, to qualify for the incentive, the e-prescription must be written for a beneficiary who is enrolled in Medicaid FFS, Medicaid Managed Care, or Family Health Plus programs. The incentive program does not affect current Medicaid prior authorization requirements. Consequently, before transmitting the e-prescription for certain drugs, prior authorization may be required.The incentive payment will be applicable to one original fill and up to five (5) refills within 180 days to both the prescriber and pharmacy, provided that the refilled item is picked up by or delivered to the beneficiary. This represents a maximum payment of $4.80 to the prescriber, and $1.20 to the pharmacy. MSSNY is working with the Department of Health to assure that physicians and their eligible ancillary prescribing associates are apprised of the availability of this incentive program and its requirements. The long-term goals of the program are to reduce medication errors, encourage pharmaceutical practices that produce better patient outcomes, and yield savings.
Posted in MEDICAID UPDATES | No Comments »
Customer Care Online Inquiry Form added to NGSMedicare.com Web site.
Friday, April 23rd, 2010
A Customer Care Online Inquiry Form has been added to the NGSMedicare.com Web site.
The form can be used by providers/suppliers to submit questions and requests (claims filing issues, Medicare coding queries, etc.) to the General Inquiries team and offers a faster and more efficient alternative to the current paper process. To access the new online inquiry form on the National Government Services Web site, follow these steps:
- Go to the www.NGSMedicare.com home page
- Select your Business Type, Region, and select Go
- Select the Resources navigation category
- Select the Contact Us subnavigation option
- Select the Provider Contact Center index link
- Under the page heading Written Correspondence and Inquiries, select the Customer Care Online Inquiry Form link
Thank you,
National Government Services, Inc.
Corporate Communications
Posted in MEDICARE UPDATES | No Comments »
President Obama Signs Yet Another SGR Bandaid Bill
Monday, April 19th, 2010
Late on Friday, April 16 the President signed H.R. 4851, the Continuing Extension Act of 2010, into law, reinstating Medicare physician payments to where they were on March 31 and again postponing the 21.3 percent cut that was supposed to take effect in 2010. This most recent extension of 2009 payment rates will continue through the end of May, and will be applied retroactively to all physician services provided to Medicare patients in April. The legislation passed the Senate at about 5:45 last night by a bipartisan vote of 59-38, and subsequently passed the House shortly after 8:00 pm by a bipartisan vote of 289-112.
Yesterday (4/15), the hold on processing April claims that the Centers for Medicare & Medicaid Services (CMS) had placed to avoid implementing the payment cut technically expired. However, with Congressional action so imminent, we do not believe many claims were actually processed at the lower payment rates. However, we have been informed by CMS that any claims paid that reflected the 21.3 percent cut will be reprocessed automatically without any action required from physicians.
The AMA is continuing to work closely with House and Senate leadership offices and with White House officials on a long-term solution to the sustainable growth rate formula, and we expect to have more to report on these efforts very soon.
Posted in MEDICARE UPDATES, NATIONAL HEALTHCARE NEWS | No Comments »
CMS ISSUES FINAL 2011 PAYMENT POLICIES FOR MEDICARE ADVANTAGE AND PRESCRIPTION DRUG PLANS
Friday, April 9th, 2010
Background: On April 5, 2010, the Centers for Medicare & Medicaid Services (CMS) announced the capitation rates for Medicare Advantage plans for 2011. The 2011 Rate Announcement was accompanied by the final 2011 Call Letter for Medicare Advantage (Part C) and Medicare prescription drug (Part D) plans.
CMS stated in the 2011 Advance Notice that, if new legislation was enacted after the Advance Notice was released, but before the Rate Announcement was published, changes would be incorporated into the Announcement. As required by Section 1102 of the Health Care and Education Reconciliation Act of 2010, the capitation rates for 2011 are the same as the capitation rates for 2010.
In previous years’ Rate Announcements, CMS included final estimates of the National Per Capita Growth Percentages (MA Growth Percentages) as well as tables summarizing the key assumptions that were used to develop the MA Growth Percentages. The final estimates of the MA Growth Percentages were used to trend the previous years’ capitation rates to the payment year. Given that the capitation rates for 2011 are the same as the capitation rates for 2010, the MA Growth Percentages have no relevance for the 2011 capitation rates. Therefore, this Rate Announcement does not include final estimates of the MA growth percentages or the associated key assumptions tables.
The Rate Announcement also contains the following key changes in response to this new legislation:
- CMS will not implement the new CMS-HCC and CMS-HCC ESRD dialysis and risk adjustment models or the recalibrated frailty factors in 2011.
- CMS will maintain the 2011 State ESRD rates at the 2010 amounts.
- As required by the Patient Protection and Affordable Care Act of 2010, CMS will calculate the government Part D premium subsidy amounts for low-income beneficiaries using plans’ basic part D premiums before the premiums are reduced by Part C rebates. This will help ensure that the premium subsidy in each Part D region provides low-income beneficiaries with a sufficient choice of plans for which they would incur no premium liability.
The Rate Announcement also contains a discussion of the provisions in the health reform legislation that begin to close the Part D coverage gap in 2011 and the effect of these provisions on plans’ Part D bids.
In addition to changes resulting from new legislation, the following key changes or updates have been made to the Advance Notice and draft Call Letter in response to public comments received from beneficiary advocacy groups, associations, Congressional agencies, members of the public, and health plans:
- CMS describes the methodology that will be used to adjust the ‘default’ risk scores for new enrollees to reflect the predicted costs of full risk enrollees in chronic care SNPs.
- CMS notes that for beneficiaries to receive reimbursement for clinical trial services, beneficiaries (or providers acting on their behalf) must notify their plan that they have received clinical trial services and provide documentation of the cost sharing incurred, such as a Medicare Summary Notice (MSN). CMS will explore ways that this information can be provided to plans in the future to alleviate the potential burden on beneficiaries.
- CMS states that, at this time, low-income beneficiaries who originally chose to enroll in their current plan will not be reassigned, but several methods to make beneficiaries more aware of their options are being considered. CMS will also continue to evaluate the merits of reassigning beneficiaries based on beneficiary drug utilization.
- CMS announces that we intend to issue a regulation proposing to authorize the release of Part C and Part D payment data.
Annual parameter updates to Medicare Part D benefits are unchanged (with the exception of a $10 increase in the Initial Coverage Limit).
|
Part D Benefit Parameters |
2010 | 2011 |
| Defined Standard Benefit | ||
| Deductible | $310 | $310 |
| Initial Coverage Limit | $2,830 | $2,840 |
| Out-of-Pocket Threshold | $4,550 | $4,550 |
| Minimum Cost-sharing for Generic/Preferred
Multi-Source Drugs in the Catastrophic Phase |
$2.50 | $2.50 |
| Minimum Cost-sharing for Other Drugs in the
Catastrophic Phase |
$6.30 | $6.30 |
| Retiree Drug Subsidy | ||
| Cost Threshold | $310 | $310 |
| Cost Limit | $6,300 | $6,300 |
(Note: The changes from 2010 to 2011 are rounded to the closest appropriate unit)
The Final Rate Announcement and Call Letter can be viewed at: http://www.cms.hhs.gov/MedicareAdvtgSpecRateStats/ .
Posted in MEDICARE UPDATES | No Comments »
CMS Needs Your Help With the Medicare Contractor Provider Satisfaction Survey
Friday, April 9th, 2010
CMS needs to hear from you!
- To date, the response rate for physicians, hospitals, RHCs, and FQHCs, randomly selected to participate in the 2010 MCPSS, and billing agents designated by providers as proxy respondents, is lower than expected.
- If you or your office received a letter inviting you to participate in this survey, or you have been designated by a provider as a proxy respondent, now is the time to give CMS your feedback on your satisfaction with the performance of the Medicare contractor that processes and pays your fee-for-service (FFS) Medicare claims.
- Your feedback is very important to the success of this survey, as you represent many other organizations similar in size, practice type, and geographical location.
- Completion of the survey is quick and easy – it only takes a few minutes of your time.
- To complete the survey or to designate a proxy respondent to complete the survey on your behalf, please call the MCPSS Provider Helpline at 1-800-835-7012 or send an email to mcpss@scimetrika.com. Someone on the MCPSS team will be happy to assist you.
- Approximately 30,000 Medicare FFS health care providers were randomly selected to participate in the 2010 survey; only those selected may participate. A new random sample is selected each year.
- For more information, visit the CMS MCPSS website at http://www.cms.hhs.gov/mcpss, or read the CMS MLN Matters Special Edition article, SE1005, at http://www.cms.hhs.gov/MLNMattersArticles/downloads/SE1005.pdf featuring the survey.
- CMS urges you to take a few minutes today to complete and submit this important survey. Your feedback is needed now. Don’t delay. Please respond today!
Posted in MEDICARE UPDATES | No Comments »
Providers Receiving Paper Remittances
Friday, April 9th, 2010
Providers now have an alternative to waiting two weeks to have their paper remittances mailed to them. Simply sign up for Medicaid’s Electronic Funds Transfer (EFT) option and you may also sign up to receive your paper remittance via a pdf file two weeks early.
Advantages of Electronic Funds Transfer (EFT)
- Save trips to the bank to deposit your checks from Medicaid.
- Eliminates the possibility of your checks being lost in the mail.
- Good for the environment by eliminating the printing of paper checks.
For information about how to sign up for EFT visit www.emedny.org , and click on Provider Enrollment Forms. Then click on Provider Maintenance Forms and scroll to the bottom of the page. The EFT form is located in the section titled Miscellaneous Maintenance Forms.
If you sign up for EFT and are receiving paper remittances, you are also eligible to have your paper remittance sent to you on eXchange as a PDF file. The PDF file will be sent to you 2 weeks earlier than your paper remittance would be mailed. The PDF remittance will look exactly like the paper remittance and contain the same information, but it offers some obvious advantages. This is a brand new option being offered only to Medicaid providers who sign up for EFT.
Advantages of PDF Remittances
- The PDF file will be transmitted to you on the check date, more than two weeks earlier than your paper remittance.
- You will be able to access the results of the current Medicaid claims processing cycle almost immediately, allowing you to make any necessary corrections to your claims much sooner, and improve your cash flow.
- The PDF file format allows you to word search, so you can locate specific claims more quickly.
- The PDF file may be printed with Adobe Reader* and/or saved on your computer.
- Adobe Reader® (6.0 release or higher required) is distributed free of charge by Adobe Systems Incorporated.Transmission of the PDF file is more secure and efficient than mailing hardcopies of remittances.
- You become a larger part of the GO GREEN effort to help the planet.
How Do I Sign Up?
The PDF Remittance Request Form can be located on www.emedny.org by selecting Provider Enrollment Forms, then Provider Maintenance Forms. Carefully follow instructions and return the form to the address indicated.
You may sign up for EFT and PDF remittances at the same time by completing both applications and sending them together to the address specified on the EFT application. Your PDF remittances will begin even before your first payment is received by Electronic Funds Transfer!
Please note that in order to receive your remittances on eXchange, you must have an eXchange user ID. If you are not currently enrolled in eXchange, call the Call Center at the number below for assistance.
Conversion from a paper remittance to a PDF file format remittance offers you a great opportunity to streamline and enhance your Medicaid billing practice. We urge you to give it serious consideration.
If you have any additional questions about Electronic Funds Transfer or PDF Remittances, contact the eMedNY Call Center at 1-800-343-9000.
Posted in MEDICAID UPDATES | No Comments »
2010 PQRI & eRx Q&A Session Coming on April 15
Monday, April 5th, 2010
The Centers for Medicare & Medicaid Services’ (CMS) Provider Communications Group will host a national provider conference call on the 2010 Physician Quality Reporting Initiative (PQRI) and Electronic Prescribing Incentive Program (eRx). This toll-free call will take place from 3:30 p.m. – 5:00 p.m., EDT, on Thursday, April 15, 2010.
The PQRI is voluntary quality reporting program that provides an incentive payment to identified individual eligible professionals (EPs), and beginning with the 2010 PQRI, group practices who satisfactorily report data on quality measures for covered Physician Fee Schedule (PFS) services furnished to Medicare Part B Fee-For-Service (FFS) beneficiaries.
The PQRI was first implemented in 2007 as a result of section 101 of the Tax Relief and Health Care Act of 2006 (TRHCA), and further expanded as a result of the Medicare, Medicaid, and SCHIP Extension Act of 2007 (MMSEA), and the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA).
The eRx Incentive Program is an incentive program for eligible professionals initially implemented in 2009 as a result of section 132(b) of the MIPPA. The eRx Incentive Program promotes the adoption and use of eRx systems by individual eligible professionals (and beginning with the 2010 eRx Incentive Program, group practices).
Following a few program announcements and updates, the lines will be opened to allow participants to ask questions of CMS PQRI and eRx subject matter experts.
Educational products are available on the PQRI dedicated web page located at, http://www.cms.hhs.gov/PQRI , on the CMS website, in the Educational Resources section, as well as educational products are available on the eRx dedicated web page located at http://www.cms.hhs.gov/ERxIncentive on the CMS website. Feel free to download the resources prior to the call so that you may ask questions of the CMS presenters.
Conference call details:
Date: April 15, 2010 Time: 3:30 p.m. EDT
Conference Title: Physician Quality Reporting Initiative (PQRI) – National Provider Call
In order to receive the call-in information, you must register for the call. It is important to note that if you are planning to sit in with a group, only one person needs to register to receive the call-in data. This registration is solely to reserve a phone line, NOT to allow participation. Registration will close at 3:30 p.m. EDT on April 14, 2010, or when available space has been filled. No exceptions will be made, so please be sure to register prior to this time.
- To register for the call participants need to go to:
http://www.eventsvc.com/palmettogba/041510
- Fill in all required data.
- Verify that your time zone is displayed correctly in the drop down box.
- Click “Register”.
- You will be taken to the “Thank you for registering” page and will receive a confirmation email shortly thereafter. Note: Please print and save this page, in the event that your server blocks the confirmation emails. If you do not receive the confirmation email, please check your spam/junk mail filter as it may have been directed there.
For those of who will be unable to attend, a transcript of the call will be available at least one week after the call at http://www.cms.hhs.gov/pqri on the CMS website.
If you require services for the hearing impaired please send an email to: Medicare.TTT@PalmettoGBA.com.
Posted in MEDICARE UPDATES | No Comments »
Timely Filing Requirements for Medicare Fee-For-Service Claims
Thursday, April 1st, 2010
On March 23, 2010, President Obama signed into law the Patient Protection and Affordable Care Act (PPACA), which amended the time period for filing Medicare fee-for-service (FFS) claims as one of many provisions aimed at curbing fraud, waste, and abuse in the Medicare program.
The time period for filing Medicare FFS claims is specified in Sections 1814(a), 1835(a)(1), and 1842(b)(3) of the Social Security Act and in the Code of Federal Regulations (CFR), 42 CFR Section 424.44. Section 6404 of the PPACA amended the timely filing requirements to reduce the maximum time period for submission of all Medicare FFS claims to one calendar year after the date of service.
Under the new law, claims for services furnished on or after January 1, 2010, must be filed within one calendar year after the date of service. In addition, Section 6404 mandates that claims for services furnished before January 1, 2010, must be filed no later than December 31, 2010. The following rules apply to claims with dates of service prior to January 1, 2010. Claims with dates of service before October 1, 2009, must follow the pre-PPACA timely filing rules. Claims with dates of service October 1, 2009, through December 31, 2009, must be submitted by December 31, 2010.
Section 6404 of the PPACA also permits the Secretary to make certain exceptions to the one-year filing deadline. At this time, no exceptions have been established. However, proposals for exceptions will be specified in future proposed rulemaking.
Please be on the alert for more information pertaining to the Patient Protection and Affordable Care Act.
Posted in MEDICARE UPDATES | No Comments »
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