Medicare, Medicaid, MCO Information
Medicare’s Claim Edits for Ordering/Referring Providers
Medicare’s Claim Edits for Ordering/Referring Providers Page 2
Free Conference Calls Re: Florida Medicaid Electronic Health Record $$ Incentive Program
August 5, 2010
Dear Doctors - It looks like Florida Medicaid is really gearing up to be able to assist with EHR implementation and to be able to pay the Medicaid incentive payment ($63,750 over 6 years). Please read below to learn how to access these conference calls and learn how you may be eligible and apply for the Medicaid incentive payment. Patricia
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© 2010 Agency for Health Care Administration |
PECOS Enrollment - Deadline July 1, 2010
The date for Referral Providers to be in PECOS has been moved up to July 1, 2010.
The following and the attachments provide information that may be helpful to you in ensuring you are in compliance.
Only physicians who have not had any changes in their practices (moved, added providers, etc.) in the past 5 years have to re-enroll because they are probably not in PECOS. If they have had any changes or are new providers in the past 5 years, they should already be in PECOS even if they did a paper application, First Coast should have put them into PECOS. CMS has a link to a report on all physicians in PECOS. You can access it at:
http://www.cms.gov/MedicareProviderSupEnroll/06_MedicareOrderingandReferring.asp#TopOfPage
Here is the link to the PECOS area on the CMS site. http://www.cms.gov/MedicareProviderSupEnroll/04_InternetbasedPECOS.asp It has additional links to information on what to do. Attached is some additional information on PECOS. Hope it is helpful.
You can also go to the FMA website to obtain other links. Go to: http://www.fmaonline.org/Provider_Enrollment.aspx
PECOSWebScreenExample_001.pdfEnrollment_tips_001.pdf
Medicare_enrollment_001.pdf
PECOS_Info_March_2010.pdf
PECOS_Info_for_Members.pdf
Medicare_Enrollment_Process_PECOS.pdf
CMS to review PECOS Enrollment Process
Medicare Slashes Payments Today by 21 Percent
CONGRESS FAILS SENIORS;
21 PERCENT MEDICARE CUT IN EFFECT TODAY
WASHINGTON, D.C. - Today, Medicare begins processing physician payments with the drastic 21 percent cut that Congress failed to stop, and now seniors and physicians are paying the price of Congress' Medicare mismanagement.
"Congress is playing Russian roulette with seniors' health care," said AMA President Cecil B. Wilson, M.D. "Congress has finally taken its game of brinkmanship too far, as the steep 21 percent cut is now in effect and physicians will be forced to make difficult practice changes to keep their practice doors open."
"This is no way to run a major health coverage program - already the instability caused by repeated short-term delays is taking its toll," said Dr. Wilson. "About one in five physicians say they have already been forced to limit the number of Medicare patients in their practice. Nearly one-third of primary care physicians have already been forced to take that action. The top two reasons physicians gave for these actions were the ongoing threat of future cuts and the fact that Medicare payment rates were already too low."
"It is astounding that Congress has let seniors down through their inability to deal with this problem on time and in a responsible fashion," said Dr. Wilson.
This afternoon, the Senate passed an amended version of H.R. 3962, now called the "Preservation of Access to Care for Medicare Beneficiaries and Pension Relief Act of 2010," by unanimous consent. This legislation provides a 2.2 percent Medicare physician payment update for six months, from June 1 through November 30, 2010, in lieu of the scheduled 21 percent cut.
The Senate voted to delay the cut another six months, but the cut is still in place until the U.S. House of Representatives acts.
Unfortunately, the House of Representatives is not scheduled to hold any floor votes until next Tuesday evening. As a result, the Centers for Medicare and Medicaid Services (CMS) is instructing its carriers today to lift the hold on processing claims for services provided on or after June 1, and to begin processing them under the law's negative update requirement. In other words, claims will start to be paid today at the 21 percent lower rate, on a first in/ first out flow basis.
Once H.R. 3962 is passed by the House and signed by the President, CMS will retroactively adjust any June claims that have been paid.
Medicare SGR UPDATE
Physicians and Patients Harmed By Senate Impasse on Medicare Physician Payment Cuts
As the clock continues to tick toward Friday's final deadline for implementation of the 21.3 percent cut in Medicare physician payments produced by the sustainable growth rate (SGR) formula, Senate debate continued on June 17 over H.R. 4213, the American Jobs and Closing Tax Loopholes Act. In addition to providing another short-term reprieve from the impending Medicare cut, the legislation would increase federal Medicaid funding and extend various expiring programs such as disaster relief and long-term unemployment insurance benefits.
The debate and delay in the Senate centers on growing concerns about how much the legislation would add to the federal deficit. On June 16, a substitute amendment to the House-passed version of the bill, offered by Senator Max Baucus (D-MT) was defeated on a bipartisan vote of 45-52. That amendment would have afforded a 19-month reprieve from the scheduled Medicare payment cuts by providing a 2.2 percent update for the remainder of 2010 and an additional 1.0 percent update in 2011. In 2012, physician payments would have been reduced by 33 percent.
After the defeat of his first amendment, Senator Baucus introduced a second substitute amendment late on June 16 with reduced spending and additional funding offsets. The SGR relief provision was scaled back to a six-month, 2.2 percent update that would expire on November 30, 2010, after which the 21.3 percent cut originally scheduled for 2010 would take effect. Reports from Capitol Hill today indicate that this package may still lack the bipartisan supported needed to reach the 60 vote threshold required to end debate and pass a final bill.
Earlier today, an amendment offered by Senator John Thune (R-SD) was defeated on a vote of 41-57. The amendment was far less costly than either Baucus proposals, and according to the Congressional Budge Office would begin reducing the federal deficit. It also would have provided 2.0 percent Medicare physician payment updates for the remainder of 2010 and all of 2011 and 2012, following by a steep payment cut of well over 30 percent and an additional statutory cut of 4 percent. The Thune amendment also included medical liability caps on non-economic damages and other traditional tort reforms.
Because the Senate is considering substantial revisions to H.R. 4213, the bill will have to be sent back to the House for passage. While House leaders have indicated they are prepared to stay in session late tomorrow so that a vote can be held on the bill, it is far from clear that the Senate will be able to complete its consideration before the weekend.
CMS Will Process Claims on 6-18 with 21 Percent Cut
If legislation is not signed into law before the weekend, the Centers for Medicare & Medicaid Services (CMS) will have no option but to instruct its contractors to begin processing Medicare claims for physician services provided in June at rates that reflect the 21.3 percent cut. Once the House and Senate act to avert the cut, claims will be processed as follows: (1) where the submitted charge is higher than the new rate, the contractor will automatically reprocess the claim; and (2) if the submitted charge is lower than the new rate, the physician should call the contractor. CMS says almost all physicians submit claims for more than the Medicare rates. No one is going to be reviewing the limiting charge for the period that the cut was in place because CMS assumes Congress will ultimately make the fix retroactive. Finally, the OIG and CMS are close to releasing a document to waive patient co-pay requirements for situations such as the retroactive increases that were made to the geographic practice cost index (GPCI) increases. CMS will share that document once it is available.
Congressional Inaction Is a Dereliction of Duty
Democrats and Republicans in Congress are responsible for the current Medicare payment debacle. Congress has missed three separate deadlines and is now allowing cuts to go into effect that they pledged they would not allow to occur. We expect our elected officials to resolve budget issues without punishing physicians, seniors and military families. State medical societies and national specialty societies sent a joint statement to Congress on June 16 that emphasizes this point (see http://www.ama-assn.org/ama1/pub/upload/mm/399/sgr-sign-on.pdf). Continue to let your Representatives and Senators know that their inaction is unacceptable, and that it is harming patients and physicians across the country.
Contact Senators George LeMieux and Bill Nelson and urge them to act quickly - 800 833-6354.
AMA HSR Bulletin - Dec. 9, 2009 - Senate negotiations take a new turn
If you're having trouble viewing this email, you may see it online.
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Florida seniors need Congress to act on Medicare cuts formula
Florida_seniors_need_Congress_to_act_on_Medicare_cuts_formula_pdf.doc
HEALTH SYSTEM REFORM Talking Points
Dear Doctors -
The AMA is continuing its efforts to advocate for improvements in the Senate Finance Committee's health system reform proposal, as Senate leaders prepare to craft a single Senate package for floor consideration.
Attached are talking points the AMA has prepared on three key issues that have not yet been resolved: (1) repealing Medicare's sustainable growth rate (SGR) formula; (2) the Independent Medicare Advisory Commission; and (3) physician resource use outliers. These documents have also been posted on the AMA's health system reform microsite, www.hsreform.org. Please feel free to use them in your own advocacy efforts.
Download: Independent_Medicare_Commission_tkpts_(2).pdf
Download: Repealing_SGR.pdf
Download: RUR_talking_points.pdf
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NPI Policy Change
MEDICARE/MEDICAID
NPI Policy Change
Effective October 5, 2009 all claims (electronic or paper) will require the National Provider Identifier (NPI) of the referring provider. CMS will implement the policy in two phases, but has not yet specified when the Phase I will end and Phase II will begin. In Phase I, CMS will reject any claims that require, but do not include the NPI of a referring/ordering physician. You can spot these claims by looking for remittance advice remark code M68 and there will be no payment. In Phase II, no claim will be paid without a valid NPI from referring/ordering provider who is eligible to refer or order the service being billed on the claim. To read more on this, click here. Click here to locate NPI numbers.
SCAM ALERT-CMS has become aware of a scam targeting physician offices
CMS SCAM ALERT
The Centers for Medicare & Medicaid Services (CMS) has become aware of a scam where perpetrators are sending faxes to physician offices posing as the Medicare carrier or Medicare Administrative Contractor (MAC). The fax instructs physician staff to respond to a questionnaire to provide an account information update within 48 hours in order to prevent a gap in Medicare payments. The fax may have the CMS logo and/or the contractor logo to enhance the appearance of authenticity.
Medicare FFS providers, including physicians, non-physician practitioners, should be wary of this type of request. If you receive a request for information in the manner described above, please check with your contractor before submitting any information. Medicare providers should only send information to a Medicare contractor using the address found in the download section of the CMS.gov website found at http://www.cms.hhs.gov/MLNGenInfo/ or http://www.cms.hhs.gov/MedicareProviderSupEnroll .
Medicare's e-Prescribing Incentive Program
An easy to understand guide on how the Medicare E-prescribing incentive program will work beginning January 1, 2009.
Remember that in 2012, there will be a penalty for providers (physicians, ARNPs, etc.) who write prescriptions only on paper. The Medicare program, in the interim, will be paying a bonus to those who adopt e-prescribing now. Considering the penalty to come, it behooves all prescribing practitioners who treat Medicare patients to take this seriously and try to reap the bonus payment while it exists.
And, the physicians who actually do e-prescribe now all say they would not go back to writing paper scripts: The phone calls from pharmacists who have trouble deciphering handwriting have decreased to a trickle, and they like being prompted of a patient's potential drug-to-drug interactions as well as if a particular drug is not on the patient's insurance's formulary.
Medicare_Practical_Guide_to_the_E-prescribing_Incentive_Program_001.pdf
Online provider enrollement now available!
January 6, 2009
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Provider enrollment |
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Online provider enrollment now available |
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Internet-based Medicare enrollment is available for Medicare physicians and nonphysician practitioners (NPPs) in 44 states and the District of Columbia. It's fast, secure, and easy. Now there's a better way for physicians and NPPs to enroll or make a change in their Medicare enrollment information. The Internet-based Provider Enrollment, Chain, and Ownership System (PECOS) will allow physicians and NPPs to enroll, make a change in their Medicare enrollment, view their Medicare enrollment information on file with Medicare, or check on the status of a Medicare enrollment application via the Internet. Previously, the Centers for Medicare & Medicaid Services (CMS) announced that Internet-based PECOS is available to physicians and NPPs in the District of Columbia and the following states:
CMS has announced the expansion of Internet-based PECOS for physicians and NPPs in the following states:
Physicians and NPPs (located in the District of Columbia and in the states shown above) who wish to access Internet-based PECOS, may go to https://pecos.cms.hhs.gov CMS will expand the availability of Internet-based PECOS for physicians and NPPs to all states over the next two months. In addition, CMS will make Internet-based PECOS available next year to all providers and suppliers (except those who supply durable medical equipment, prosthetics, orthotics, and supplies). Fast This means that it will take less time to enroll. Physicians and NPPs are required by regulation to report certain changes in their enrollment information within specified timeframes. Internet-based PECOS will allow them to update, make corrections, and check on the status of their Medicare enrollment applications as much as 50 percent faster than by paper. Changes include a change in practice location, ownership, or final adverse action (medical license suspension or revocation). For additional information about the types of changes that must be reported, go to the download section of http://www.cms.hhs.gov/MedicareProviderSupEnroll Secure Authorized individuals include physicians and NPPs. Their user IDs and passwords protect the access to their enrollment information. After physicians or NPPs create user IDs and passwords (or change their passwords), they should keep this information secure and not share it with anyone. By safeguarding their user IDs and passwords, they are taking an important step in protecting their enrollment information. CMS does not disclose Medicare enrollment information to anyone except when authorized or required to do so by law. Easy Note: Physicians and NPPs are still required to sign and date the certification statement and to mail the certification statement and all supporting paper documentation to the Medicare contractor. A Medicare contractor will not process an Internet enrollment application without the signed and dated certification statement and the required supporting documentation. In addition, the effective date of filing an enrollment application is the date the Medicare contractor receives the signed certification statement that is associated with the Internet submission. Additional information Source: PERL 200812-13, 200812-25, 200812-34, 200812-45 |
.Medicare Quick Facts
Medicare_Quick_Facts_001.pdf
Eight Ways to Help Maintain Health Administrative Processes
Eight_Ways_to_Help_Maintain_Health_Administrative_Processes_001.pdf
Top 5 Self Service Tools and Resources
Top_Five_Self-Service_Tools_and_Resources_001.pdf
Competitive Acquisition Program
Competitive_Acquisition_Program.pdf
