e-RX: Medicare e-prescribing hardship exemptions under review (jump to story)
EFT: suppliers and providers who are not currently receiving Medicare EFT payments are required to submit the CMS-588 EFT form (jump to story)
SNFs: Allowing Physician Assistants to Perform Skilled Nursing Facility (SNF) Level of Care Certifications and Recertifications (jump to story)
ACA: the final rule on preventive health services will ensure that women with health insurance coverage will have access to the full range of the Institute of Medicines recommended preventive services, including all FDA -approved forms of contraception. (jump to story)
EHR Incentive Program: what can still be completed in 2012 in order to receive an incentive payment for CY2011 (jump to story)
5010: National Provider Call: Medicare FFS Implementation of HIPAA Version 5010 and D.0 Transactions (jump to story)
Claims Crossovers: Greater instances of Medicare correspondence letters that make reference to error N22226 as the basis for patient claims not crossing over(jump to story)
ICD-10: What’s Your Plan, Man?(jump to story)
MLN: Medicare Learning Network Announcements, Updates and Revisions (jump to story)
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Medicare e-prescribing hardship exemptions under review
Last fall, physicians had the opportunity to seek hardship exemptions and avoid penalties for failing to successfully participate in Medicares e-prescribing program. The Centers for Medicare & Medicaid Services (CMS) is reviewing each hardship exemption request on an individual basis and has not yet completed its analysis. Therefore, it is possible that some physicians will be subjected to a 1 percent Medicare payment penalty inappropriately until the backlog of exemption requests is reviewed. Ultimately, CMS will reprocess the claims.
Read information regarding remittance advice and information on the impact to physician reimbursement and patient copays. More information on the penalty program can be found here.
Find additional electronic prescribing information and resources on the AMA website.
The ACA (Affordable Care Act) Mandates Federal Payment to Providers and Suppliers Only by Electronic Means
Existing regulations at 42 CFR 424.510(e)(1)(2) require that at the time of enrollment, enrollment change request, or revalidation, providers and suppliers that expect to receive payment from Medicare for services provided must also agree to receive Medicare payments through electronic funds transfer (EFT). Section 1104 of the Affordable Care Act further expands Section 1862(a) of the Social Security Act by mandatingfederal payments to providers and suppliers only by electronic means. As part of CMSs revalidation efforts, all suppliers and providers who are not currently receiving EFT payments are required to submit the CMS-588 EFT form with the Provider Enrollment Revalidation application, or at the time any change is being made to the provider enrollment record by the provider or supplier, or delegated official.
For more information about provider enrollment revalidation, review the Medicare Learning Networks Special Edition Article #SE1126, titled Further Details on the Revalidation of Provider Enrollment Information.
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Allowing Physician Assistants to Perform Skilled Nursing Facility (SNF) Level of Care Certifications and Recertifications
http://www.cms.gov/
A Statement by U.S. Department of Health and Human Services Secretary Kathleen Sebelius
In August 2011, the Department of Health and Human Services issued an interim final rule that will require most health insurance plans to cover preventive services for women including recommended contraceptive services without charging a co-pay, co-insurance or a deductible. The rule allows certain non-profit religious employers that offer insurance to their employees the choice of whether or not to cover contraceptive services. Today the department is announcing that the final rule on preventive health services will ensure that women with health insurance coverage will have access to the full range of the Institute of Medicines recommended preventive services, including all FDA -approved forms of contraception. Women will not have to forego these services because of expensive co-pays or deductibles, or because an insurance plan doesnt include contraceptive services. This rule is consistent with the laws in a majority of states which already require contraception coverage in health plans, and includes the exemption in the interim final rule allowing certain religious organizations not to provide contraception coverage. Beginning August 1, 2012, most new and renewed health plans will be required to cover these services without cost sharing for women across the country.
After evaluating comments, we have decided to add an additional element to the final rule. Nonprofit employers who, based on religious beliefs, do not currently provide contraceptive coverage in their insurance plan, will be provided an additional year, until August 1, 2013, to comply with the new law. Employers wishing to take advantage of the additional year must certify that they qualify for the delayed implementation. This additional year will allow these organizations more time and flexibility to adapt to this new rule. We intend to require employers that do not offer coverage of contraceptive services to provide notice to employees, which will also state that contraceptive services are available at sites such as community health centers, public clinics, and hospitals with income-based support. We will continue to work closely with religious groups during this transitional period to discuss their concerns.
Scientists have abundant evidence that birth control has significant health benefits for women and their families, it is documented to significantly reduce health costs, and is the most commonly taken drug in America by young and middle-aged women. This rule will provide women with greater access to contraception by requiring coverage and by prohibiting cost sharing.
This decision was made after very careful consideration, including the important concerns some have raised about religious liberty. I believe this proposal strikes the appropriate balance between respecting religious freedom and increasing access to important preventive services. The administration remains fully committed to its partnerships with faith-based organizations, which promote healthy communities and serve the common good. And this final rule will haveno impact on the protections that existing conscience laws and regulations give to health care providers.
Receiving an EHR Incentive Program Payment for CY2011
As 2012 begins, CMS wants to remind eligible professionals (EPs) participating in the Medicare Electronic Health Record (EHR) Incentive Program of important deadlines approaching and what can still be completed in 2012 in order to receive an incentive payment for CY2011.
Important Medicare EHR Incentive Program Dates
On Saturday, December 31, 2011, the reporting year ended for EPs who participated in the Medicare EHR Incentive Program in 2011. What does this mean? For participating EPs, they must have completed their 90-day reporting period by the end of 2011.
However, EPs have until Wednesday, February 29, 2012 to actually register and attest to meeting meaningful use to receive an incentive payment for CY2011 through the Medicare & Medicaid EHR Incentive Program Registration and Attestation System.
Payment Threshold Information
Wednesday, February 29, 2012 is also the deadline for EPs to submit any pending Medicare Part B claims from CY2011, as CMS allows 60 days after Saturday, December 31, 2011 for all pending claims to be processed. This means that EPs have 60 days in 2012 to submit claims for allowed charges incurred in 2011.
Medicare EHR incentive payments to EPs are based on 75% of the Part B allowed charges for covered professional services furnished by the EP during the entire payment year. If the EP did not meet the $24,000 threshold in Part B allowed charges by the end of CY2011, CMS expects to issue an incentive payment for the EP in April 2012 for 75% of the EP’s Part B charges from 2011.
Note for Medicaid Participants: Medicaid incentives will be paid by the states, but the timing will vary according to state. Please contact your State Medicaid Agency for more details about payment.
Want more information about the EHR Incentive Programs? Visit the EHR Incentive Programs website for the latest news and updates on the EHR Incentive Programs.
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National Provider Call: Medicare FFS Implementation of HIPAA Version 5010 and D.0 Transactions Register Now
Wednesday, January 25, 2012, 2-3:30pm ET
CMS will host a special National Provider Call regarding the Medicare FFS implementation of HIPAA Version 5010 and D.0 transaction standards.
Target Audience: Vendors, clearinghouses, and providers who need to make Medicare FFS-specific changes in compliance with HIPAA Version 5010 requirements.
Agenda (there will be no slide presentation for this call):
- HIPAA Version 5010 implementation update
- Question & answer session
If you would like to submit a question related to this topic in advance of, during, or following the call, please email your inquiry to the 5010 FFS Information resource mailbox at 5010FFSinfo@CMS.hhs.gov. Note that this resource box will only accept emails the day before, the day of, and the day after this call; your emailed questions will be answered as soon as possible, and may not be answered during the call.
Registration Information: In order to receive the call-in information, you must register for the call. Registration will close at 12pm on the day of the call or when available space has been filled; no exceptions will be made, so please register early. For more details, including instructions on registering for the call, please visit http://www.eventsvc.com/
Greater instances of Medicare correspondence letters that make reference to error N22226 as the basis for patient claims not crossing over
On Monday, December 5, 2011, CMS issued a Special Edition MLN Matters Article (SE1137) entitled Additional Health Insurance Portability and Accountability Act (HIPAA) 837 5010 Transitional Changes and Further Modifications to the Coordination of Benefits Agreement (COBA) National Crossover Process. CMS issued this guidance for the benefit of physicians/practitioners, providers, and suppliers to help them understand why they were seeing greater instances of Medicare correspondence letters that made reference to error N22226 as the basis for why their patients claims could not be crossed over.
CMS has since learned that concern exists in the provider community concerning whether billing of hardcopy CMS 1500 or UB04 claims or HIPAA version 4010A1 or National Council for Prescription Drug Programs (NCPDP) version 5.1 batch claims will result in Medicare being unable to cross those claims over to COBA supplemental payers that have cut-over to exclusive receipt of crossover claims in the version 5010 837 claim formats or NCPDP D.0 batch claim formats. This is not true.
During the 90-day Version 5010 non-enforcement period (Sunday, January 1, 2012 through Saturday, March 31, 2012), Medicare will have the systematic capability to perform up- or down-version conversion of incoming claim formats (ie. convert incoming hardcopy formats to HIPAA equivalent claim formats and convert incoming version 4010A1 claim formats to 5010 formats and vice-a-versa), in accordance with external supplemental payer specifications concerning production claims format. This practice will discontinue, however, at the conclusion of the 90-day non-enforcement period, with the exception below. (This action is controlled by information that the Common Working File receives concerning individual supplemental payers ability to accept HIPAA 5010 or NCPDP D.0 claim formats in production mode.)
Note that physicians/practitioners, providers, and suppliers that have authorization under the Administrative Simplification Compliance Act (ASCA) to submit claims using a hardcopy format should know that Medicare has the systematic capability to convert keyed claims into outbound-compliant HIPAA 837 claim formats for crossover claim transmission purposes. This is true at all times, not just during the 90-day non-enforcement period.
What’s Your Plan, Man?
Is your organization preparing for a smooth transition to ICD-10 on Tuesday, October 1, 2013? ICD-10 National Provider Calls, hosted by the CMS Provider Communications Group, can help you prepare for the US healthcare industry’s change from ICD-9 to ICD-10 for diagnosis and inpatient procedure coding.
Video slideshow presentations from the following National Provider Calls are available on the CMS YouTube Channel. These video slideshows include the call slide presentation and audio with captions; each call includes presentations by CMS subject matter experts, followed by a question and answer session.
- ICD-10 Implementation Strategies and Planning Thursday, November 17, 2011
The ICD-9-CM and ICD-10 Cooperating Parties CMS, the American Hospital Association (AHA), the American Health Information Management Association (AHIMA), and the Centers for Disease Control and Prevention (CDC) discuss ICD-10 implementation strategies and planning, and the CMS Provider Billing Group discuss the Medicare FFS claims processing guidance issued in August 2011.
- ICD-10 Implementation Strategies for Physicians Wednesday, August 3, 2011
CMS subject matter experts discuss how physician offices can prepare for the change to ICD-10 for medical diagnosis and inpatient procedure coding and provide updates on national ICD-10 implementation issues affecting all providers.
- CMS ICD-10 Conversion Activities Wednesday, May 18, 2011
CMS subject matter experts discuss the ICD-10 conversion process currently taking place within CMS, including a case study from the Coverage and Analysis Group on their transition to ICD-10 for the lab national coverage determinations (NCDs).
Podcasts, complete audio files, and complete written transcripts for these ICD-10 National Provider Calls are also available on the CMS ICD-10 webpage at http://www.CMS.gov/ICD10/
Available 24/7, YouTube video presentations and podcasts make learning about the ICD-10 transition easy and convenient. Check them out today.
Medicare Learning Network Announcements, Updates and Revisions
From the MLN: Health Professional Shortage Area Bonus Payment Policy Reminders MLN Matters ArticleReleased – A new MLN Matters Special Edition Article #SE1202, Health Professional Shortage Area (HPSA) Bonus Payment Policy Reminders, has been released in downloadable format. This article is designed to provide education on the HPSA Bonus Payment Program, and provides information about the program and resources that providers can use to determine whether they are eligible to receive the bonus payment.
From the MLN: New Medicare Coverage of Radiology and Other Diagnostic Services Fact Sheet Released - A new Medicare Coverage of Radiology and Other Diagnostic Services fact sheet (ICN 907164) has been released in downloadable format. This fact sheet is designed to provide education on Medicare coverage and billing information for radiology and other diagnostic services, and includes specific information concerning billing and coding requirements and an overview of coverage guidelines.
From the MLN: New Fast Fact on MLN Provider Compliance Webpage – A new fast factis now available on the MLN Provider Compliance webpage. This page provides the latest educational products designed to help Medicare Fee-For-Service providers understand and avoid common billing errors and other improper activities. Please bookmark this page and checkbackoften as a new fast fact is added each month!
From the MLN: Acute Care Hospital Inpatient Prospective Payment System Fact Sheet Revised – The Acute Care Hospital Inpatient Prospective Payment System fact sheet (ICN 006815) has been revised and is available in downloadable format. This fact sheet includes information on payment background, the basis for the Acute Care Hospital Inpatient Prospective Payment System payment, payment rates, and how payment rates are set.
From the MLN: Items and Services That Are Not Covered Under the Medicare Program Booklet and Medicare Claim Submission Guidelines Fact Sheet Now Available in Hardcopy – The Items and Services That Are Not Covered Under the Medicare Program booklet (ICN 906765), available now in hardcopy, includes information about the four categories of items and services that are not covered under the Medicare program and applicable exceptions to exclusions and the Advance Beneficiary Notice of Noncoverage.
The Medicare Claim Submission Guidelines fact sheet (ICN 906764), available now in hardcopy as well, includes information about applying for a National Provider Identifier and enrolling in the Medicare program, filing Medicare claims, and private contracts with Medicare beneficiaries.
From the MLN: Medicare Claim Review Programs BookletRevised – The revised Medicare Claim Review Programs: MR, NCCI Edits, MUEs, CERT, and RAC booklet (ICN 006973) is designed to provide education on the different CMS claim review programs and assist providers in reducing payment errors, including, in particular, coverage and coding errors. It includes frequently asked questions, resources, and an overview of the various programs, including Medical Review, Recovery Audit Contractor, and the Comprehensive Error Rate Testing Program.
From the MLN: Substance (Other Than Tobacco) Abuse Structured Assessment and Brief Intervention (SBIRT) Fact Sheet Revised – This revised Substance (Other Than Tobacco) Abuse Structured Assessment and Brief Intervention (SBIRT) fact sheet (ICN 904084) is designed to provide education on SBIRT, an early intervention approach that targets those with nondependent substance use to provide effective strategies for intervention prior to the need for more extensive or specialized treatment.
From the MLN: Non-Specific Procedure Code Description Requirement for HIPAA Version 5010 Claims MLN Matters ArticleReleased – The new Non-Specific Procedure Code Description Requirement for HIPAA Version 5010 Claims MLN Matters Special Edition Article (#SE1138) is designed to provide education on the requirements for non-specific procedure codes for HIPAA 5010 claims, as established in Change Request 7392. It includes guidance to help providers comply with the requirements and submit HIPPA-compliant claims for all non-specific procedure codes.
From the MLN: Federally Qualified Health Center Fact Sheet Revised – The revised Federally Qualified Health Center fact sheet (ICN 006397) includes the following information: background; FQHC designation; covered FQHC services; FQHC preventive primary services that are not covered; FQHC Prospective Payment System; FQHC payments; and Medicare Prescription Drug, Improvement, and Modernization Act of 2003 provisions that impact FQHCs.
From the MLN: Medicare Preventive Services Series: Part 2, Web-Based-Training Course (WBT) Revised – This WBT is designed to provide education on Medicare Preventive Services. It includes information on Medicares coverage for the initial preventive physical exam (IPPE), ultrasound screening for abdominal aortic aneurysm (AAA), screening electrocardiogram (EKG), Annual Wellness Visit (AWV), cardiovascular screening blood tests, diabetes-related services, human immunodeficiency virus (HIV) screening and smoking and tobacco-use cessation counseling services. To access the WBT, visit the MLN Products page, scroll to the Related Links Inside CMS, and select the Web-Based Training (WBT) Courses.
From the MLN: MLN Guided Pathways (Basic, A, and B) Provider-specific Resource Booklets Revised – The revised MLN Guided Pathways curriculum is designed to allow learners to easily identify and select resources by clicking on topics of interest. The curriculum begins with basic knowledge for all providers and then branches to information for either those enrolling on the 855B, I, and S forms or on the 855A form (or Internet-based PECOS equivalents). The resource booklets are:
- MLN Guided Pathways to Medicare Resources Basic Curriculum for Health Care Professionals, Suppliers, and Providers
- MLN Guided Pathways to Medicare Resources Intermediate Curriculum for Health CareProviders (Part A)
- MLN Guided Pathways to Medicare Resources Intermediate Curriculum for Health Care Professionals and Suppliers (Part B)
From the MLN: MLN Guided Pathways Provider-specific Resource Booklet Revised – The Revised MLN Guided Pathways to Medicare Resources provider-specific resource booklet provides various specialties of healthcare professionals, (physicians, chiropractors, optometrists, podiatrists), nurses (APN, RNCNS, NP, Midwife) PAs, social workers, psychologists, therapists (OT, PT, SLP), dietitians, nutritionists, suppliers (ambulance, ASC, DMEPOS, FQHC, RHC, Labs, mammography, radiation therapy, portable x-ray), and providers (CMHC, CORF, ESRD, HHA, hospice, OPT, pathology and SNF) with resources specific to their specialty including Internet-Only Manuals (IOMs), Medicare Learning Network publications, CMS webpages, and more. This version includes the addition of pathways for Anesthesiology Assistant/Certified Registered Nurse Anesthetist, Anesthesiologist, Ophthalmologist, and Optometrist, along with a fully developed pathway for Mass Immunization Roster Biller.
All of the MLN Guided Pathways booklets above are available at http://www.CMS.gov/
From the MLN:Preventive Services Educational Resources for Health Care Professionals MLN Matters ArticleReleased – The new Preventive Services Educational Resources for Health Care Professionals MLN Matters Special Edition Article (#SE1142) is designed to provide education on available educational resources related to Medicare-covered preventive services. It includes a list of MLN products that can help Medicare FFS providers understand coverage, coding, reimbursement, and billing requirements related to these services.
From the MLN: Advanced Payment Accountable Care Organization Model Fact Sheet Available- The new Advanced Payment Accountable Care Organization Model fact sheet (ICN 907403) is designed to provide education on the advance payment model for Accountable Care Organizations (ACOs). It includes a summary of the Advance Payment ACO Model, background, and information on the structure of payments, recoupment of advance payments, eligibility, and the application process.
From the MLN: Summary of Final Rule Provisions for Accountable Care Organizations Under the Medicare Shared Savings Program Fact Sheet Available – The new Summary of Final Rule Provisions for Accountable Care Organizations Under the Medicare Shared Savings Program fact sheet (ICN 907404) is designed to provide education on the provisions of the final rule that implements the Medicare Shared Savings Program with ACOs. It includes background, information on how ACOs impact beneficiaries, eligibility requirements to form an ACO, and information on monitoring and tying payment to improved care at lower costs.
From the MLN: Improving Quality of Care for Medicare Patients: Accountable Care Organizations Fact Sheet Available- The new Improving Quality of Care for Medicare Patients: Accountable Care Organizations fact sheet (ICN 907407) is designed to provide education on improving quality of care under ACOs. It includes a table of quality measures under the program.
From the MLN: Medicare Shared Savings Program and Rural Providers Fact Sheet Available – The new Medicare Shared Savings Program and Rural Providers fact sheet (ICN 907408) is designed to provide education on how the Medicare Shared Savings Program impacts rural providers. It includes information on federally qualified health centers, rural health clinics, critical access hospitals, and how this program impacts them.
Here is a collection of the latest Medicare updates to get your New Year off to a good informed start:
Pay Cut: Physicians continue to receive 2011 pay rates for an additional two months while lawmakers seek a compromise on a package that could last through the remainder of 2012 (jump to story)
PQRS - National Provider Call on Physician Quality Reporting System & Electronic Prescribing Incentive Program (jump to story)
ICD-10: Did you miss the November 17th National Provider Call on ICD-10? YouTube Slideshow, Podcasts here (jump to story)
5010: New FAQs for 90 Day Discretionary Enforcement Period of ASC X12 Version 5010 (jump to story
Medicare Enrollment: Having trouble committing to Medicare this year? You have five more weeks to think about it. (jump to story)
eRx: The 2012 Electronic Prescribing (eRx) Incentive Program payment adjustment feedback report ain’t gonna happen due to the huge volume of exemptions filed.(jump to story)
IDTF: Did you get your accreditation to be able to perform the technical component of MRIs, CTs and Nuclear Medicine tests for Medicare patients? (jump to story)
PQRS: CMS announces the posting of 2012 Physician Quality Reporting System educational products (jump to story)
EFT & RA: Interim Final Rule Standards for the Health Care Electronic Funds Transfers (EFT) and Remittance Advice transaction (RA) (jump to story)
January is a tough time for independent medical practices for several reasons:
- In private practices, the physicians typically don’t carry over any cash from year to year, so the practice starts in January from a cash position of zero.
- Most deductibles begin in January – if practices don’t collect deductibles at time of service, they find themselves hurting because their revenue goes way down.
- The Medicare debacle every year creates improper (lower) reimbursement as Congress struggles to the last possible minute over physician payments. (Here’s a simple yet helpful exercise for Congress. Congress, close your eyes and think of your favorite Medicare-age person. Is it you, your wife, your mother, your father, your neighbor or best friend? Now think of that person not being able to see a doctor when they need to because all doctors have opted out of Medicare and the only place they can get care is the local Emergency Room. It is a very ugly picture. What other profession is MADE to accept payment that is less than it costs to provide? Who do you love, Congress, who won’t be able to get care?)
- Many annual maintenance contracts come due in January
- Deals on large purchases are good (think EMRs) as vendors try to book revenue in the current year. Practices tend to make commitments to purchases now that will have to be paid for in the new year
What’s a practice to do?
Everyone knows what a mess we’ve had in the past when CMS has had to pay according to the SGR, then it was reversed at the last minute and CMS had to pay additional amounts on services they had considered paid in full – a headache no matter how good your software is.
To avoid that, CMS will hold any claims for 10 business days before re-evaluating based on any change in the Medicare fee schedule for 2012. This will not actually hold anyone’s payments, as Medicare pays their claims in 14 days.
CMS made the following announcement today:
Many physicians have some type of lab testing capability in their practices, with most practice labs classified as Waived Labs, which means having a Certificate of Waiver. This Certificate enables a practice to perform simple tests including tests such as urine dipsticks, rapid Strep A for sore throats, Mono Tests, pregnancy slide tests on urine, and Rapid Flu tests.
There is little effort required to become or maintain a Waived Lab
There are no personnel qualification requirements, and the only regulation is to follow the manufacturer’s instructions on the test packages. In order to obtain a Certificate of Waiver, an application form (the CMS116 form) must be completed and submitted to CLIA at the state CLIA office. The CLIA office will issue a CLIA identification number and the practice will receive a bill for the Certificate of Waiver for $150. Life is wonderfully simple at a Certificate of Waiver level.
I haven’t written much about the impending 29% Medicare physician payment cut. This threatened cut has happened every year for the past 10 years. Every year at the last second, Washington is convinced that if cuts take place, physicians really will stop seeing Medicare patients and they halt the cut.
It’s not a bluff. Physicians can’t afford to see Medicare patients, TriCare (ex-military) patients and disabled patients with Medicare benefits now, and they will drop out by the tens of thousands if they get paid any less. Any businessperson worth their salt will tell you that when revenue does not exceed expenses, you do not have a sustainable business model. Physician have cut expenses to the bone, taken deep cuts in their salaries and ultimately have sold their practices when they just can’t make it anymore.
But never mind the doctor, what about the patients? What happens to them when physicians stop seeing Medicare patients? Texas Medical Association has made an outstanding video that explains it in language we can all understand.
Other organizations that are working to eliminate physician reimbursement being tied to the SGR are MGMA and the AMA.
CMS Announces 90-Day Period of Enforcement Discretion for Compliance with New HIPAA Transaction Standards
Today the Centers for Medicare & Medicaid Services Office of E-Health Standards and Services (OESS) announced that it would not initiate enforcement action until March 31, 2012, with respect to any HIPAA covered entity that is not in compliance 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. Notwithstanding OESS discretionary application of its enforcement authority, the compliance date for use of these new standards remains January 1, 2012 (small health plans have until January 1, 2013 to comply with NCPDP 3.0).
CMS has posted the transcript from the National Provider Call on Thursday, October 27, 2011
Dont miss this opportunity to hear from CMS experts on this important topic. Click on National Provider Call on Revalidation of Medicare Provider Enrollment to view the transcript. This transcript contains a number of post call clarifications such as where to find the listing of providers which have received a notice to revalidate. The audio file will be posted in the near future.
Now Available Online: List of Providers sent a Revalidation Request
In response to provider requests, CMS has posted a listing of providers who have been sent a request to revalidate their Medicare enrollment information. The listing containsthe name and national provider identifier (NPI) of each provider sent a letter, as well as the date the letter was sent. To see the listing, click on Revalidation Phase 1 Listing in the Downloads section of the Medicare Provider Supplier Enrollment Revalidation Page. NOTE: You must widen each column in the spreadsheet to view the contents. CMS will be updating this list monthly.
IMPORTANT: This does not affect those providers which have already received a revalidation notice. If you have received a revalidation notice from your contractor, respond to the request by completing the application either through internet-based PECOS or completing the appropriate 855 application form.
The first set of revalidation notices went to providers who are billing, but are not currently in the Provider Enrollment, Chain and Ownership System (PECOS). To identify these providers, contractors searched their local systems and if a Provider Transaction Access Number (PTAN) for a physician was not in PECOS, a revalidation request for that physician was sent. CMS asks all providers who receive a request for revalidation to respond to that request.
For providers NOT in PECOS the revalidation letter will be sent to the special payments or primary practice address because CMS doesn’t have a correspondence address. For providers in PECOS the revalidation letter will be sent to the special payments and correspondence addresses simultaneously; if these are the same it will also be mailed to the primary practice address. If you believe you are not in PECOS and have not yet received a revalidation letter, contact your Medicare contractor. Contact information may be found here.
As we finish off another month here at MMP, we wanted to go back over some of our most popular posts from the month and get ready for another busy, productive, and meaningful month. Presenting, The Best of Manage My Practice, October 2011!
- Are you ready for the holidays? How about the New Year? Even though it’s still a few months off, make sure you don’t see an interruption in your practice’s cashflow by getting ready for the January 1st 5010 deadline!
- CMS has released the Premiums and Deductibles for Medicare patients for 2012, so you can start informing staff and patients now. More importantly, will 2012 be the year that you get serious about collecting deductibles at the time of service?
- Mary Pat’s “Collection Basics”series about the fundamentals of Revenue Cycle Management in Physician offices is now at part three! Check out Patient Collections Basics: Developing a Financial Assistance Program.
- One of Healthcare’s most misunderstood and underutilized documents- the Medicare Advance Beneficiary Notice- is changing for 2012. Make sure you’re ready.
- And finally, the Office of the Inspector General (OIG) of he department of Health and Human services has released its 2012 Work Plan for areas it will concentrate on investigating. Better safe than sorry! Mary Pat goes over the highlights here.
We’ve started this monthly wrap-up to make sure you don’t miss any of the great stuff we post throughout the month on Manage My Practice, but we also want to hear from you! What were your favorite posts and discussions this month? Did we skip over your favorite from October? Let us know in the comments!
CMS just announced the new numbers for premiums and deductibles for 2012. Now is the ideal time to think about Medicare deductibles and what your policy is on collecting deductibles at time of service.
If you’ve been hesitant to collect deductibles, ask yourself if you can handle the loss or delay of payment of $140 per Medicare patient. Most practices can’t. If you are thinking about collecting deductibles and other front-end collection techniques, my book “The Smart Manager’s Guide to Collecting at Checkout” is your guide to making it happen for your healthcare group. Click here to read more.
MEDICARE PART B (covers a portion of the cost of physicians services, outpatient hospital services, certain home health services, durable medical equipment, and other items)
- In 2012, the Part B deductible will be $140, a decrease of $22 from 2011.
- The standard Medicare Part B monthly premium will be $99.90 in 2012, a $15.50 decrease over the 2011 premium of $115.40.
- The standard premium is set to cover one-fourth of the average cost of Part B services incurred by beneficiaries aged 65 and over, plus a contingency margin. The contingency margin is an amount to ensure that Part B has sufficient assets and income to (i) cover Part B expenditures during the year, (ii) cover incurred-but-unpaid claims costs at the end of the year, (iii) provide for possible variation between actual and projected costs, and (iv) amortize any surplus assets. Most of the remaining Part B costs are financed by Federal general revenues. (In 2012, about $2.9billion in Part B expenditures will be financed by the fees on manufacturers and importers of brand-name prescription drugs under the Affordable Care Act.)
- The largest factor affecting the contingency margin for 2012 is the current law formula for physician fees, which will result in a payment reduction of about 29percent in 2012. For each year from 2003 through 2011, Congress has acted to prevent smaller physician fee reductions from occurring. The 2012 reduction is almost certain to be overridden by legislation enacted after Part B financing has been set for 2012. In recognition of the strong possibility of increases in Part B expenditures that would result from similar legislation to override the decrease in physician fees in 2012, it is appropriate to maintain a significantly larger PartB contingency reserve than would otherwise be necessary. The asset level projected for the end of 2012 is adequate to accommodate this contingenIn 2012, Social Security monthly payments to enrollees will increase by 3.6 percent. The dollar increase in benefit checks is expected to be large enough on average to cover the increase in the Part B premium of $3.50 that most beneficiaries will experience. For those who were paying the standard premium of $115.40, their benefits checks will only increase.
