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Archive for the ‘MEDICARE UPDATES’ Category
« Older Entries | Newer Entries »Important E-Prescribing (eRx) Incentive Updates
Friday, September 30th, 2011
Please see the important deadline reminder below.
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Good morning everyone,
Please share the message below with your internal and external partners interested in the Medicare Electronic Prescribing (eRx) Incentive Program. In your message, please direct eligible professionals and others interested in the Medicare Electronic Prescribing (eRx) Incentive Program to cut and paste the URLs into their internet browser should they have a problem accessing the URLs embedded in the message.
Thanks
The Centers for Medicare & Medicaid Services (CMS) would like to remind eligible professionals and group practices participating in the Medicare Electronic Prescribing (eRx) Incentive Program that the deadline to request a hardship exemption for the 2012 eRx payment adjustment is November 1, 2011.
Eligible professionals and group practices should determine if they are subject to the 2012 eRx payment adjustment by reviewing the MLN Article SE1107. If you believe that you may be subject to the 2012 eRx payment adjustment, you should determine if you meet any of the hardship exemption categories specified by CMS in the 2011 Medicare Electronic Prescribing (eRx) Incentive Program Final Rule.
In addition, a Quick Reference Guide is available to help you understand the changes that the eRx Final Rule made to the 2011 Medicare eRx Incentive Program. As a result of changes to the program, eligible professionals and group practices have until November 1, 2011 to submit a significant hardship exemption request and rationale.
Please note, to be considered for an exemption under the significant hardship exemption category “Eligible professionals who register to participate in the Medicare or Medicaid Electronic Health Record (EHR) Incentive Programs and adopt Certified EHR Technology,” an eligible professional must:
(1) have registered for either the Medicare or Medicaid EHR Incentive Program (for instructions on how to register for one of the EHR Incentive Programs, we refer readers to the Registration and Attestation page of the EHR Incentive Programs section of the CMS Web site at http://www.cms.gov/EHRIncentivePrograms/20_RegistrationandAttestation.asp#TopOfPage);
AND
(2) provide identifying information as to the Certified EHR Technology (as defined at 42 CFR 495.4 and 45 CFR 170.102) that has been adopted for use no later than October 1, 2011. Please note that, in order to qualify for an exemption to the 2012 eRx payment adjustment under this significant hardship exemption category, it is not necessary that an eligible professional receive an incentive payment under the Medicare or Medicaid EHR Incentive Program.
Eligible professionals wishing to register for the Medicaid EHR Incentive Program in states that have not yet launched their respective programs may initiate the registration process at the CMS Registration and Attestation System, and obtain a registration number but will not be able to successfully complete registration. If a State has not launched its Medicaid EHR Incentive Program, the State name will not appear in the drop-down menu for eligible professionals to choose from. However, a registration number is assigned even if registration is not successfully completed.
In order to initiate registration for the Medicaid EHR Incentive Program, please visit https://ehrincentives.cms.gov/hitech/login.action and follow the instructions to begin the registration process. Obtaining a CMS EHR Incentive Programs registration number, even if the registration is not successfully completed, suffices for the purposes of applying for a significant hardship exemption for the 2012 Medicare e-Prescribing payment adjustment.
To request an exemption, individual eligible professionals must submit their hardship exemption requests through the Quality Communications Support Page and group practices participating under the group practice reporting option (GPRO) must submit hardship exemption requests via a letter to CMS.
Please remember that CMS will review these requests on a case-by-case basis. All decisions on significant hardship exemption requests will be final.
For additional information and resources, please visit www.cms.gov/erxincentive on the CMS website.
Geanelle G. Herring MSW
Geanelle Griffith Herring
Centers for Medicare & Medicaid Services
Provider Communications Group
Division of Provider Relations & Outreach
Posted in MEDICARE UPDATES | No Comments »
NYS Department of Health Medicaid Managed Care Call September 14
Wednesday, September 7th, 2011
Do you have questions regarding prescription drug coverage for your Medicaid patients when, starting October 1, their pharmacy coverage will be transitioned to Medicaid Managed Care?
At the request of the Medical Society of the State of New York (MSSNY), on Wednesday, September 14, Department of Health staff led by Janet Elkind, Director of the Bureau of Pharmacy & Policy Operations, will host a call specifically for physicians and their staff to ask questions regarding this important change in Medicaid prescription drug coverage.
The call will take place at 5:00 PM.
The call-in information is:
Call in #: 866-394-2346
Passcode: 590 814 6107
Please confirm your participation in this call by e-mailing mhardin@mssny.org
As has been previously reported in the MSSNY e-news, all physicians that treat Medicaid beneficiaries should be aware that, effective October 1, their patients enrolled in Medicaid Managed Care (MMC) plans will begin receiving their prescription drug coverage through their plans, rather than through the state fee for service program. The change was one of a myriad of cost-saving measures that were proposed by the Governor’s Medicaid Redesign Team and enacted as part of the 2011-12 State Budget. Medicaid prescription drug coverage had been “carved out” of MMC since the late 1990s.
MMC plans will establish their own formularies and prior authorization procedures. However, health plans will be required to include on their formularies all categories of prescription drugs that are currently part of the New York State Medicaid fee for service prescription program. Consistent with New York’s managed care utilization review laws, plans will also be required to maintain internal appeals systems and assure access to an external appeal to address circumstances where patients are denied coverage for medications that are prescribed by their treating physicians.
MMC plans are required to develop and implement comprehensive implementation and communication plans to assure patient access to needed medications. These transition plans must be approved by the NYS Department of Health (DOH). DOH has indicated that it will permit a one-time, temporary fill of non-formulary drugs for up to a 30 day supply of medication. This would include drugs that are on a plan’s formulary but require prior authorization or step therapy under a plan’s utilization management rules.
Recognizing the confusion that implementation of this change may cause, MSSNY has urged DOH to take a number of steps to reduce transitional issues. These include asking DOH to maintain a link on its website where physicians will be able to easily check the formularies and prescription authorization procedures that will be established by each MMC plan; assuring MMC plans have sufficient staff to promptly respond to physician requests for non-formulary medications; and facilitating meetings and communications with physicians across the State of New York to get local physician feedback.
Posted in MEDICAID UPDATES | No Comments »
The Countdown to Version 5010 Implementation Is Underway
Tuesday, September 6th, 2011
National Government Services News
- Did you know that effective January 1, 2012 all covered entities will be required to use the new Health Insurance Portability and Accountability Act (HIPAA) 5010 version for electronic filing?
- Did you know that effective January 1, 2012 electronic submitters who are not using version 5010 for HIPAA electronic transactions will have their claims rejected and they won’t receive payment?
- Did you know that there are less than 130 days for the version 5010 implementation?
Medical offices and providers should feel the pressure to get their systems ready for the version 5010 implementation. National Government Services has created several helpful resources to assist electronic submitters to prepare for the version 5010 transition. These resources are available on the Version 5010 Implementation page located on the Electronic Submission (EDI) section on the National Government Services Web site.
We have also offered free monthly Webinars for all providers and facilities to join and will continue to offer these free monthly webinars. However, despite these free education opportunities, medical offices are still not prepared for the version 5010 change. Be proactive and start preparing for version 5010 today!
- Electronic Data Interchange Claims Transmission and Report Download for the Labor Day Holiday
- National Government Services Provider Outreach and Education Survey
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Posted in MEDICARE UPDATES | No Comments »
AMA Continues to Press CMS on E-prescribing Penalty
Tuesday, August 30th, 2011
The AMA continues to hear concerns expressed by physicians, states and specialty societies that a significant number of physicians will be subjected to the e-prescribing penalty in January 2012.
Consequently, the AMA’s Executive Vice President, James Madara, MD, called Centers for Medicare & Medicaid Services (CMS) Administrator Donald Berwick, MD, to urge the agency to provide more flexibility so that a 1 percent penalty in 2012 does not affect as many physicians. During the call, Dr. Madara thanked Dr. Berwick for issuing a recent proposed rule creating additional penalty exemptions, but went on to alert the administrator to the concerns being expressed. He urged Dr. Berwick to consider additional steps, such as establishing a new reporting period in 2012 and refraining from applying the penalty until 2013.
The AMA strongly believes that the agency plans to apply the penalty a year earlier than called for by Congress. Dr. Madara’s call follows a July 25 sign-on comment letter to CMS, where the AMA was joined by 92 states and specialty societies in calling for greater program flexibility. The AMA will continue to follow-up with CMS to secure additional changes to the program.
Posted in MEDICAID UPDATES, MEDICARE UPDATES | No Comments »
Six Month Check-In: Act Now for the Version 5010 Transition
Wednesday, July 27th, 2011
The Version 5010 transition is less than six months away for all HIPAA-covered entities. This means that to submit transactions electronically, all covered entities must upgrade from Version 4010/4010A to Version 5010. Version 5010, unlike Version 4010, accommodates the new ICD-10 code sets, and is a required preliminary step for the use of the new ICD-10 medical code sets.
Before the compliance deadline of Sun Jan 1, 2012, you should conduct internal and external transactions within your organizations and with your billing partners – including payers, vendors, clearinghouses, and providers. External testing should take place now in order to make sure that you are able to send and receive compliant transactions effectively. Testing now will help identify any potential issues that may arise, and allow the necessary time to address them.
The CMS ICD-10 website has resources to support providers, payers, and vendors as they make the transition to Version 5010 and ICD-10. Keep up to date on Version 5010 and ICD-10 by visiting http://www.CMS.gov/ICD10 for the latest news and resources to help you prepare.
Posted in MEDICARE UPDATES | No Comments »
ATTENTION PHYSICIANS! E-PRESCRIBING INCENTIVE REMINDER:
Thursday, June 23rd, 2011
The New York Medicaid e-prescribing incentive program applies only to non-facsimile electronic transmissions when compliant with Medicare Part D data standards.
E-Prescribing Incentive checks are being returned by prescribers who claim they do not e-prescribe.
PLEASE NOTE THE FOLLOWING:
Electronic Prescription Definition
New York State Pharmacy Regulations (http://www.op.nysed.gov/part63.htm) recognize two distinct types of electronically-transmitted prescriptions:
· a prescription transmitted electronically by facsimile;
- · a prescription transmitted electronically by means other than facsimile; such non-facsimile prescriptions are required by regulation to be electronically encrypted, meaning protected to prevent access, alteration or use by any unauthorized person.
The New York Medicaid Program accepts both types of electronically-transmitted prescriptions for standard claim reimbursement. However, pharmacies must verify a prescription is compliant with Medicare Part D data standards and requirements and NYS Pharmacy Regulations before submitting for the e-prescribing incentive.
Claims for prescriptions transmitted electronically by means other than facsimile and not Medicare Part D compliant are recognized by New York Medicaid for claim reimbursement purposes, but do not qualify for the e-prescribing incentive reimbursement.
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.
For more information go to: http://www.health.ny.gov/health_care/medicaid/program/update/2009/2009-11spec.htm
Posted in MEDICAID UPDATES | No Comments »
The Centers for Medicare & Medicaid Services Banking Change
Monday, June 20th, 2011
JUNE 17
Important News from National Government Services:
The Centers for Medicare & Medicaid Services (CMS) has converted its banking contracts with JP Morgan and U.S. Bank to Federal Acquisition Regulation (FAR) contracts. These banks serve all the Medicare contractors. Accordingly, CMS has instructed the banks to close all bank accounts and letters of credit associated with the old configuration and contracts.
Normally, Medicare checks are valid for a 12-month period after the payment date on the check and then they are automatically stale-dated, at which point they become void. CMS needed to close some of the old bank accounts prior to the end of the 12-month period due to contractual requirements. Some checks drawn on these old bank accounts may be presented for payment within the next two to three months, but will be returned and annotated “account closed.” If providers encounter this situation, they may contact the Provider Contact Center and have the checks reissued under a new appropriate account number. If the provider receives a fee for the check being returned as unpaid please bring that to the attention of the Provider Contact Center and they will address that issue as well for the provider. While we do not anticipate this being a large impact for providers it is important that you are aware of what to do if the situation arises.
Please visit our Web at www.NGSMedicare.com for the Provider Contact Center information located at Resources > Contact Us > Provider Contact Center.
Thank you,
National Government Services, Inc.
Corporate Communications
Posted in MEDICARE UPDATES | No Comments »
CMS-New York to Host HITECH Open Door Forum (ODF) Calls for NYS Providers
Tuesday, March 15th, 2011
The New York Regional Office of the Centers for Medicare & Medicaid Services will be hosting two Open Door Forum calls for providers in New York on Thursday, March 24, 2011 from 1:00 PM to 2:30 PM and Wednesday, March 30, 2011 from 1:00 PM to 2:30 PM, to present an overview of the definition of meaningful use as well as the Medicare and Medicaid incentive payment programs that are part of the HITECH legislation and final rule. The calls will also include participants from the State Medicaid Agency and New York – Health Information Technology Extension Centers (the regional extension centers for the State of New York). The March 24th teleconference is directed toward upstate New York (outside of NYC) providers, with the respective servicing e-Collaborative REC giving a presentation. Similarly, the March 30th teleconference is directed toward New York City metropolitan area providers joined with a presentation by the NYC REACH REC. Brief presentations will be made and there will be ample time during the call for questions and answers regarding HITECH. Please feel free to attend either of the ODF’s as your schedule permits.
Dial-in instructions will be forthcoming.
We ask that you forward this message to any colleagues, members or other providers in New York who may benefit from this HITECH education session. We look forward to your participation.
Paul Velez
Centers for Medicare & Medicaid Services
Division of Financial Management &
Fee for Service Operations
26 Federal Plaza Room 38-130
New York, NY 10278
Voice: 212-616-2533
Fax: 212-264-2790
Posted in MEDICARE UPDATES | No Comments »
Change in Jurisdiction 13 PO Box Address for Overpayment Recovery Unit
Wednesday, March 9th, 2011
Effective April 4, 2011, the current Jurisdiction 13 P.O. Box addresses for returning overpayments will discontinue and the following P.O. Box address will be used:
National Government Services, Inc.
Overpayment Recovery Unit (returned Medicare issued checks)
Jurisdiction 13 (Connecticut and New York)
P.O. Box 7204
Indianapolis, IN 46207- 7204
As a reminder, all P.O. Box numbers are available on the Resources > Contact Us > P.O. Box Mailing Addresses section of the www.NGSMedicare.com Web site.
Posted in MEDICARE UPDATES | No Comments »
Medicaid Redesign Team Makes Historic Recommendations
Friday, March 4th, 2011
HISTORIC PROGRESS MADE IN REFORMING MEDICAID IN NEW YORK STATE
New York spends more on Medicaid per capita than any other state in the nation, but we rank only 21st in program quality for patients. In most counties, Medicaid costs alone account for more than half of the entire county tax levy.
To reform the system, Governor Cuomo created a Medicaid Redesign Team. The Team — comprised of health care professionals, stakeholders, and legislators — was charged with reducing costs and improving patient care. The Team held open meetings throughout the state and reviewed more than 4,000 ideas from team members, outside health care professionals, and citizens.
Last week, the Team accomplished their goal, submitting an unprecedented consensus plan that meets the Governor’s budget target and saves over $2.3 billion. What’s more, under the plan, one million New Yorkers will now have access to an innovative “patient-centered” medical program, making New York the national leader in providing this type of personal care. Today, the legislation to enact the plan was submitted to the Legislature to be included as part of the Executive Budget.
If you would like more information on this historic plan, click here to read about the Medicaid report. Thank you.
March 3, 2011
Posted in MEDICAID UPDATES, NEWS FROM THE NYS LEGISLATURE | No Comments »
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