Thursday, November 14th, 2013
AMA submits recommendations to Senate Finance and House Ways & Means Committees on repealing the SGR
On Oct. 30, the Senate Finance Committee and the House Ways and Means Committee released a bipartisan, bicameral discussion draft proposal that “would permanently repeal the SGR update mechanism, reform the fee-for-service (FFS) payment system through greater focus on value over volume, and encourage participation in alternative payment models.” The AMA submitted recommendations to the committees on Nov.11, to build upon and strengthen the draft proposal to best achieve the shared goal of developing a new, more stable Medicare payment and delivery system that supports high-quality care. The AMA will continue its advocacy efforts with the committees and all members of Congress to shape and advance legislation this year to eliminate the SGR.
AMA, state and specialty societies urge CMS to intervene in Medicare Advantage terminations
The AMA and 81 state and specialty societies sent a letter on Nov. 8, urging CMS to take immediate action to ensure that beneficiaries participating in Medicare Advantage (MA) plans have accurate and reliable information to make health insurance elections during the 2014 Open Enrollment period, and to address a lack of MA sponsor transparency on network adequacy. The AMA, state medical associations, and national medical specialty societies have been contacted by hundreds of physicians who have been terminated from 2014 MA plan networks in certain markets. The terminations are “without cause” and have been timed in a manner that undermines the accuracy and reliability of the information Medicare beneficiaries rely upon to make important decisions about their 2014 health insurance coverage. The timing and process used to communicate the terminations and modifications to the networks are inconsistent with CMS guidance and regulations. The AMA, state and specialty societies urged CMS to act to ensure that the program is transparent and equitable.
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Wednesday, October 30th, 2013
Medicare Advantage Outreach and Education Bulletin
Empire BlueCross BlueShield
We want you to know about changes to our individual Medicare Advantage HMO and LPPO plan service areas. These changes will take effect Jan. 1, 2014. Some plan service areas will be eliminated or reduced.
These service area changes do not impact your participation in the Medicare Advantage network.* Employer or union sponsored Medicare Advantage plan members are not affected by these changes. Empire Medicare Advantage member ID cards contain a CMS identifier in the lower right corner of the card. The number will be five characters (XXXXX) followed by three characters (XXX). The member is in an employer or union sponsored plan when the last three digits Start with an eight (8XX).
Empire will continue to offer Medicare Advantage HMO plans in Albany, Bronx, Kings, Nassau, New York, Putnam, Queens, Richmond, Rockland, Saratoga, Schenectady, Suffolk and Westchester counties. Empire will continue to offer Medicare Advantage LPPO plans in Albany, Bronx, Fulton, Kings, Nassau, Rensselaer, Richmond, Rockland, Saratoga, Schenectady, Schoharie and Suffolk counties. Specific plan changes by county are detailed below.
We will no longer offer Empire MediBlue Select HMO plans in Dutchess, Nassau, Orange, Sullivan and Ulster counties. We will reduce the service area of Empire MediBlue Essential HMO plans in Albany, Dutchess, New York, Orange, Putnam, Schenectady and Sullivan counties.
We will reduce the service area of Empire MediBlue Freedom I LPPO plans in Columbia, Delaware, Greene, Montgomery, Warren and Washington counties. We will reduce the service area of Empire MediBlue Freedom II LPPO plans in Clinton, Columbia, Essex, Fulton, Montgomery, Rensselaer, Suffolk, Sullivan, Ulster, Warren and Washington counties. We will reduce the service area of Empire MediBlue Freedom III LPPO plans in Albany, Greene, King, Rensselaer, Saratoga, Schenectady, Schoharie, Warren and Washington counties.
As of Oct. 1, 2013, Empire will not market Medicare Supplement plans. Members that currently participate in one of Empire’s Medicare Supplemental plans will be able to retain their coverage.
Prior to Oct. 2, 2013, Medicare Advantage members affected by these changes will receive a letter from us that explains their Medicare coverage options. Members will continue to have coverage through their current plans until December 31, 2013. It’s important to note that members may have a different network of providers and/or different benefit structure when switching from previous plans.
We are working with Centers for Medicare & Medicaid Services (CMS) to help ensure our members understand options for continuing their Medicare health insurance coverage.
We understand our members may contact their doctors’ offices with questions about their plan when they receive this notification. Our customer service representatives are available to assist them with their concerns. Members may call the customer service telephone number in the
letter they receive from us or they may contact our customer service through the number provided on the back of their member ID cards.
We are always evaluating our Medicare Advantage products to ensure that they meet our members’ needs for access, cost and quality.
If you have any questions, please contact your provider network manager.
* Providers who may receive termination notices for reasons other than service area reductions/eliminations are not impacted by this Notice.
Services provided by Empire HealthChoice HMO, Inc. and/or Empire HealthChoice Assurance, Inc., licensees of the Blue Cross and Blue Shield Association, an association of independent Blue Cross and Blue Shield plans. The Blue Cross and Blue Shield names and symbols are registered marks of the Blue Cross and Blue Shield Association.
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Tuesday, October 22nd, 2013
Medicare’s Common Working File (CWF) system detects erroneous billings when there are two new patient CPT codes being billed within a three-year period of time by the same physician or physician group. If Medicare discovers that a new patient code has been paid more than one time in a three-year period to the same physician, then Medicare Contractors will consider this an overpayment and will take steps to recoup the payment. If the situation is detected prior to payment of a second claim, the second claim will be rejected. Please share with appropriate staff.
Codes that are checked:
New Patient Definition:
The ‘Medicare Claims Processing Manual,’ Chapter 12, Section 30.6.7 provides that ‘Medicare interpret the phrase ‘new patient’ to mean a patient who has not received any professional services (i.e., E/M service or other face-to-face service (e.g., surgical procedure) from the physician or physician group practice (same physician specialty) within the previous three years). For example, if a professional component of a previous procedure is billed in a three-year time period (e.g., a lab interpretation is billed and no E/M service or other face-to-face service with the patient is performed, then this patient remains a new patient for the initial visit).’
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Friday, October 11th, 2013
Access to Jurisdiction K Local Coverage Determinations during the Federal Government Shutdown
The Centers for Medicare & Medicaid Services (CMS) Coverage Database will not be updated on its usual weekly basis during the federal government shutdown. In the event that the shutdown continues through the Jurisdiction (JK) transition dates of October 18 and October 25, 2013, the JK local coverage determinations (LCDs) will be effective on the transition dates even if they are not viewable as “Active” LCDs for their respective effective dates. These LCDs are currently listed on the “Future” LCD index for the JK states and will continue to be available from that index.
For access to the JK LCDs, use this link: JK LCDs. This will take you to the Index for Maine Part A. The LCDs listed here are the same for all JK states, Part A and Part B.
For access to the JK home health and hospice (HH&H) specific LCDs, use this link: HHH LCDs Effective October 18, 2013.
These links can also be found on the Jurisdiction K Transition Information Web site at http://www.ngsmedicare.com/wps/portal/ngsmedicare/jktransition.
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Thursday, August 8th, 2013
As previously announced the NYS Department of Health will soon require all billing providers to sign up for electronic funds transfer (EFT) payments and either Electronic Remittance Advice (ERA) or a PDF version of the paper remittance delivered via eMedNY eXchange.
This requirement will apply to existing providers as their current ETIN Certification is renewed over the next year. The recertification notices sent by eMedNY will alert providers if they are required to sign up for EFT and/or ERA or PDF remittances.
For new providers who submit enrollment applications as of . Please visit www.emedny.org on or after this date for information and instructions for enrolling new providers. Please pay careful attention to the new requirement for a Certification Statement and an EFT Application to accompany each new enrollment packet for billing providers. For more information click here.
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Wednesday, July 24th, 2013
FOR IMMEDIATE RELEASE July 23, 2013
AMA: In Reforming Medicare, Details Matter
Physicians urge lawmakers to ensure sustainable resources, not increase administrative burden
Statement attributable to: Ardis D. Hoven, MD
President, American Medical Association
“The American Medical Association (AMA) is pleased that the Energy and Commerce Committee and other congressional leaders continue their work to end the broken Medicare physician payment system this year and move toward a Medicare program that rewards high quality care for our nation’s senior citizens and reduces costs. There is clear bipartisan support for fixing this failed formula and making improvements in the program, but the details matter considerably and there is still work to be done to ensure a strong future for Medicare.
“When crafting new payment systems, lawmakers must ensure that funding for Medicare’s payments to physicians is sufficient to allow for sustainable practice environments that give physicians the ability to invest in new ways of improving care for patients. This includes maintaining budget neutrality related to adjustments to correct misvalued codes as part of that ongoing process. Changes to quality reporting requirements should build on the existing system rather than attempting to implement a new regimen that adds administrative burdens and could distract from more effective efforts to improve patient care.
“The AMA and 110 other physician organizations have developed principles for transitioning Medicare to include an array of payment models that allow physicians the flexibility to choose options that will help lower costs and improve the quality of care for patients. We will continue to work with the committee to achieve the best Medicare system for patients and physicians.”
Tuesday, July 16th, 2013
Thursday, June 27th, 2013
In 1967, the group 5th Dimension released a song called ‘Let the Sunshine In’ (also known as ‘The Age of Aquarius’). It’s a song that, once someone starts singing it, leaves you hearing it in your head for hours.
Now fast-forward to 2013, and the words of this song point to something very different: the ‘National Physician Payment Transparency Program: Open Payments’ – an initiative from Section 6002 of the Affordable Care Act. This program is intended to increase public awareness and knowledge of the financial relationships between physicians/teaching hospitals and the manufacturers of drugs, biologicals, medical supplies, devices, and ‘Group Purchasing Organizations’, or GPOs. A GPO is a group of businesses that earn discounts from vendors based on their collective buying power.
Starting , manufacturers and GPOs will begin reporting payments or ‘transfers of value’ made to physicians or teaching hospitals. ‘Transfers of value’ can refer to consulting fees, gifts, entertainment, travel/lodging, etc. The Centers for Medicare and Medicaid (CMS) will collect the data annually and publish it on its website at www.cms.gov.
CMS’s statement about this program lists the purpose of this effort as:
It’s important to note that financial payments or transfers of value do not necessarily mean a violation of law or an implication of fraud or abuse. The purpose of the act is to open the door, let the sun shine in, and give the public a clear view of the relationships between these entities.
The first report will contain the data from August through December 2013 and will be posted to the CMS website by. Physicians and teaching hospitals enrolled with Medicare have been notified by CMS through various media channels.
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Monday, March 12th, 2012
Tuesday, January 10th, 2012
Flu Season is Here! While seasonal flu outbreaks can happen as early as October, flu activity usually peaks in January. Remind your patients that annual vaccination is recommended for optimal protection. Medicare pays for the seasonal flu vaccine and its administration for seniors and others with Medicare with no co-pay or deductible. Healthcare workers, who may spread the flu to high risk patients, should get vaccinated too. Don’t forget to immunize yourself and your staff. Protect your patients. Protect your family. Protect yourself. Get the Flu Vaccine—Not the Flu.
Remember – The flu vaccine plus its administration are covered Part B benefits. CMS has posted the 2011-2012 seasonal flu vaccine payment limits at http://www.CMS.gov/McrPartBDrugAvgSalesPrice/10_VaccinesPricing.asp. Note that the flu vaccine is NOT a Part D-covered drug.
For more information on coverage and billing of the flu vaccine and its administration, as well as related educational provider resources, visit http://www.CMS.gov/MLNProducts/35_PreventiveServices.asp and http://www.cms.gov/immunizations.
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