Archive for June, 2010


Opportunity for Nonparticipating Physicians/Practitioners to Become Participating

Monday, June 28th, 2010

June 28, 2010

In consideration of the recent enactment of the Preservation of Access to Care for Medicare Beneficiaries and Pension Relief Act of 2010, which established a 2.2 percent update to the Medicare Physician Fee Schedule (MPFS), the Centers for Medicare & Medicare Services (CMS) is offering physicians and other practitioners, whose current participation status is non-participating, the opportunity to become participating (PAR).  This opportunity is being offered only to those physicians/practitioners whose current PAR status is non-participating.  This opportunity is available through July 16, 2010.

Non-participating physicians/practitioners who would like to become a participating physician/practitioner should download and complete the Medicare Participating Physician or Supplier Agreement (Form CMS-460).  The form can be obtained by using the following CMS web site link:

Any new CMS-460 form received during this limited enrollment period will be retroactive for claims with dates of service of January 1, 2010, and later.  However, the change in participation status will only apply to new MPFS claims submitted after your new status as a participating physician/practitioner is processed.  Claims previously submitted and processed will not be adjusted for only a change in participation status.

Medicare claims administration contractors (Medicare Administrative Contractors and carriers) will accept and process requests to become a participating physician/practitioner that are submitted on the CMS-460 form and are post-marked on or before July 16, 2010.

Diane Maupai  for

Robin Fritter, Director

Division of Provider Relations& Outreach

Provider Communications Group, CMS

(410) 786-7485

Posted in MEDICARE UPDATES | No Comments »


Monday, June 28th, 2010


The Centers for Medicare & Medicaid Services (CMS) today issued a proposed rule that would implement key provisions in the Affordable Care Act of 2010 that expand preventive services for Medicare beneficiaries, improve payments for primary care services, and promote access to health care services in rural areas.  The proposed policies would apply to payments under the Medicare Physician Fee Schedule for services furnished on or after January 1, 2011.

The proposed rule would implement provisions in the Affordable Care Act that will eliminate out-of-pocket costs for beneficiaries for most preventive services, including the new annual wellness visit.  This visit augments the benefits of the Initial Preventive Physical Examination (IPPE or “Welcome to Medicare Visit”) with an annual wellness visit that allows the physician and patient to develop a personalized prevention plan that includes not only the preventive services generally available to the Medicare population, but additional services that may be appropriate because of the patient’s individual risk factors.

The proposed rule would improve access to primary care services by implementing an incentive payment for primary care services furnished by primary care practitioners that can include physicians, nurse practitioners, clinical nurse specialists and physician assistants.  The proposed rule would also implement a payment incentive program for general surgeons performing major surgery in areas designated by the Secretary as Health Professional Shortage Areas (HPSAs), would allow physician assistants to order post-hospital extended care services in skilled nursing facilities, and would pay certified nurse midwives for their services under the Medicare Physician Fee Schedule (MPFS) at the same rates as physicians.

To read the entire CMS Press Release issued today (6/25) click here:

CMS Issued Fact Sheets (6/25) with additional details at:

The proposed rule is available at:


CMS will accept comments on the proposed rule until August 24, 2010, and will respond to them in a final rule to be issued on or about November 1, 2010.  Except as otherwise  specified, the payment policies and rates adopted in the final rule will be effective for services on or after January 1, 2011.


The President Signs the Preservation of Access to Care for Medicare Beneficiaries and Pension Relief Act of 2010

Friday, June 25th, 2010

2.2 Percent Medicare Physician Fee Schedule Update for June 1, 2010, Through November 30, 2010

On June 25, 2010, President Obama signed into law the “Preservation of Access to Care for Medicare Beneficiaries and Pension Relief Act of 2010.”  This law establishes a 2.2 percent update to the Medicare Physician Fee Schedule (MPFS) payment rates retroactive from June 1 through November 30, 2010.  The Centers for Medicare & Medicaid Services (CMS) has directed Medicare claims administration contractors to discontinue processing claims at the negative update rates and to temporarily hold all claims for services rendered June 1, 2010, and later, until the new 2.2 percent update rates are tested and loaded into the Medicare contractors’ claims processing systems.  Effective testing of the new 2.2 percent update will ensure that claims are correctly paid at the new rates.  We expect to begin processing claims at the new rates no later than July 1, 2010.  Claims for services rendered prior to June 1, 2010, will continue to be processed and paid as usual.

Claims containing June 2010 dates of service which have been paid at the negative update rates will be reprocessed as soon as possible.  Under current law, Medicare payments to physicians and other providers paid under the MPFS are based upon the lesser of the submitted charge on the claim or the MPFS amount.  Claims containing June dates of service that were submitted with charges greater than or equal to the new 2.2 percent update rates will be automatically reprocessed.  Affected physicians/providers who submitted claims containing June dates of service with charges less than the 2.2 percent update amount will need to contact their local Medicare contractor to request an adjustment.  Submitted charges on claims cannot be altered without a request from the physician/provider.  Physicians/providers should not resubmit claims already submitted to their Medicare contractor.

Valerie A. Haugen, Director
Division of Provider Information Planning & Development
Provider Communications Group, CMS


NYS Medicaid Preferred Drug List Effective 6.17.10

Wednesday, June 16th, 2010

The following link will take you to the most recent updated Preferred Drug List.  Please feel free to share this with your members or post a link to your website.  If your organization would like to schedule a presentation or if you have any questions or concerns regarding this program, please contact 518-951-2051.

Please be aware of changes to the preferred and non-preferred status of some drugs on the preferred drug list, effective June 17, 2010.

In addition to these changes, the New York State Medicaid Clinical Drug Review Program (CDRP) is expanding to require prior authorization for the following:

  • Growth Hormones (Genotropin®, Nutropin®, Nutropin AQ®, Saizen®, Humatrope®, Norditropin®, Omnitrope®, Tev-Tropin®, and Zorbtive®) for enrollees 21 years of age or older effective June 17, 2010.

Please visit

The preferred drug list can be found at:

A ‘quicklist’ of preferred drugs only can be found at:

Prior Authorization Forms and Worksheets can be found at:

EFFECTIVE IMMEDIATELY all changes to the NYS Medicaid Preferred Drug List will be communicated to providers via the monthly Medicaid Update publications.  Notifications will no longer be mailed to providers.

Posted in MEDICAID UPDATES | No Comments »

Medicare Contractors Hold Claims for Services Provided in June for an Additional Three Business Days

Monday, June 14th, 2010

CMS is now directing its contractors to continue holding June 1 and later claims through Thursday, June 17, lifting the hold on Friday, June 18. This means that unless Congress sends legislation averting the cut to President Obama for signature within the next few days, carriers will begin processing claims with the 21% cut on Friday, June 18th.  CMS acknowledges in this message that the additional delay could pose cash flow problems for some physicians.

The choice between not getting paid from Medicare at all or getting paid 79% of current rates places physicians between a rock and a hard place with no good options.  If Congress fails to act before Friday, then carriers will start processing June claims at the reduced rates and, whenever Congress does act, these claims will need to be reprocessed and retroactively adjusted.  To avoid the hassle of reprocessing, practices that can afford it may wish to hold claims themselves until after the issue is resolved.

There is only one truly good option and that is for Congress to repeal the formula that produces these cuts.  To contact your Senators and urge them to act quickly, call (800) 833-6354 .

CMS Message to Physicians:

The 2010 Medicare Physician Fee Schedule

The Continuing Extension Act of 2010, enacted on April 15, 2010, extended the zero percent (0%) update to the 2010 Medicare Physician Fee Schedule (MPFS) through May 31, 2010.  At this time, Congress is debating the elimination of the negative update that took effect June 1, 2010.  The Centers for Medicare & Medicaid Services (CMS) is hopeful that Congressional action will be taken within the next several days to avert the negative update.

To avoid disruption in the delivery of health care services to beneficiaries and payment of claims for physicians, non-physician practitioners, and other providers paid under the MPFS, CMS had instructed its contractors on May 27th to hold claims for services paid under the MPFS for the first 10 business days of June (i.e., through June 14, 2010).  This hold only affects MPFS claims with dates of service of June 1, 2010, and later.

Given the possibility of Congressional action in the very near future, CMS is now directing its contractors to continue holding June 1 and later claims through Thursday, June 17, lifting the hold on Friday, June 18.

This action will facilitate accurate claims processing at the outset and minimize the need for claims reprocessing if Congressional action changes the negative update.  It also should minimize the provider and beneficiary burdens and costs associated with reprocessing claims.

We understand that the delayed processing of Medicare claims may present cash flow problems for some Medicare providers.  However, we expect that the delay, if any, beyond the normal processing period will be only a few days. Be on the alert for more information regarding the 2010 Medicare Physician Fee Schedule Update.



Monday, June 14th, 2010

The US Department of Health and Human Services (HHS) Agency for Healthcare Research and Quality (AHRQ) announced the recipients of the medical liability reform and patient safety grants today.  These grants are the result of strong AMA advocacy for physicians and close collaboration with the state medical associations, as we continue to work for comprehensive medical liability reform.

The grants fall into two categories:

  • Grants to jump-start and evaluate efforts. Three-year grants of up to $3 million to states and health systems for implementation and evaluation of medical liability and patient safety demonstrations.
  • Planning grants. One year grants of up to $300,000 to states and health systems in order to plan to implement and evaluate medical liability and patient safety demonstrations.

The grant recipients are:

Demonstration Grants:

> Timothy McDonald, M.D., J.D., University of Illinois at Chicago, IL, $2,998,083.

> Stanley Davis, M.D., Fairview Health Services, Minneapolis, MN, $2,982,690.

> Eric Thomas, M.D., M.P.H., University of Texas Health Science Center, Houston, TX, $1,796,575.

> Ann Hendrich, M.S., R.N., F.A.A.N., Ascension Health System, St. Louis, MO, $2,990,612.

> Thomas Gallagher, M.D., University of Washington, Seattle, WA, $2,972,209.

> Judy Kluger, J.D., New York State Unified Court System, New York, NY, $2,999,787.

> Alice Bonner, M.S., APRN, BC, Massachusetts State Department of Public Health, Boston, MA, $2,912,566.

In a related story:

The Department of Health and Human Services’ Agency for Healthcare Research and Quality (AHRQ) today announced grants to support efforts by States and health systems to implement and evaluate patient safety approaches and medical liability reforms. New York State will receive $2.99M to support a medical liability demonstration focusing on adverse events involving general surgical and obstetrical care at a small number of hospitals in New York, Bronx and Kings Counties. The demonstration involves an early disclosure component, a clinical safety initiative and in those instances where early disclosure has not lead to resolution, the direction of any medical malpractice lawsuit to selected judges in New York, Kings or Bronx Counties. The judges, who will be selected for their strengths and temperament, will receive training in targeted areas of medicine and in negotiation and mediation skills. Their goal will be to achieve rapid settlements whenever possible. This demonstration grant is part of the patient safety and medical liability initiative that President Obama announced during a September 9, 2009 address to a joint session of Congress. The NYS Office of Court administration and the NYS Department of Health had jointly applied for this demonstration funding.

Posted in NATIONAL HEALTHCARE NEWS | No Comments »


Monday, June 14th, 2010

With the 2010-11 influenza season approaching, it is important to begin preparing to combat this deadly disease. Influenza viruses account for approximately 36,000 deaths nationally every year. Physicians are encouraged to help New York State combat the influenza virus is by joining the Influenza ILINet Surveillance Program.

The ILINet Surveillance Program works in collaboration with the New York State Department of Health (NYSDOH) and the Centers for Disease Control (CDC) to provide a state and nationwide report on the spread of the influenza virus and its current activity. The ILINet data, in combination with other influenza surveillance data, can be used to guide prevention and control activities, vaccine strain selection, and patient care. ILINet Providers help fight the disease by collecting and reporting their total number of patient visits and their total numbers of patient visits for Influenza-Like-Illness (ILI) to the CDC on a weekly basis. Free of charge, ILINet Providers are permitted to submit a designated number of patient specimens to the NYSDOH Wadsworth Center for virus testing and sub-typing.

Additionally, all ILINet Providers receive a free subscription to the CDC’s Morbidity and Mortality Weekly Report and Emerging Infectious Diseases Journal.

Further information may be obtained from the MSSNY website or by contacting:

Donna Gowie OR      Beth Nivin
New York State Program Coordinator New York City Program Coordinator
(518) 473-4439 (212) 442-9050
Or visit:



Monday, June 7th, 2010

The Senate Health Committee this week unanimously voted to report to the Senate floor legislation (S.5204-A, Breslin) that would permit physicians to collectively negotiate contract terms with health insurance companies under close supervision by New York State. Identical legislation (A.4301-B, Canestrari) is before the Assembly Ways and Means Committee.

Such collective action is now prohibited. As a result, most physicians face one-sided contracts from health insurers with little, if any, opportunity to negotiate. At a time when New York State and all New Yorkers are reeling from the financial tumult of the last two years, health insurer profiteering must end. This bill will assure that physicians are able to provide their patients the care they need and deserve, and receive fair compensation for providing this care.
With just 2+ weeks remaining in the legislative session, all physicians are urged to continue to call and write their respective legislators to request that this legislation be brought to a vote and approved by the full Assembly and the full Senate. Immediate focus should be placed on the members of the Assembly Ways and Means Committee to ask that the bill be brought to a vote before the Committee and reported to the Assembly floor. Members of the Committee include:

Albany (518) 455-5861
District (516) 489-6610