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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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.

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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

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Medicare Contractors Hold Claims for Services Provided in June for an Additional Three Business Days

Monday, June 14th, 2010

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