June 25, 2010
Medicare payment cut delayed for six months, 2.2 percent increase is effective June 1
One week after the Centers for Medicare and Medicaid Services (CMS) began processing Medicare claims with the 21 percent reduction in payment, which was originally scheduled to take affect on Jan. 1, Congress passed a temporary fix that post-pones the cut until Dec. 1.
In place of the cut, H.R. 3962 provides a 2.2 percent Medicare fee schedule update for physician services through November. The increase will be applied retroactively to claims for services provided on or after June 1.
June 18, 2010
Medicare claims to be processed with 21.2 percent cut
The Centers for Medicare and Medicaid Services has instructed Medicare contractors to begin processing physician reimbursements for the month of June with the scheduled 21.2 percent cut mandated by law.
The Senate passed a bill that would remove the cuts through Nov. 30, but the House, adjourned until next week, still needs to approve it. The bill instead provides a 2.2% increase in pay.
In an e-mail sent to congressional staffers and in a message posted to its physicians listserv, CMS said it would not extend the current hold on physicians' claims — something it has been doing since June 1 in anticipation of congressional action that would halt the cuts.
Fix Medicare Now!
My Doctor. My Choice. is a coalition of physicians and patients working together for better health care in Alabama.
Congress is forcing Alabama doctors to limit the number of Medicare patients they can see or worse, quit seeing Medicare patients altogether. Seniors and their physicians are united in the fight to save Medicare, which must be fixed if doctors are to continue seeing Medicare patients and seniors are to continue receiving the kind of high quality care they expect and deserve.
Regardless of whether you’re a physician, a Medicare recipient or even a concerned citizen, sign the petition urging Congress to Fix Medicare Now!
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What is PECOS?
Although enrolled in Medicare, many physicians and non-physician practitioners who are eligible to order items or services or refer Medicare beneficiaries to other Medicare providers or suppliers for services do not have current enrollment records in Medicare. A current enrollment record is one that is in the Medicare Provider Enrollment, Chain and Ownership System (PECOS) and also contains the physician/non-physician practitioner’s National Provider Identifier (NPI). Under Phase 2 of the above referenced CRs, a physician or non-physician practitioner who orders or refers and who does not have a current enrollment record that contains the NPI will cause the claim submitted by the Part B provider/supplier who furnished the ordered or referred item or service to be rejected.
CMS continues to urge physicians and non-physician practitioners who are enrolled in Medicare but who have not updated their Medicare enrollment record since November 2003 to update their enrollment record now. If these physicians and non-physician practitioners have no changes to their enrollment data, they need to submit an initial enrollment application which will establish a current enrollment record in PECOS.
For physicians and non-physician practitioners who order or refer—
• If you are not enrolled in the Medicare program, or if you enrolled more than 6 years ago and have not submitted any updates or changes to your enrollment information in more than 6 years, you do not have an enrollment record in PECOS. In order to continue to order or refer items or services for Medicare beneficiaries, you will have to submit an initial enrollment application. You may do so either by (1) using Internet-based PECOS (which transmits your enrollment application to the Medicare carrier or A/B MAC via the Internet—be sure to mail the signed and dated Certification Statement to the carrier or A/B MAC immediately after submitting the application), or (2) filling out the appropriate paper Medicare provider enrollment application(s) (CMS-855I and CMS-855R, if appropriate) and mailing the application, along with any required additional supplemental documentation, to the local Medicare carrier or A/B MAC, who will enter your information into PECOS and process your enrollment application. Information on how to enroll in Medicare is found on the Medicare provider/supplier enrollment web site at www.cms.hhs.gov/MedicareProviderSupEnroll.
• If you are already enrolled in Medicare, make sure you have a current enrollment record. You can find out if you have an enrollment record in PECOS by calling your designated carrier or A/B MAC or by going on-line, using Internet-based PECOS, to view your enrollment record. We will be posting information to the Medicare provider/supplier enrollment web site that will guide you through this process. Information about Internet-based PECOS and a link to Internet-based PECOS can be found on the Medicare provider/supplier enrollment web site. Before using Internet-based PECOS, we recommend that you read the information that is posted there and that is available in the downloadable documents section.
• If you are a dentist or a physician with a specialty such as a pediatrics who is eligible to order or refer items or services for Medicare beneficiaries but have not enrolled in Medicare because the services you provide are not covered by Medicare or you treat few Medicare beneficiaries, you need to enroll in Medicare in order to continue to order or refer items or services for Medicare beneficiaries.
• If you are a physician who is employed by the Department of Veterans Affairs, the Public Health Service, or the Department of Defense Tricare program but have not enrolled in Medicare because you would not be paid by Medicare for your services, you need to enroll in Medicare in order to continue to order or refer items or services for Medicare beneficiaries.
If you are a resident who has a medical license but have not enrolled in Medicare because you would not be paid by Medicare for your services, you do not need to enroll in Medicare in order to continue to order or refer items or services for Medicare beneficiaries. The teaching physician—not the resident—should be identified in claims as the ordering/referring provider when a resident orders or refers items or services for Medicare beneficiaries.
April 30, 2010
Online training available from Cahaba GBA
Cahaba GBA has introduced an online self-service training tool for their provider community called “Cahaba University." Read More.
March 22, 2010
Medicare Appeal Process brochure available
The Centers for Medicare and Medicaid Services (CMS) has issued a revised Medicare Appeals Process brochure, now available in a downloadable format from the Medicare Learning Network.
The brochure provides an overview of the Medicare part A and Part B administartive appeals process available to physicians who provide services to Medicare beneficiaries.
February 15, 2010
In mid-December, the Centers for Medicare and Medicaid Services (CMS) announced that as of Jan. 1, 2010, consultation codes would no longer be paid for Medicare beneficiaries. The consultation codes comprise 99241-99244 for office or other outpatient consults and 99251-99255 for inpatient consultations. Read more.
February 3, 2010
CMS encourages e-prescribing
The Centers for Medicare and Medicaid Services (CMS) offers educational products on the Electronic Prescribing Incentive (eRx) Program on their eRx Web page.
• 2010 eRx Measure Specifications and Release Notes provides guidance on the 2010 eRx measure specifications for claims or registry-based reporting and release notes describing changes from the 2009 eRx measure specifications.
• Claims-Based Reporting Principles for the 2010 eRx Incentive Program provides guidance on the principles for reporting the eRx measure on claims for the 2010 eRx Incentive Program.
• 2010 EHR Measure Specifications for eRx and Release Notes provides guidance on the 2010 EHR measure specifications for eRx and release notes. In addition it details the specifications of data element names and codes.
• 2010 EHR Downloadable Resource is an Excel spreadsheet listing 2010 EHR information.
• Group Practice Reporting Option (GPRO) Requirements for Submission of 2010 eRx Data provides guidance on the GPRO requirements for submission of 2010 eRx data.
• GPRO eRx Measure Specifications provides guidance on the specifications for the eRx measure for use in the 2010 eRx GPRO.
Reporting for the 2010 eRx began Jan. 1. Please note there is no need to sign up or pre-register in order to participate.
January 21, 2010
CMS issues 2010 PQRI educational products
The Centers for Medicare and Medicaid Services (CMS) has posted information on the 2010 Physician Quality Reporting Initiative (PQRI) to the CMS Web site.
Tools include a PQRI Quality Measure List that identifies the 179 quality measures selected for the 2010 PQRI and a table that outlines each QDC that should be reported for a corresponding quality action performed by the individual EP as noted in the measures specification.
To access the 2010 PQRI educational products, visit the CMS Web site. Once on the Spotlight page, view the listing of educational products and the corresponding Web pages where they can be found.
The reporting period for the 2010 PQRI began Jan. 1. Please note there is no need to sign up or pre-register in order to participate.
January 5, 2010
CMS extends deadline for signing participation agreements
Because of the delay in the Medicare physician payment cut, the Centers for Medicare and Medicaid Services (CMS) has extended the 2010 Annual Participation Enrollment Program end date from Jan. 31 to March 17. Physicians still have time to consider their participation options with the Medicare program.
Click here for more information
November 24, 2009
CMS announces delays in implementation of changes
The Centers for Medicare & Medicaid Services (CMS) will delay, until April 5, 2010, the implementation of Phase 2 of Change Request (CR) 6417 (Expansion of the Current Scope of Editing for Ordering/Referring Providers for Claims Processed by Medicare Carriers and Part B Medicare Administrative Contractors (MACs)) and CR 6421 (Expansion of the Current Scope of Editing for Ordering/Referring Providers for Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Supplier Claims Processed by Durable Medical Equipment Medicare Administrative Contractors (DME MACs)). CRs 6417 and 6421 are applicable to Part B claims only. Read more.
Medicare to recoup overpayments through RAC program
The Centers for Medicare and Medicaid Services, along with Connolly Healthcare representatives, will conduct a conference call on Sept. 22 to educate physician practices on the intent and purpose of Medicare's Recovery Audit Contractor (RAC) program. Read More.
The Centers for Medicare and Medicaid Services, along with Connolly Healthcare representatives, will conduct a conference call on Sept. 22 to educate physician practices on the intent and purpose of Medicare's Recovery Audit Contractor (RAC) program.
AMA clarifies time table for Medicare claims processing
By statute, Medicare electronic physician claims may not be paid sooner than 14 days after the date of submission, nor can "clean" electronic claims be paid any later than 30 days after the date they are submitted. (Paper claims are paid after the 29th day.) read more...
SummaryMedicare is a health insurance program for people age 65 or older, people under age 65 with certain disabilities, and people of all ages with End-Stage Renal Disease.
Understanding Medicare Basics:
Part A Hospital Insurance - Medicare Part A helps cover inpatient care in hospitals, including critical access hospitals, and skilled nursing facilities (not custodial or long-term care). It also helps cover hospice care and some home health care. Beneficiaries must meet certain conditions to get these benefits.
Part B Medical Insurance - Medicare Part B helps cover doctors' services and outpatient care. It also covers some other medical services that Part A doesn't cover, such as some of the services of physical and occupational therapists, and some home health care. Part B helps pay for these covered services and supplies when they are medically necessary.
Prescription Drug Coverage (or Part D) - Medicare Prescription Drug Coverage is insurance provided by private companies. Beneficiaries choose a drug plan and pay a monthly premium. Enrollment occurs near the end of each year.
Prescription Drug Coverage available in Alabama
Part D Coverage Clarifications
Table of Part D Drugs/Part D Excluded Drugs
Medicare Part D Coverage Determination Request Form
For More Information
The Centers for Medicare and Medicaid Services hosts the official site for Medicare regulations and guidance.
People with Medicare, family members, and caregivers should visit Medicare.gov, the official site for people with Medicare.