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CMS TO EXPAND MEDICARE PREVENTIVE SERVICES AND IMPROVE ACCESS TO PRIMARY CARE IN 2011
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 |
The President Signs the Preservation of Access to Care for Medicare Beneficiaries and Pension Relief Act of 2010
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 |
URGENT – Defeat the HIV Testing Bill
June 22nd, 2010
We are asking you to call your legislators in Albany regarding the HIV Testing Bill. Assemblymembers can be reached at 1-518-455-4100 and Senate at 518-455-2800. Immediate action is necessary. The bill is being sponsored by Assemblymember Richard Gottfried and Senator Thomas Duane. To send an email see article below.
We met with Assemblyman Gottfried this morning and it is his intent to move the bill forward.
This bill would require mandatory offering of HIV testing to persons 13-64 by primary care physicians in all practice settings, including the private physician office.
A Bill introduced this late is session, means that it may move quickly.
The Bill is in the Senate Rules Committee and in the Assembly Health Committee. We urge you to contact your representatives and urge defeat of this proposal.
BILL REQUIRING PHYSICIANS TO OFFER AN HIV TEST INTRODUCED IN NYS LEGISLATURE; PHYSICIANS URGED TO CALL LEGISLATORS
A bill mandating the offering of an HIV test in all clinical settings, including the private physicians offices, has been introduced in the Legislature by Senator Thomas Duane and Assemblymember Richard Gottfried. S.8227/A.11487 has gone directly to the Senate Rules Committee and to the Assembly Health Committee. The introduction of this legislation indicates a disturbing trend in the interference by the New York State Legislature into the physician-patient relationship. The bill would require that all primary care physicians, defined in the bill as family medicine, general pediatrics, primary care, internal medicine, primary care obstetrics or primary care genecology, to offer an HIV test to all patients ages 13 to 64. The bill does allow for oral, informed consent when the test being given is a Rapid HIV test. Written informed consent is still needed for the blood test, however, consent would be included in the signed general consent for medical care and remains in effect until it is revoked. Under the measure, an opt-out provision for HIV testing must be included in the consent form. The bill does contain provisions for occupational exposure and testing of the source patient/release of information that MSSNY supports, however, the overall bill provisions are cause for strong concerns. Physicians are urged to call their legislators and urge that this measure be defeated. Senators can be reached by calling 518-455-2800 and Assemblymembers can be reached at 518-455-4100. E-mail addresses for each member can be obtained by logging on to the Senate/Assembly website at: www.nysenate.gov/senators or http://assembly.state.ny.us
Posted in NEWS FROM THE NYS LEGISLATURE |
NYS Medicaid Preferred Drug List Effective 6.17.10
June 16th, 2010
The following link will take you to the most recent updated Preferred Drug List. Please feel free to share this with your members or post a link to your website. If your organization would like to schedule a presentation or if you have any questions or concerns regarding this program, please contact 518-951-2051.
Please be aware of changes to the preferred and non-preferred status of some drugs on the preferred drug list, effective June 17, 2010.
In addition to these changes, the New York State Medicaid Clinical Drug Review Program (CDRP) is expanding to require prior authorization for the following:
- Growth Hormones (Genotropin®, Nutropin®, Nutropin AQ®, Saizen®, Humatrope®, Norditropin®, Omnitrope®, Tev-Tropin®, and Zorbtive®) for enrollees 21 years of age or older effective June 17, 2010.
Please visit https://newyork.fhsc.com/
The preferred drug list can be found at:
https://newyork.fhsc.com/downloads/providers/NYRx_PDP_PDL.pdf
A ‘quicklist’ of preferred drugs only can be found at:
https://newyork.fhsc.com/downloads/providers/NYRx_PDP_PDLquicklist.pdf
Prior Authorization Forms and Worksheets can be found at:
https://newyork.fhsc.com/providers/PA_forms.asp
EFFECTIVE IMMEDIATELY all changes to the NYS Medicaid Preferred Drug List will be communicated to providers via the monthly Medicaid Update publications. Notifications will no longer be mailed to providers.
Posted in MEDICAID UPDATES |
Medicare Contractors Hold Claims for Services Provided in June for an Additional Three Business Days
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 |
NEW YORK STATE TO RECEIVE $2.99M FEDERAL GRANT TO SUPPORT MEDICAL LIABILITY DEMONSTRATION
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:
Posted in NATIONAL HEALTHCARE NEWS |
PHYSICIAN GRASSROOTS ACTION IN SUPPORT OF COLLECTIVE ACTION LEGISLATION ESSENTIAL
June 14th, 2010
Posted in NEWS FROM THE NYS LEGISLATURE |
PHYSICIANS ENCOURAGED TO JOIN THE NYSDOH INFLUENZA ILINET SURVEILLANCE PROGRAM
June 14th, 2010
The ILINet Surveillance Program works in collaboration with the New York State Department of Health (NYSDOH) and the Centers for Disease Control (CDC) to provide a state and nationwide report on the spread of the influenza virus and its current activity. The ILINet data, in combination with other influenza surveillance data, can be used to guide prevention and control activities, vaccine strain selection, and patient care. ILINet Providers help fight the disease by collecting and reporting their total number of patient visits and their total numbers of patient visits for Influenza-Like-Illness (ILI) to the CDC on a weekly basis. Free of charge, ILINet Providers are permitted to submit a designated number of patient specimens to the NYSDOH Wadsworth Center for virus testing and sub-typing.
Additionally, all ILINet Providers receive a free subscription to the CDC’s Morbidity and Mortality Weekly Report and Emerging Infectious Diseases Journal.
Further information may be obtained from the MSSNY website or by contacting:
Posted in FLU/IMMUNIZATION UPDATES, HEALTH DEPARTMENT UPDATES |
BUDGET EXTENDER BILL ENACTED BY LEGISLATURE INCLUDES SUBSTANTIAL REDUCTIONS TO VARIOUS HEALTH CARE PROGRAMS; HITS HOSPITALS HARD
June 14th, 2010
Posted in NEWS FROM THE NYS LEGISLATURE |
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)
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.
Posted in MEDICARE UPDATES |
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