Wednesday, December 15th, 2010
The Centers for Medicare & Medicaid Services (CMS) is listening and wants to hear from you about the services provided by your Medicare Fee-for-Service (FFS) contractor responsible for processing and paying your Medicare claims. CMS is preparing to conduct its annual Medicare Contractor Provider Satisfaction Survey (MCPSS). This survey offers Medicare FFS providers and suppliers an opportunity to give CMS feedback on their interactions with Medicare FFS contractors related to seven key business functions: Provider Inquiries, Provider Outreach & Education, Claims Processing, Appeals, Provider Enrollment, Medical Review, and Provider Audit & Reimbursement.
The survey will be sent to a random sample of approximately 30,000 Medicare FFS providers and suppliers. Those who are selected to participate in the 2011 MCPSS will be notified starting in mid-December. CMS understands that providers and suppliers themselves may not be able to respond directly to the survey, but may have a staff member who can act as a proxy to respond on their behalf. The respondent can be anyone within the provider’s organization who is knowledgeable of the Medicare claims process and is designated to respond to the MCPSS. If you are selected to participate, please take the time to complete this important survey. CMS encourages participation in the survey on the Internet via a secure website. It will take no more than 20 minutes. Other modes of participation are available by mail, fax, or telephone. To learn more about the MCPSS, please visit the CMS website at http://www.cms.hhs.gov/MCPSS .
Wednesday, December 15th, 2010
The NCMS/NAM is located at 1200 Stewart Avenue adjacent to the Meadowbrook Parkway in Garden City, New York. Our telephone number is 516-832-2300.
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Monday, December 13th, 2010
A new Medicare home health law goes into effect on January 1st that affirms the role of the physician as the person who orders home health care based on personal examination of the patient. Effective in January, a physician who certifies a patient as eligible for Medicare home health services must see the patient. The law also allows the requirement to be satisfied if a non-physician practitioner (NPP) sees the patient, when the NPP is working for or in collaboration with the physician.
As part of the certification form itself, or as an addendum to it, the physician must document that the physician or NPP saw the patient, and document how the patient’s clinical condition supports a homebound status and need for skilled services. The face-to-face encounter must occur within the 90 days prior to the start of home health care, or within the 30 days after the start of care. While the long-standing requirement for physicians to order and certify the need for home health remains unchanged, this new requirement assures that the physician’s order is based on current knowledge of the patient’s condition.
A more detailed announcement on this subject will be available within the next few days, on the home health agency website at: http://www.cms.gov/center/hha.asp, under the Spotlight section. Additional guidance will be available next week via a Special Edition article on our Medicare Learning Network website at: http://www.cms.gov/MLNGenInfo. Questions and answers regarding this requirement will be available the week of December 13th via Medicare’s home health agency website, http://www.cms.gov/center/hha.asp. Finally, we expect a video training module describing this new requirement to be released within the next few weeks.
Monday, December 13th, 2010
Posted December 09, 2010
By Kathleen Sebelius, Secretary of the Department of Health and Human Services
Strengthening Medicare is one of our top priorities and today marks an important day for people on Medicare and their doctors and other health care providers. With strong support from the Administration, Congress has passed legislation that will prevent a significant pay cut for doctors from taking effect on January 1 and extend critical Medicare and Medicaid policies that would otherwise expire at the end of this year.
This action will help us to ensure that people with Medicare can continue to see the doctor they know and trust. We know that stable, predictable, and adequate payments for health care providers are critical to allowing them to give patients the best care possible. Medicare is so important for millions of Americans, ranging from elderly couples to middle-aged people living with a significant disability, which is why fixing this unfair pay cut has been a top priority for the President and the Department of Health and Human Services.
This one-year fix will help provide some important stability and security for doctors and their patients as we continue to work with Congress on a permanent solution to fix Medicare’s physician payment system once and for all.
As we head into a new year, as a result of this legislation, people with Medicare are assured the same quality of, and access to, care they had before. For example, the legislation extends for a year a program that helps low income Medicare beneficiaries pay their Medicare Part B premiums.
While this is great news, I would encourage Medicare beneficiaries and their caregivers to check out some of the other important things happening in 2011 to further strengthen Medicare.
Starting in January 2011, if you hit the prescription drug donut hole, you will get a 50% discount on brand-name drugs. Starting in 2013, you will pay less and less for your brand-name Part D prescription drugs in the donut hole.
By 2020, the coverage gap will be closed, which means there will be no more “donut hole,” and you will only pay 25% of the costs of your drugs until you reach the yearly out-of-pocket spending limit. Seniors will also get certain free preventive services, such as annual wellness visits and personalized prevention plans.
Strengthening Medicare also means extending the Medicare Trust fund, and it means ensuring better coordination of care between doctors so you’ll be less likely to experience preventable and harmful re-admissions to the hospital.
For more about what we’re doing to make Medicare stronger and to get your questions about Medicare answered, visit http://www.medicare.gov/. To find out if you qualify for extra help or to apply, call or visit your State Medical Assistance (Medicaid) office, and ask for information on Medicare Savings Programs.
A link can be found here: http://www.healthcare.gov/news/blog/SGR.html
Tuesday, December 7th, 2010
The AMA learned yesterday (Dec. 6) evening that Senate Majority Leader Harry Reid (D-NV), Finance Committee Chairman Max Baucus (D-MT), Minority Leader Mitch McConnell (R-KY), and Finance Committee Ranking Member Charles Grassley (R-IA) have reached agreement on a proposal to stop the Medicare physician payment cuts being produced by the sustainable growth rate (SGR) formula for 12 months, through the end of 2011. The White House was also actively involved in the negotiations. In addition, the proposal would extend a number of expiring payment policies, which presumably include the “floor” on geographic adjustments to the physician work component of the Medicare physician payment schedule. (A full list of the policies to be extended has not yet been made available.)
While there has been general bipartisan agreement for several weeks on the importance of stabilizing physician payments for at least a year, negotiations centered on identifying financing offsets for the approximately $19 billion cost of the proposal that would receive bipartisan support. We have been informed that the costs would be offset by recouping a greater proportion of overpayments that in some circumstances may be made to consumers who are deemed eligible for subsidies to purchase coverage in the health insurance exchanges that will be established by the Affordable Care Act. We understand that this offset is sufficient to finance the entire legislative package and that there are no provisions to achieve savings through changes in physician payment policies.
The proposal was presented yesterday afternoon to members of the Senate Finance Committee for their review. Assuming committee members and rank-and-file Senators support the proposal, it could be considered on the Senate floor later this week.
We will keep you informed as the situation develops.
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Nassau Academy of Medicine
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