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Archive for the ‘NATIONAL HEALTHCARE NEWS’ Category
« Older Entries |The Transition to ICD-10 is Coming October 1, 2013
Tuesday, July 13th, 2010
Remember: – On October 1, 2013, medical coding in U.S. health care settings will change from ICD-9-CM to ICD-10. The transition will require business and systems changes throughout the health care industry. Everyone who is covered by the Health Insurance Portability and Accountability Act (HIPAA) must make the transition, not just those who submit Medicare or Medicaid claims. The compliance dates are firm and not subject to change. If you are not ready, your claims will not be paid. Preparing now can help you avoid potential reimbursement issues. Ask your clearinghouse, billing service or software vendor what you need to do to be ready for ICD-10. For more information about ICD-10 Implementation, please read MLN Matters® Special Edition article SE1019 located at http://www.cms.gov/MLNMattersArticles/downloads/SE1019.pdf on the CMS website.
Posted in MEDICARE UPDATES, NATIONAL HEALTHCARE NEWS | No Comments »
CMS Will Not Automatically Deny PECOS Claims for Missing Deadline
Monday, July 12th, 2010
This week, CMS announced that it will not automatically deny Medicare claims filed by providers who do not meet the July 6 deadline for enrolling in the Provider Enrollment, Chain and Ownership System, CQ HealthBeat reports. PECOS is designed to ensure that only eligible providers bill Medicare for services, CQ HealthBeat reports. In May, CMS changed the deadline for PECOS enrollment for providers from Jan. 3, 2011, to July 6, 2010. However, the National Association of Chain Drug Stores said that the July deadline would effectively deny access to products, such as diabetes testing strips and monitoring devices, covered under Medicare Part B. Part B covers certain types of care outside hospitals.
CMS denied NACDS’ request to reinstate the Jan. 3 deadline. However, the agency said that it will “for the time being, not implement changes that would automatically reject claims based on orders, certifications, and referrals made by providers” whose application have not been approved by July 6.
About 800,000 providers successfully have enrolled through PECOS, but “some providers have encountered problems,” CMS said, adding that it will continue to remind providers to enroll and help them with the procedure, as well as “process all applications expeditiously.”
Posted in MEDICARE UPDATES, NATIONAL HEALTHCARE NEWS | No Comments »
CMS TO EXPAND MEDICARE PREVENTIVE SERVICES AND IMPROVE ACCESS TO PRIMARY CARE IN 2011
Monday, June 28th, 2010
PROPOSALS WOULD IMPLEMENT AFFORDABLE CARE ACT BENEFITS
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: http://www.cms.gov/apps/media/press_releases.asp
CMS Issued Fact Sheets (6/25) with additional details at: http://www.cms.gov/apps/media/fact_sheets.asp
The proposed rule is available at: http://www.federalregister.gov/OFRUpload/OFRData/2010-15900_PI.pdf
Or http://www.federalregister.gov/inspection.aspx#special
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.
Posted in MEDICARE UPDATES, NATIONAL HEALTHCARE NEWS | No Comments »
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
Posted in MEDICARE UPDATES, NATIONAL HEALTHCARE NEWS | 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.
Posted in MEDICARE UPDATES, NATIONAL HEALTHCARE NEWS | No Comments »
NEW YORK STATE TO RECEIVE $2.99M FEDERAL GRANT TO SUPPORT MEDICAL LIABILITY DEMONSTRATION
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:
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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.
Posted in MEDICARE UPDATES, NATIONAL HEALTHCARE NEWS | No Comments »
AMA Ad Campaign targets Senate Failure to Fix SGR
Friday, June 4th, 2010
Posted in NATIONAL HEALTHCARE NEWS | No Comments »
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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Monday, May 24th, 2010
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