May
10
2012
States will receive an $11 billion boost for primary-care physicians in their Medicaid programs over the next two years, under a new proposed rule.
The temporary increase in 2013 and 2014 is mandated by a provision of the 2010 federal healthcare overhaul and aims to bring Medicaid primary-care payments in line with the level provided by Medicare. The provision, released Wednesday, would increase average Medicaid primary care payments by 34%, according to one estimate cited by CMS.
“Promoting high-quality primary-care is a pillar of the Affordable Care Act, and this proposed rule helps States and physicians provide every American, no matter where they live, access to the care they need to stay healthy,” HHS Secretary Kathleen Sebelius said in a news release (PDF). “This new rule can help improve health and reduce costs by preventing illnesses before they happen and catching small problems before they turn into big ones.”
Medicaid physicians eligible for the increased funding include family medicine, general internal medicine, pediatric and related subspecialists, according to HHS’ news release. The increased payment requires no matching payments by states.
The increased payments aim to encourage primary-care physicians to provide checkups, preventive screenings and vaccines to Medicaid beneficiaries. The rule also acknowledges that federal officials hope the increased rate encourages more physicians to participate in the Medicaid program because more clinicians will be needed under the program’s coming expansion. Other provisions of the Patient Protection and Affordable Care Act will begin expanding Medicaid’s enrollment by at least 16 million in 2014.
“We’re optimistic that this will help us attract and keep primary care doctors caring for Medicaid patients in our state,” Andy Allison, director of the Arkansas Division of Medical Services, said in a call with reporters.
Cindy Mann, director of the Center for Medicaid and CHIP Services at CMS, acknowledged in the call with reporters the limited efficacy of a temporary boost in physician reimbursements. Her agency plans to study the impact of the increased physician pay and “options” for continuing such benefits after the boost expires by 2015.
Apr
30
2012
Organized medicine is pushing back against a Medicare proposal to recoup overpayments quickly from physicians, who would be required to go back through up to 10 years of medical records when determining if they received excess pay.
The American Medical Association and state and specialty medical organizations have called on the Centers for Medicare & Medicaid Services to clarify — or in some cases abandon — new requirements that practices must return overpayments within 60 days. About 110 groups, led by the AMA, sent an April 16 letter to CMS acting Administrator Marilyn Tavenner calling on the agency to make necessary changes before the proposal is finalized.
The AMA specifically requested several revisions to the overpayment proposal that would reduce administrative burdens for physicians significantly, said AMA Chair-elect Steven J. Stack, MD. “Current CMS initiatives, like the Medicare recovery audit program, are already in place, and conflicting requirements will make it difficult for physicians to know which guidelines to follow.”
CMS has proposed that physicians be able to review their previous 10 years of claims to identify any overpayments that might be suspected during that time frame. The 10-year look-back is inappropriate, wrote Paul A. Hamlin, MD, president of the Medical Society of the State of New York, in a March 27 letter. The medical society would support the retrospective period only if its intent was “to put the fear of the federal government into those who knowingly and willfully with malice of intent act to defraud” the Medicare program. But the consequences of innocent mistakes by physicians and practice administrators must not also be swept up by rules aimed at those knowingly committing fraud and abuse, he said.
If you have any questions plese feel free to shoot me in email at bsayers@mmsofslo.com
Apr
30
2012
Yesterday, the Centers for Medicare & Medicaid Services (CMS) released the final rule detailing requirements for ordering and referring in Medicare. In 2009, CMS began issuing warnings for Medicare claims that failed to meet CMS’s ordering and referring criteria, including requiring the ordering/referring provider have an enrollment record in the Provider Enrollment, Chain and Ownership System (PECOS). An interim final rule released in 2010 further detailed these ordering and referring requirements.
The final rule released yesterday includes changes to some of the previous requirements. Notably, CMS changed the regulatory language from requiring an enrollment in PECOS to requiring enrollment in Medicare — including PECOS or other legacy Medicare enrollment systems. Additionally, CMS removed specialist services from those that are required to list the ordering or certifying provider on the claim and meet the other criteria. This change resulted in CMS replacing the term “refer” with “certify” for the applicable items and services. The requirements in this final rule apply to ordered or certified items and services including DMEPOS, clinical laboratory and imaging services, and home health claims billed by Medicare Part B suppliers. For these claims, ordering or certifying providers must be eligible to order or certify in Medicare, their legal name and NPI must be listed on the claim, and they must have an enrollment record in Medicare. The requirements vary slightly for medical interns and residents who order or certify these items and services.
CMS will continue to issue warnings for claims that fail to meet these criteria, but at this point CMS will not deny claims that do not meet the criteria. In the future, CMS will begin to deny claims, but has not indicated when this will occur.
If you have any questions, please feel free to shoot me an email at bsayers@mmsofslo.com
Apr
30
2012
MGMA submitted comments this week requesting that the Centers for Medicare & Medicaid Services (CMS) significantly revise a proposed rule aimed at implementing a provision of the Affordable Care Act (ACA). The provision requires that practices report and return overpayments of Medicare and Medicaid funds within 60 days of being identified. Though the requirement went into effect on March 23, 2010 (the date the ACA became law), details of how CMS plans to enforce this provision still need to be finalized.
Any questions, feel free to shoot me an email @ bsayers@mmsofslo.com
Mar
16
2012
Hey Everyone,
The CMS will not begin enforcing the mandated move to Version 5010 transaction standards for an additional three months, 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.
If anyone has any questions about how this may affect your practice, please feel free to contact me, Bob Sayers.
If any practice is in need of a 2012 HIPAA Handbook/Manual please contact Chris Wolman @ MMS, for one. 805.547.1255 ext. 148.
Also, our sister company, Global Healthcare Solutions, is hosting a webinar for the Security Risk Analysis part of MeaningfulUse for various electronic health records.
The Specific Meaningful Use measure is:
Conduct or review a security risk analysis per 45 CFR 164.308 (a) (1) and implement security updates as necessary and correct identified security deficiencies as part of its risk management process.
Come to this webinar on March 28 @ 4:45 PM PT and get your practice over one of the bumps of meaningful use. Send an email to cwolman@mmsofslo.com to RSVP your practice.
Thanks,
Bob Sayers
Feb
17
2012
A House-Senate Conference Committee tasked with identifying a compromise to avoid the pending 27.4 percent Medicare physician payment cut reached a 10-month deal that would maintain current physician payment rates through the end of the year. The measure was approved this afternoon by both the House and Senate. The measure now goes to President Obama for his signature. The President is expected to sign the bill.
Feb
15
2012
Federal lawmakers on Wednesday, February 15, 2012, reached a tentative agreement on a payroll tax holiday bill that averts a 27.4% cut in Medicare physician payment rates and extends current rates until the end of 2012, according to a GOP aide.
As I hear more I will keep you posted.
Thanks for reading,
Bob
Feb
2
2012
Please join me and Medical Management Strategies on our Webinar on 5010.
The webinar will be availible for Clients and Non-Clients.
On February 16 at 1:45 PM (PT) and 4:45 PM (PT).
This webinar will go over problems and implications experienced from 5010, how to avoid these problems, and cash flow issues!
Space is filling up quick, and please RSVP with Chris. Contact Chris at cwolman@mmsofslo.com and 805.710.3306
Click MGMA letter for a letter from the MGMA to the Department of Health and Human Services, and several of the items that the MGMA has noticed!
This is a real problem that needs a solution. Medical Management Strategies has found th solution to 5010! Please contact us and RSVP to this webinar so we can help you and your practice too!
Feb
1
2012
January 2012 Update – 5010 Transition
Most payers are still struggling with the 5010 EDI (Electronic Data Information) transition. Again, this has effected anyone involved with electronic billing for medical claims which is pretty much everyone industry wide. Here is the most recent update to items noticed that occurred in January of this year.
(1) Noridian Medicare: (DME Billing)
Noridian Medicare has been experiencing major issues with processing 5010 claims since January 1st. Their 5010 system is experiencing intermittence outage. Noridan is working to fix the problem. You may experience delay in payment compensations.
(2) Medicare Update on 2012Payments:
a) Medicare has begun to release EOBs (Explanation of Benefits) for the beginning of January dates of service and releasing the 10 day hold.
b) Medicare is still delaying their 5010 implementation until April 1, 2012. During this 90 day non enforcement period (1-1-3-31-12), Medicare will have the systematic capability to perform up or down version conversions of incoming claim formats (either converting these to the 5010 format when necessary for cross over claims (billing secondaries) and/or leaving them in the 4010 EDI format. What has been occurring is these transitions are not always perfect and has created its own set of issues as well.
(3) Medicare and Blue Cross
Medical Management Strategies has also noticed that with all the changes going on in the industry for Electronic Data Information going to the new version 5010, there have been a number of significant issues that have occurred for Medicare and Blue Cross payers particularly. Medicare has had a number of issues to deal with this January which included revamping fee schedules, processing claims from clearinghouses in the older version since they put a hold on converting to the 5010 until April 1st, applying deductibles, etc. as well as crossover issues. Although they’ve been trying to notice everyone of how these transitions have been dealt with, there are still a number of issues particularly with clearinghouses to Medicare as well as crossover claims. Clearinghouses are reporting acknowledgements of claims going to Medicare and Medicare then stating they never received the batches.
From Medical Management Strategies Perspective…
For MMS, we’ve been monitoring all clients’ claims closely to make sure we try and minimize cash shortfalls. Not all Electronic claims are going through smoothly and what we’re finding is it is hit and miss. Many claims go through without an issue and then some don’t. As we discover this each time, we are working these through timely as best we can. A lot of this is out of our hands as this is an industry wide adjustment to claims processing in general and many of the payers are struggling with this on a daily basis. Most of us will notice a drop in cash flow during this transition. MMS will keep you updated as we learn more.
Jan
20
2012
As we all read, discussed and prepared for the big change in the CMS-1500 claim form, from the 4010 format to the new 5010 format, effective January 1, 2012, it has happened and what a mess it has created.
With a transition of this magnitude, everyone that touches medical claims is dealing with issues. Providers, practice management system vendors, clearinghouses and payers are all experiencing challenges and subsequently increased calls and delays.
Even providers who were ready for 5010 are experiencing rejections as the industry moves out of the testing phase into live production. MMS clients are no exception. MMS is doing everything we can to make sure your claims are getting processed. Everyone will experience some slow down of payments over this initial period until all parties can straighten out their issues.
I will keep you up to date, thanks for reading.
Bob Sayers