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Archive for the ‘MEDICARE UPDATES’ Category
« Older Entries | Newer Entries »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.
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One-Time Mailing of Solicitation Letter to Physicians and Non-Physician Practitioners Who Are Currently Enrolled In Medicare But Who Do Not Have Enrollment Records In The Provider Enrollment, Chain and Ownership System (PECOS)
Friday, June 11th, 2010
Provider Types Affected
Physicians and non-physician practitioners who are currently enrolled in Medicare but who do not have an established enrollment record in PECOS are affected by this issue.
Provider Action Needed
Physicians (doctors of medicine or osteopathy, dental medicine, dental surgery, podiatric medicine, optometry, and chiropractic medicine), physician assistants, certified clinical nurse specialists, nurse practitioners, clinical psychologists, certified nurse midwives, or clinical social workers should establish and update a record in the Medicare PECOS if they do not already have a record in that system. This article, based on CR 6842, advises you that your Medicare contractor will be mailing the letter shown in the attachment to CR 6842 if you do not have a record in PECOS. The letter will request that you take the steps to establish such a record and will explain how to do so. It is important that you maintain your enrollment information to ensure you are eligible for future Medicare initiatives and incentives.
Background
The letter will explain that Medicare records indicate you do not have an enrollment record in PECOS because you enrolled in Medicare prior to implementation of PECOS and you have not submitted any updates or changes to your Medicare enrollment information in the past 6 (or more) years.
You should know that if you do not have an enrollment record in PECOS:
Your information may not be current and updating your record in PECOS ensures payment accuracy for the services you provide to Medicare patients.
It is possible that you may not be able to receive incentive payments from Medicare for meaningful use of certified electronic health records. These incentive payments are authorized by the American Recovery and Reinvestment Act of 2009. More information on this initiative, also known as HITECH, is available at http://www.cms.gov/Recovery/11_HealthIT.asp on the Centers for Medicare & Medicaid Services (CMS) website.
Many physicians and non-physician practitioners order items or services for Medicare beneficiaries. You need an approved enrollment record in PECOS to continue to refer or order items or services for your Medicare patients.
If you do not have a current and active Medicare enrollment record, it is imperative that you take the necessary action to establish your enrollment record as soon as possible.
You can do this in one of two ways, whichever you prefer:
Use Internet-based PECOS to complete and send your enrollment application to the Medicare carrier or A/B MAC via the Internet. Before you begin, be sure you have a National Provider Identifier (NPI) and have created a User ID and password in the National Plan and Provider Enumeration System (NPPES). You will need the NPPES User ID and password in order to access Internet-based PECOS. If you need help creating an NPPES User ID and password, or if you are not sure you ever created them or cannot remember what they are, you may contact the NPI Enumerator for assistance at 1-800-465-3203. Visit http://www.cms.gov/MedicareProviderSupEnroll to read the documents that are available about Internet-based PECOS on the CMS Provider/Supplier Enrollment webpage. Having that information at hand
before you access the system, could avoid the need to contact the CMS End User Services (EUS) Help Desk for assistance after you begin.
Fill out the appropriate paper Medicare provider enrollment application(s) (CMS-855I and, if appropriate, the CMS-855R as well) and mail the application(s), along with any required additional supplemental documentation, to the Medicare carrier or A/B MAC. These forms are downloadable from the CMS Provider/Supplier Enrollment web page (shown above) or the CMS forms page http://www.cms.gov/cmsforms/cmsforms/list.asp on the CMS website.
Additional Information
The official instruction, CR 6842, issued to your Medicare carrier and or MAC regarding this change may be viewed at http://www.cms.gov/Transmittals/downloads/R712OTN.pdf on the CMS website.
CMS’s Proposed Rule for incentive payments from Medicare for the meaningful use of certified electronic health records may be viewed at http://edocket.access.gpo.gov/2010/pdf/E9-31217.pdf on the Internet. Additional information about the Electronic Health Records initiative is available at http://www.cms.gov/Recovery/11_HealthIT.asp on the CMS website.
The Medicare Learning Network Catalog has three fact sheets explaining provider enrollment responsibilities enrolled in the Medicare program. Go to http://www.cms.gov/MLNProducts/downloads/MLNCatalog.pdf on the CMS website to view these fact sheets which are briefly described as follows:
Fee-For-Service Provider Enrollment Reporting Responsibilities for Individual Physicians Enrolled in the Medicare Program (Suggested for physicians)
After enrolling in the Medicare Program, all physicians are responsible for maintaining and reporting changes in their Medicare enrollment information to their designated Medicare contractor. This fact sheet outlines such reportable events for physicians.
Fee-For-Service Provider Enrollment Reporting Responsibilities for Individual Non-Physician Practitioners Enrolled in the Medicare Program (Suggested for non-physician practitioners)
After enrolling in the Medicare Program, all non-physician practitioners are responsible for maintaining and reporting changes in their Medicare enrollment information to their designated Medicare contractor. This fact sheet outlines such reportable events for individual non-physician practitioners.
Fee-For-Service Provider Enrollment Reporting Responsibilities for Physician Group Practices Enrolled in the Medicare Program (Suggested for physician group practice)
After enrolling in the Medicare Program, all physician group practices are responsible for maintaining and reporting changes in their Medicare enrollment information to their designated Medicare contractor. This fact sheet outlines such reportable events for physician group practices.
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CONGRESS RETURNS TO WASHINGTON MONDAY AND NEEDS TO ADDRESS SGR CUT
Monday, June 7th, 2010
Congress will return to Washington this Monday, June 7, 2010, and will attempt to retroactively prevent the 21% Medicare physician cut that technically went into effect on June 1. Prior to the Memorial Day recess, the United States House of Representatives passed legislation to again prevent the 21% cut, provide a 2.2% increase for the rest of this year, and an additional 1% increase for 2011, but then a reversion to SGR in 2012. It is not clear at this moment whether there will sufficient votes in the Senate to enact this legislation, or whether another alternative SGR fix proposal will need to be advanced.
In response to the outrage in the physician community that failure to address this problem has caused, the American Medical Association launched this past week a major radio, TV, and newspaper ad campaign that urged the Senate to once and for all fix the Medicare SGR problem. According to AMA, TV and radio ads ran in Arizona, Maine, Missouri, Nevada, South Dakota and Virginia. Print ads were run in national papers such as the New York Times, Wall Street Journal and USA Today, as well as regional papers in Arizona, Florida, Georgia, Iowa, Illinois, Massachusetts, Maine, Missouri, North Carolina, Nevada, Ohio, Oregon, South Dakota, Tennessee, Texas, Wisconsin, and Virginia, states with possible key swing votes.
To temporarily prevent implementation of the 21% cut, the Centers for Medicare & Medicaid Services has issued instructions to its contractors to postpone processing claims for Medicare physician services provided on or after June 1 for 10 days to provide time for Congress to complete its action and overturn the scheduled cut retroactive to June 1. All physicians are urged to contact their respective member of Congress as well as Senators Schumer and Gillibrand, to express disappointment in Congress’ failure to address this problem, and the threat to access to care in their communities if this problem is not solved. Your action is essential to remind our legislators just how severe this problem is! Physicians can call using the AMA’s Grassroots Hotline at 1-800-833-6354.
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House Passes Short-term SGR Relief
Tuesday, June 1st, 2010
This afternoon (May 28, 2010), the House passed an amended version of H.R. 4213, the “American Jobs and Closing Tax Loopholes Act of 2010,” which includes provisions to suspend Medicare physician payment cuts produced by the sustainable growth rate (SGR) formula for 19 months. In lieu of the 21 percent cut originally scheduled for 2010, the House-passed proposal would implement a 2.2 percent payment update for the remainder of this year, and a 1 percent payment update for 2011. In 2012, the SGR formula will resume, with an estimated 33 percent payment cut taking effect that year.
The SGR provisions were voted on separately from the rest of the legislation, passing on a bipartisan vote of 245 to 171. To see how your Representative voted, visit http://clerk.house.gov/evs/2010/roll325.xml.
Because the Senate is adjourning for the week-long Memorial Day Recess, it will not vote on the legislation until after it returns on June 7. This represents the third time in 2010 that Congress has missed a deadline, causing a Medicare payment cut to take effect. As was previously the case, the Centers for Medicare & Medicaid Services has instructed its carriers to hold Medicare claims for services provided on or after June 1 for 10 business days, until June 14, which should provide sufficient time for Congress to stop implementation of the cut retroactively.
Physicians are encouraged to contact Congress to explain how its mismanagement of the Medicare program is wreaking havoc on their practices. They should use our grassroots hotline, at 1-800-833-6354, or send an email at http://www.capwiz.com/ama/issues/alert/?alertid=15086046&type=CO.
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CMS Announces New Time Period for Submission of Medicare Claims
Tuesday, May 25th, 2010
In an effort to streamline the claims process, as required by section 6404 of the PPACA, CMS has changed the maximum period for the submission of Medicare claims to not more than 12 months after date of service, beginning with claims with dates of service on or after January 1, 2010.
For more details, please read the MLN Matters Article #MM6960 at http://www.cms.gov/MLNMattersArticles/download /MM6960.pdf on the CMS website. This is a shorter time period that was previously allowed for filing claims. Prior to the PPACA, the basic time limits for filing claims were on or before December 31 of the following year for services that were furnished in the first 9 months of the calendar year, and on or before December 31 of the second following year for, services that were furnished in the last three months of the calendar year.
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Medicare Payment Adjustments Made for 2010
Tuesday, May 25th, 2010
On May 10, Medicare contractors received new files that will make significant payment changes for some services and geographic regions. These include certain corrections in the final 2010 physician fee schedule rule, as well as implementation of several provisions in the Patient Protection and Affordable Health Care Act (PPACA) enacted earlier this year. All the changes are retroactive to January 1, and all contractors must implement them by May 31.
The six PPACA provisions implemented in the new file would do the following: (1) extend the 1.0 work geographic practice cost index (GPCI) floor that expired on Dec. 31, 2009; (2) raise practice expense GPCIs in low cost areas by reflecting only half the geographic wage and rent cost differences in their calculation; (3) extend the current 5 percent add-on payment for specified psychiatry services; (4) increase payments for bone density tests; (5) extend the therapy cap exception that expired on April 1; and (6) extend a provision allowing independent labs to bill for the technical component of physician pathology services.
The corrections to the final 2010 rule involve a number of cardiology codes that were undervalued by the Centers for Medicare & Medicaid Services (CMS) due to errors in the calculation of the practice expenses associated with myocardial perfusion imaging and professional liability insurance expenses for invasive cardiology procedures. The AMA had pressed CMS to make these corrections, which will lead to payment increases of 40 percent or more for some codes. These changes will be implemented in a budget neutral manner and so lead to very minor payment rate changes for other services. Once the contractors have the new files in place, all claims going forward will be processed at the revised rates. However, CMS is still discussing the best way to handle the millions of 2010 claims that were paid at the rates in effect before these corrections and updates were made. With many different changes occurring at the same time, the situation is complicated and the process for adjusting previously paid claims may vary by service, geographic area, or other factors.
Additional information will be made available once CMS has determined the best way to proceed. Until then, physicians may want to hold off on resubmitting previously-processed claims affected by the payment changes, since these resubmissions will likely be denied as duplicate claims. The AMA will continue to monitor the situation and work with CMS to make this process as smooth as possible.
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Monday, May 24th, 2010
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2010 Physician Quality Reporting Initiative (PQRI) Program Update
Wednesday, May 19th, 2010
It is not too late to start participating in the 2010 Physician Quality Reporting Initiative (PQRI) and potentially qualify to receive incentive payments. A new six month reporting period begins on July 1, 2010.
The 2010 Physician Quality Reporting Initiative (PQRI) has two reporting periods: 12-months (January 1-December 31, 2010) and 6-months (July 1-December 31, 2010). For 2010, eligible professionals (EPs) who satisfactorily report PQRI measures for the 6-month reporting period will become eligible to receive a PQRI incentive equal to 2.0% of their total Medicare Part B allowed charges for services performed during the reporting period.
If you have not participated in the PQRI program, you can begin by reporting PQRI data for July 1-December 31, 2010 using any of the following four options:
- Claims-based reporting of individual measures for 80% or more of applicable patients on at least 3 individual measures or on each measure if less than 3 measures apply
- Claims-based reporting of one measures group for 80% or more of applicable Medicare Part B FFS patients of each EP (with a minimum of 8 patients)
- Registry-based reporting of at least 3 individual PQRI measures for 80% or more of applicable Medicare Part B FFS patients of each EP
- Registry-based reporting of one measures group for 80% or more of applicable Medicare Part B FFS patients of each EP (with a minimum of 8 patients)
PQRI claims-based reporting involves the addition of quality-data codes (QDC) to claims submitted for services when billing Medicare Part B. EPs also have the option of using a qualified registry to assist in collecting PQRI measure data. The registry will submit this quality data directly to Medicare, eliminating the need for adding QDCs to the Medicare Part B claim.
Eligible professionals do not need to sign up or pre-register to participate in the 2010 PQRI. Submission of QDCs for individual PQRI measures to CMS through a qualified registry or for a measures group through claims or a qualified registry will indicate intent to participate.
Although there is no requirement to register prior to submitting the data, there are some preparatory steps that EPs should take prior to undertaking PQRI reporting. CMS has created many educational products that provide information about how to get started with PQRI reporting. To access all available educational resources on PQRI please visit, http://www.cms.hhs.gov/PQRI/ on the CMS website. Eligible professionals are encouraged to visit the PQRI webpage often for the latest information and downloads on PQRI.
Resources
- 2010 PQRI Implementation Guide at http://www.cms.gov/PQRI/Downloads/2010_PQRI_ImplementationGuide_02-10-2010_FINAL.pdf
- Qualified Registries for 2010 PQRI Reporting at
http://www.cms.gov/PQRI/20_AlternativeReportingMechanisms.asp#TopOfPage
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Important Notice Regarding Least Costly Alternative for Drugs Billed to the Medicare Carrier
Wednesday, May 12th, 2010
Effective April 19, 2010, the least costly alternative (LCA) policy for drugs billed to the Medicare carrier will be suspended. The National Government Services Local Coverage Determination (LCD) for Luteinizing Hormone Releasing Hormone (LHRH) (L26369) is the only National Government Services policy pertaining to Part B providers with LCA information. This policy will be retired and replaced as a coverage article attached to the National Government Services LCD for Drugs and Biologicals, Coverage for Labeled and Off-Labeled Indications (L25820). This article will not contain LCA provisions.
The Centers for Medicare & Medicaid Services (CMS) Internet-Only Manuals (IOMs) will be revised by CMS in the near future.
Questions regarding this educational article may be directed to the Clinical Provider Outreach and Education Department at clinical.education@wellpoint.com.
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Newly-Released MLN Matters Article Regarding Changes to Medicare Claims Submission Requirements
Tuesday, May 11th, 2010
JUST RELEASED: MLN Matters Article #MM6960 – Systems Changes Necessary to Implement the Patient Protection and Affordable Care Act (PPACA) Section 6404 – Maximum Period for Submission of Medicare Claims Reduced to Not More Than 12 Months
The Centers for Medicare & Medicaid Services (CMS) has released MLN Matters Article #MM6960 to advise providers who submit claims to Medicare contractors that, as a result of the Affordable Care Act (ACA), claims with dates of service on or after January 1, 2010, received later than one calendar year beyond the date of service will be denied by Medicare. For more details, please read the article at http://www.cms.gov/MLNMattersArticles/downloads/MM6960.pdf on the CMS website.
Valerie A. Haugen, Director
Division of Provider Information Planning & Development
Provider Communications Group, CMS
(410) 786-6690
valerie.haugen@cms.hhs.gov
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