2011 Electronic Prescribing (eRx) Incentive Program Update

Monday, January 10th, 2011

In November, the CMS announced that, beginning in 2012, eligible professionals who are not successful electronic prescribers may be subject to a payment adjustment on their Medicare Part B Physician Fee Schedule (PFS) covered professional services. Section 132 of the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA) authorizes CMS to apply this payment adjustment whether or not the eligible professional is planning to participate in the eRx Incentive Program.

From 2012 through 2014, the payment adjustment will increase each calendar year.  In 2012, the payment adjustment for not being a successful electronic prescriber will result in an eligible professional or group practice receiving 99% of their Medicare Part B PFS amount that would otherwise apply to such services.  In 2013, an eligible professional or group practice will receive 98.5% of their Medicare Part B PFS covered professional services for not being a successful electronic prescriber in 2011 or as defined in a future regulation. In 2014, the payment adjustment for not being a successful electronic prescriber is 2%, resulting in an eligible professional or group practice receiving 98% of their Medicare Part B PFS covered professional services.

The payment adjustment does not apply if <10% of an eligible professional’s (or group practice’s) allowed charges for the January 1, 2011 through June 30, 2011 reporting period are comprised of codes in the denominator of the 2011 eRx measure.

Please note that earning an eRx incentive for 2011 will NOT necessarily exempt an eligible professional or group practice from the payment adjustment in 2011.

How to Avoid the 2012 eRx Payment Adjustment

• Eligible professionals – An eligible professional can avoid the 2012 eRx Payment if (s)he:

1. Is not a physician (MD, DO, or podiatrist), nurse practitioner, or physician assistant as of June 30, 2011 based on primary taxonomy code in NPPES;
2. Does not have prescribing privileges. Note: (S)he must report (G8644) at least one time on an eligible claim prior to June 30, 2011;
3. Does not have at least 100 cases containing an encounter code in the measure denominator;
4. Becomes a successful e-prescriber; and
5. Reports the eRx measure for at least 10 unique eRx events for patients in the denominator of the measure.

·         Group Practices – For group practices that are participating in eRx GPRO I or GPRO II during 2011, the group practice MUST become a successful e-prescriber.

Depending on the group’s size, the group practice must report the eRx measure for 75-2,500 unique eRx events for patients in the denominator of the measure.

For additional information, please visit the “Getting Started” webpage at http://www.cms.gov/erxincentive on the CMS website for more information; or download the Medicare’s Practical Guide to the Electronic Prescribing (eRx) Incentive Program under Educational Resources.

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Medicare Sets Physician Payment Rates In 2011

Monday, January 10th, 2011

Following passage of the Medicare and Medicaid Extenders Act of 2010—which President Obama signed on December 15—the Centers for Medicare & Medicaid Services (CMS) adjusted its calculations of the 2011 Medicare payment rates that had been published in the final rule. CMS issued a final 2011 conversion factor of $33.9764 and provided new files to the Medicare carriers. The carriers have been testing the new files and are in the process of posting them to their websites. All 2011 claims are expected to be paid on time and at the correct rates with no adjustments or claims holds necessary.

Click here to view the new payment schedule file. Download the zip file RVU11AR to view the final 2011 relative values, which are in the file PPRRVU11.xlsx. To learn more, visit here and view instructions CMS sent to its carriers.

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CMS To Conduct the 2011 Medicare Contractor Provider Satisfaction Survey

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 .

Thank you.

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Good News for People with Medicare and Their Doctors

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.

And these examples are just the beginning. The Affordable Care Act also aggressively fights Medicare fraud and enhances benefits in the Medicare Advantage program.

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

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Senators Reach Bipartisan Agreement on SGR Proposal

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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Senate Agreement to Delay Medicare Physician Cuts for 31 days

Friday, November 19th, 2010

…. Discussions Continue on SGR Relief for all of 2011.

On November 18, Senate Majority Leader Harry Reid reached agreement with Senate Minority Leader Mitch McConnell on a unanimous consent request for a 31-day reprieve from the 23 percent Medicare physician payment cut scheduled to take effect on December 1. This move is a necessary first step to avoid a disruption in payments while Congressional leaders continue to seek funding offsets for legislation that will stabilize Medicare physician payments through 2011. Because the Congress is adjourning for a Thanksgiving recess, final action on the 31-day extension in the House cannot take place until Congress reconvenes the week of November 29.

Thank you: The success of the grassroots effort stems from all of our efforts working together! Delivering a strong, common message is the key to future success on all of medicine’s agenda. Don’t stop now!  Keep up the pressure to secure a permanent fix for SGR relief. Physicians are again urged to contact Senators Schumer and Gillibrand as well as their respective House Representative to thank them for this temporary help AND ask them to work towards a permanent fix of the SGR.  Physicians may contact their federal legislators through the AMA’s toll-free grassroots hotline at (800) 833-6354.

Moving Medicine Forward: A thirty day extension is not the final word. Physicians should not experience a repeat of 2010 with “patches” that last only a few months, creating uncertainty and disruption for physician practices. We will continue to press Congress to pass additional legislation before it adjourns next month to eliminate the threat of SGR cuts for all of 2011.

SGR is important, but the AMA is working hard to help physicians on several other fronts. Earlier this week, Dr. Ardis Hoven, AMA Chair, and Dr. Cecil Wilson were joined by colleagues from other physician organizations to meet with senior Obama Administration officials to improve opportunities for physician led organizations to participate and prosper in emerging new payment models. AMA staff in Chicago and Washington continue to advance AMA policy in regulations under development to implement the Affordable Care Act.

We are moving forward to help physicians and their patients!

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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.

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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.”

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