Medicare Part D

2012 Medicare e-Prescribing Penalty Exemptions: The AMA has secured an opportunity for more physicians to be exempted from the 2012 Medicare e-prescribing penalty. Read more.

CMS delays 5010 enforcement: The CMS has announced it will not begin enforcing the mandated move to Version 5010 transaction standards until after June 30. The deadline for the switch to the 5010 standards was Jan. 1. In November, the CMS announced that although it was not changing the actual deadline for complying with the standards, it would not initiate enforcement action until March 31.

CMS Proposes 10 Year Look-Back Period in Medicare, Medicaid Overpayment Rule:
On February 14, CMS issued a proposed rule that would extend responsibility for Medicare overpayments through a 10-year "lookback period."

CMS Releases EHR Incentive Appeals Process Info: The Centers for Medicare & Medicaid Services (CMS) recently released guidance on the appeals process for this incentive program. The agency has added to its attestation Web site new information about the appeals process for the incentive program to adopt electronic health records.

Doc-Pay Fix: President Barack Obama signed the Middle Class Tax Relief and Job Creation Act of 2012, the bill that includes a provision to prevent a 27.4% cut to Medicare physician payment rates on Feb. 29. The president signed the bill after Congress passed the legislation Feb. 17.

Claim 2011 Medicare Incentive Payment: Physicians had until Feb. 29, 2012, to register and attest to meeting meaningful use requirements to receive payments for 2011 through the Medicare & Medicaid EHR Incentive Program Registration and Attestation System. Review important deadlines.

Physicians had until Feb. 14 to determine their Medicare participation status for 2012. The Centers for Medicare & Medicaid Services (CMS) extended the annual enrollment period from the original deadline of Dec. 31 after Congress delayed the 27.4-percent cut in payments to physicians through February.

Important Update on 2012 Medicare Physician Payment Rates:The AMA reminded physicians that even though the 27 percent cut in Medicare payments has been blocked for two months, there are still changes coming to some Medicare fees. More

CMS Initiates 90-Day Enforcement Discretion for 5010 Compliance: The Centers for Medicare & Medicaid Services announced that it would not initiate enforcement action with respect to any HIPAA covered entity non-compliant with the ASC X12 Version 5010 (Version 5010), NCPDP Telecom D.0 (NCPDP D.0), and NCPDP Medicaid Subrogation 3.0 (NCPDP 3.0) standards until 90 days after the January 1, 2012 compliance date. Notwithstanding CMS’ discretionary application of its enforcement authority, the compliance date for use of these new standards remains January 1, 2012. More

2011 Medicare Online System User ID Recertification: The Centers for Medicare & Medicaid Services requires National Government Services to conduct an annual recertification of all current Medicare online system users for:

This process will recertify all user IDs used by your employees or third parties whom you have authorized to access National Government Services systems on your behalf. This recertification must be completed by November 30, 2011. Failure to complete recertification by the November 30, 2011 deadline date will result in a disruption of your Medicare online system access. More

MedPac has endorsed a plan to repeal the SGR formula and replace it with one that keeps payment rates steady for primary care physicians over the next decade and cuts payments to specialists. The proposal will reach Congress later this month. If Congress does not act on the MedPAC plan or come up with an alternative before Jan. 1, 2012, a 30% across-the-board cut in Medicare payments mandated by the SGR will go into effect

Announcement from CMS: All providers who enrolled in the Medicare program prior to March 25, 2011, will be required to revalidate their enrollment under new risk screening criteria required by the Affordable Care Act. Providers who enrolled on or after March 25, 2011 have already been subject to this screening, and need not revalidate at this time. Medicare Administrative Contractors (MACs) will notify providers when they should update their enrollment information. Special Edition Article #SE1126 further explains this requirement.

2012 proposed Medicare rule: Read the AMA's comments regarding the 2012 Physician Fee
Schedule (PFS) proposed rule for Medicare physician payment.

Regional Medicare Conference: Coming to the Rochester Riverside Convention Center Nov. 15 and 16. Click here for more information.

Physician Quality Reporting System Maintenance of Certification Program 2011 released. Download the factsheet.

National HIPAA 5010 Testing Week: Monday through Aug. 26, hosted by CMS. During testing weekparticipants will have the added benefit of real-time help desk support and immediate direct access to Medicare administrative contractors.

Announcement from CMS: All providers and suppliers who enrolled in the Medicare program prior to Friday, March 25, 2011, will be required to revalidate their enrollment under new risk screening criteria required by the Affordable Care Act. Providers/suppliers who enrolled on or after March 25, 2011 have already been subject to this screening, and need not revalidate at this time. Medicare Administrative Contractors (MACs) will notify providers and suppliers when they should update their enrollment information. CMS has published a Special Edition Article #SE1126 to further explain this revalidation requirement.

CMS to track payer ACA compliance: The Centers for Medicare and Medicaid Services announced this week that it plans to build a Health Insurance Assistance Database to analysis inquiries and reports of payer activities by consumers related implementation of the Affordable Care Act. Plans for the database were announced in the Federal Registry.

Preparing for ICD-10: In 2013, CMS will require the use of ICD-10 for coding of diagnoses in billing/administrative transactions. The following resources may be useful:
>This timeline tool may be helpful in developing a plan for ICD 10 conversion.
>This section of the CMS website provides information on ICD-10 Conversion project.
>The AMA published a series of fact sheets about ICD-10.
> The MCMS will hold a program on transitioning to ICD-10 on Dec. 7, 2011.

lHIPAA Version 5010: To allow adequate time to meet the January 1, 2012 implementation date, providers should begin testing Version 5010 with their trading partners now. Nationa lHIPAA Version 5010 testing week announced for Mon Aug 22 through Fri Aug 26. Visit www.cms.gov/ICD10 to find out more.

CME Credit: CMS announces by completing the module From Meaningful Use to Meaningful Care providers can earn CME credit while gaining a better understanding about the purpose of the EHR Incentive Programs.

Regional Medicare Conference: This educational program will help providers understand specific Medicare regulations and prevent common claim errors. Coming to the Rochester Riverside Convention Center Nov. 15 and 16.Click here for more information.

June 30, 2011, E-prescribing Incentive Program Deadline Approaching

Preparing for ICD-10
In 2013, CMS will require the use of ICD-10 for coding of diagnoses in billing/administrative transactions. The code set allows more than 155,000 different codes and permits tracking of many new diagnoses and procedures, a significant expansion of the 17,000 codes available in ICD-9. This timeline tool may be helpful in developing a plan dfor ICD 10 conversion.

National Government Services Medicare Part B 101 Manual(May 2010)

E-prescribing Requirements Unreasonable
The AMA reports that the Federal Government Accounting Office agrees with physician groups that the 1% eprescribing penalty linked to the CMS requirement to eprescribe for 10 visits between January 1-June 30, 2011 is unreasonable. Read more about the GAO report.

CMS introduces New Center for Medicare and Medicaid Innovation
Calls it “a new engine for revitalizing and sustaining the Medicare, Medicaid and CHIP programs and ultimately to help to improve the healthcare system for all Americans." Log onto www.innovations.cms.gov

Registration Numbers Growing for EHR Incentive Programs

According to CMS, as of February 11, more than 45,000 physicians and other providers requested information or registration help from 62 regional extension centers. Registration opened on Jan. 3.

Primary Care Incentive Program (PCIP)

For primary care services furnished on or after January 1, 2011 and before January 1, 2016, a 10 percent incentive payment will be provided to primary care practitioners. To qualify for the bonus, a physician must be self-designated in a primary care specialty and a substantial portion (60 percent) of their Medicare billings must be for the designated primary care services.

New resources explains Medicare preventive care

A new brochure from the AMA helps physicians and their patients take advantages of new Medicare preventive care services called for in the Patient Protection and Affordable Care Act of 2010. According to a Feb. 4 news release from the AMA, the new rules on Medicare benefits mean that more beneficiaries will have access to preventive services at a more affordable cost.

CMS launches physician compare website

CMS launched the first phase of a searchable online physician directory for Medicare patients called Physician Compare and located at www.medicare.gov/find-a-doctor. The site is publicly available for non-Medicare patients to peruse. Patients may use the site to search for physicians in their area, find information on other health care professionals who work with Medicare beneficiaries, search by gender, and elect a preference for providers who accept Medicare approved amounts as payment in full. The site also lists whether a physician participates in the Physician Quality Reporting System. Future iterations of the site will incorporate data about the quality of care received by Medicare patients from that individual. The MCMS urges physicians and practices to access Physician Compare and confirm the accuracy and completeness of the information that is available.

Medicare sets physician payment rates for 2011

Following passage of the Medicare and Medicaid Extenders Act of 2010—which President Obama signed on Dec. 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.

Last week, 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. View the new payment schedule file. Among the files available online in the RVU11AR zip file, the final 2011 relative values are in the file PPRRVU11.xlsx. To learn more, view instructions CMS sent to its carriers.

The 2.2 percent update to the 2010 payment schedule that took effect on June 1, 2010, was the starting point for the 2011 payment update. The Medicare and Medicaid Extenders Act of 2010 (MMEA) established a payment update for 2011 of 0 percent, which means that the 2.2 percent update from last June continues throughout 2011. This payment update replaces the 25 percent pay cut that otherwise would have been imposed due to the sustainable growth rate (SGR) formula.

Although payment rates are not being cut, the 2011 conversion factor is not the same as the 2010 conversion factor. The most significant reason for the change is that the final rule included a reweighting of the work, practice expense and liability expense components of the relative value scale that reduced the numerical value of the conversion factor, even though the net impact of these changes is budget neutral. The change in the national average payment rate for code 99213 illustrates the impact of the reweighting for this code:

As the calculation shows, the average payment rate for 99213 increases by 3.3 percent from 2010 to 2011, even though the numerical value of the conversion factor is reduced. In contrast, the conversion factor that was published in the 2011 final rule, $25.4999, was much lower than the final 2011 conversion factor calculated after passage of the MMEA.

Both the MMEA and the final payment schedule rule made other modifications that will affect the payment changes that individual physicians and practices will see for 2011. In addition to the reweighting of the work, practice expense and liability expense relative values, payment impacts will be affected by 2011 being the second year of the transition to new practice expense relative values, changes in relative values for services that were identified as misvalued, updated data being used in the geographic price cost indices, and multiple procedure payment reductions for therapy and imaging services.

The impact table from the 2011 final rule, as amended by technical correction, shows the average impact of all these changes on each specialty.

EHR Incentive Program Registration

The Centers for Medicare & Medicaid Services (CMS) encourages eligible professionals, eligible hospitals and critical access hospitals to register for the Medicare and/or Medicaid EHR Incentive Program(s) as soon as possible. You can register before you have a certified EHR. Register even if you do not have an enrollment record in the Provider Enrollment, Chain and Ownership System (PECOS). Click here for overview of bonus programs.

The Registration and Attestation page (click on button below) on the EHR website now contains:

CMS announced it will indefinitely delay the January 3, 2011 effective date for PECOS edits. The automated edits would have denied claims for services that were ordered or referred by a physician or other eligible professional who was not enrolled in the PECOS system. CMS has stated that they working diligently to resolve enrollment backlogs and other system issues and will provide ample advanced notice to the providers before they begin any automatic nonpayment actions. Despite this reprieve, physicians who are not currently enrolled in PECOS should do so immediately.

Obama Signs Bill Delaying Medicare Pay Reductions

(December 15, 2010) President Barack Obama has signed the Medicare and Medicaid Extenders Act of 2010 that delays for one year a 25% reduction in Medicare payments to physicians that would otherwise take effect Jan. 1, 2011. The act also extends other expiring Medicare and Medicaid payment provisions, changes limits on the amount of excess health insurance tax credits that must be repaid to the government, and makes other Medicare and Medicaid clarifications and adjustments. The Senate passed the legislation on Dec. 7 and the House followed suit on Dec. 9.

Congress Passes One Year Medicare Fix

(December 9, 2010) The U.S. House of Representatives voted 409 to 2 to pass Medicare and Medicaid Extenders Act of 2010, extending a Medicare payment fix to physicians through 2011. The legislation is identical to a bill the Senate passed and can now be sent to President Barack Obama for his signature.

This legislation, which passed the Senate yesterday by unanimous consent, would stabilize Medicare physician payments at current rates for 12 months, through the end of 2011. It will now be sent to the White House for President Obama to sign into law. In addition to providing an additional 12-month reprieve from the 25 percent Medicare physician payment cut scheduled to take effect on January 1, the bill extends a number of payment policies that were set to expire at the end of this year. It also includes funds to enable Medicare contractors to reprocess claims for physician services affected by provisions of the Patient Protection and Affordable Care Act passed last spring with a retroactive effective date of January 1, 2010. Click here for a more detailed summary of the bill’s provisions. Medicine was supported in its advocacy efforts by aggressive grassroots pressure from AARP, which included over 100,000 contacts by seniors to Congressional offices as well as paid radio and print advertising, direct mail, teletownhalls, and educational efforts conducted jointly with medical societies in several states. Also key to successful and timely passage of the bill was the bipartisan cooperation among leaders in the Senate and the House. All parties agree with medicine that the time for recurring stop-gap measures to end the disruption caused by the sustainable growth rate formula is long past. As noted in a statement issued yesterday by President Obama: “It’s time for a permanent solution that seniors and their doctors can depend on and I look forward to working with Congress to address this matter once and for all in the coming year.”

Clinics to Assist Part B Providers With Online Provider Enrollment
National Government Services will be assisting individual physicians and practitioners with online enrollment through Internet-based PECOS clinics being held throughout Connecticut and New York. The clinics are designed to assist you in enrolling in the Internet-based PECOS system. Each attendee will be able to access Internet-based PECOS and enroll at that time. National Government Services Provider Outreach & Education staff will be on hand to assist you in entering the information and to answer any questions as you complete your enrollment.

PECOS enrollment deadline is January 3, 2011
Medicare claims received on or after January 3, 2011, will not be paid if the ordering or referring provider is not enrolled in PECOS (Provider Enrollment, Chain and Ownership System). Physicians should also be aware that PECOS enrollment is required to receive federal EHR incentives under the Medicare program. Beginning in 2011, Medicare providers who demonstrate “meaningful use” of an EHR stand to receive up to $44,000 in incentive payments over five years.

One Month Payment Fix Approved
November 29, 2010- Earlier this afternoon, the House of Representatives approved legislation that provides a 31-day reprieve from the 23 percent Medicare physician payment cut scheduled to take effect on December 1.