The Pulse

Knowledge is power. "The Pulse" is our way of keeping you informed of industry news, market trends and what's happening at IPMS. Stay informed so you can stay ahead. Check back often for updates!
 

This notice from NGS Medicare is to alert providers that the time period when providers are allowed to change their participation status with Medicare has been extended.
 

Attention Health Professionals: 2012 Annual Participation Enrollment Program Extension
 

The Centers for Medicare & Medicaid Services (CMS) is anticipating Congressional action to avert the negative update for the 2012 Medicare physician fee schedule (MPFS). Therefore, CMS is extending the 2012 Annual Participation Enrollment Period through February 14, 2012. The enrollment period now runs November 14, 2011, through February 14, 2012.
The effective date for any participation status change during the extension, however, remains January 1, 2012, and will be in force for the entire year.
Contractors will accept and process any participation elections or withdrawals made during the extended enrollment period that are postmarked on or before February 14, 2012.

Posted 12/23/2011 at www.NGSMedicare.com
 

IPMS is on Medicare’s 5010 approved entities!


http://www.ngsmedicare.com/wps/portal/ngsmedicare/!ut/p/c4/VY4xC8IwEIV_i0PmXBQXt1KLdNDFRV3kSI_2sL2E5Kx_3wRc5A3v8fEePPuwRYIrj6gcBGd7s_ePXw4RdTJuhwYup-uZBvaYqA2iJPrHDLQz8pINdDN5TUHYG7eFIypW78sk-QllLNU9OKiwiTGFlYaaO1FWpvzsJZf0_v2Ir2bzBVd2Rg8!/


New Medicare Physician Fees for January 1, 2012 – February 29, 2012

Even though Medicare announced a zero % change for the Medicare Physician Fee Schedule until February 29th there have been some behind the scene changes that affect the Medicare fees.  The fee schedules for January 1, 2012 – February 29, 2012, for Connecticut, Jurisdiction 13, have been posted on the NGSMedicare.com website under Fee Schedules.   See your local Medicare website to find fee schedule updates for your area.

The conversion factor has changed from $ 33.9764 to $ 34.0376, an 0.18% increase.  In addition to this there are changes to some of the RVU values, increases and decreases depending on the specialty.

Upon review of a few common code fees see below:

Codes

2011

2012

 

Aneth

$22.21

$22.59

Increased

88305/26

$38.95

$37.90

Decreased

11100

$115.43

$113.33

Decreased

99213

$75.89

$75.67

Decreased

93306

$265.68

$232.92

Decreased

68810

$259.77

$262.86

Increased


 

Another Certified Medical Auditor on board!


IPMS now has a third certified medical auditor on board!  Doreen Clark just passed her AAPC medical auditing exam and can now add “CPMA” – certified professional medical auditor ---  to her coding credentials.

Great job Doreen!

Sharon S. Donelli, CPC, CPMA
Integrated Physicians Management Services
Administrative Officer/Director of Coding & Compliance
 

House Bill Includes SGR Fix

Friday, December 9th, the House of Representatives released language of the health care provisions in the Middle Class Tax Relief and Job Creation Act. The bill updates the Medicare Physician Fee Schedule Sustainable Growth Rate (SGR) for 2012 and 2013 by 1% -- negating a scheduled 27.4% reduction in payments to providers,
The House is expected to vote on the bill this week. Early this week the Senate is expected to release its version of the bill. Both chambers need to pass their respective bills and send them to conference for a final bill to be drafted and sent back to both the House and Senate for full votes. Thus, Friday’s action by the House is just the beginning of what promises to be a long and uncertain week on Capitol Hill.


Source: http://www.apta.org/PTinMotion/


 


HHS delays Stage 2 of Meaningful Use until 2014
 

The Department of Health and Human Services (HHS) announced that Stage 2 of the Medicare EHR incentive program (Meaningful Use) would be delayed until 2014. Under the current requirements, eligible professionals (EPs) that begin participating in the Medicare EHR Incentive Program (meaningful use) this year would have to meet new and more challenging standards for the program in 2013. If an EP did not participate in the meaningful use program until 2012, they could wait to meet these new standards until 2014 and still be eligible for the same incentive payment. In an effort to encourage faster adoption, EPs are permitted to adopt an EHR this year, without meeting the new standards until 2014.

 


More on 5010

As we all should be aware by now, compliance with Version 5010 for electronic transactions is January 1, 2012. CMS recently announced that they will delay enforcement action until March 31, 2012. Do not mistake this for a change in the compliance date. Covered Entities are still expected to be ready for the January 1st effective date. However due to delays in some entities receiving software upgrades and problems related to testing, CMS’ Office of E-Health Standards and Services has stated they will delay any enforcement action until March 31st. The OESS will accept complaints associated with compliance of 5010 and covered entities that are the subject of complaints must show either compliance or a “good faith” effort to become compliant during this time period.

Links to information on Version 5010 available at www.CMS.gov/ICD10
 


2012 Medicare Physician Fee Schedule Reduction – What are your options?

2012 Medicare physician fee schedule has been finalized. The 2012 fee schedule is now available on the www.NGSmedicare.com website. This fee schedule reflects the 27.4 percent reduction in the Medicare physician payments based on the sustainable growth rate (SGR) formula.

Unless Congress intervenes, the 27.4 percent reduction with take effect January 1, 2012.

Physicians do have options. Participating physicians have an opportunity to choose to become a non-participating provider or opt out of the Medicare program (non-Medicare provider). However, non-physician practitioners (PA, APRN, CRNA, CNS, Nurse midwife, CSW, and clinical psychologist) may not become non-participating or opt out of Medicare under current Medicare law.

A provider can change participation status to non-participating during the open enrollment period which runs from mid-November through December 31st.

If a provider chooses to become non-participating in the Medicare program, a provider may choose either to accept or not accept assignment on Medicare claims on a claim-by-claim basis. If assignment is accepted by a non- participating provider, payment is made by Medicare directly to the practice. Reimbursement is 80% of the non-par allowed fee (the non-par allowed fee is 95% of the par allowed fee).

When a provider chooses to not accept assignment, Medicare will make payment directly to the patient. The provider may also only bill the patient for 115% of the non-par allowed amount. In addition, unassigned claims may be rejected by secondary Medicare supplemental carriers.

Providers may opt out of the Medicare program at the beginning of each calendar quarter. A valid affidavit postmarked 30 days prior to the first day of each new quarter must be submitted. A private contract must be entered into with each Medicare patient effective upon the opt out period beginning.

If a provider chooses to opt out of the Medicare program he/she is permitted to contract privately with Medicare patients. Neither the provider nor the patient can bill Medicare for services under a private contract. Provider must remain in the opt out status for 2 years and must renew their opt out status at the end of 2 years.

Disadvantages with Medicare non-participation or Medicare opt out

  • While the Medicare non-participating physicians can collect 115% of the Medicare non-participating reimbursement rate, that is only 109.25% of the participating amount.

  • Non-participating providers will not be paid directly for unassigned claims. Providers will see increased difficulty collecting reimbursement because Medicare payments will be sent directly to the patient.

  • The provider will need to consider related cash flow and administrative implications associated with becoming non-participating.

  • A provider who opts out of Medicare will have “on-call” limitations or reimbursement lost, because a provider cannot bill for services provided to a Medicare beneficiary.

 
 


January 1, 2012 is the deadline for transition to Version 5010 for Electronic Claims!!!

Currently most healthcare information is sent to insurance carriers electronically. The Administrative Simplification Act of 2001 required the use of electronic claims for Medicare reimbursement and HIPAA mandated that all electronic transactions be in a standard format. That format presently is 4010, however, 4010 cannot handle the changes that are effective with the passage of the Affordable Care Act and the upcoming implementation of ICD-10. The updated format presently being tested is 5010. 5010 will increase field sizes for ICD-10 to accommodate the longer codes and will allow more diagnosis codes per claim. In addition 5010 will be able to distinguish between different primary diagnosis, admitting diagnosis and patient reason visit codes (very helpful for inpatients). It will also address indicators for conditions that were “present on admission” and support monitoring of certain illness mortality rates, outcomes for specific treatment options, hospital lengths of stay and clinical reasons for care. 5010 will also standardize business information related to transactions.

IPMS has been actively testing our 5010 electronic formats for months and we continue to make progress, assuring readiness for January 1, 2012.

Sharon S. Donelli, CPC, CPMA
Integrated Physicians Management Services
Administrative Officer/Director of Coding & Compliance

 

Here an Audit, There an Audit………Everywhere an Audit

Beginning this month, November 2011 and continuing through December 2012, the Department of Health and Human Services Office for Civil Rights will be conducting audits of Privacy and Compliance efforts. Throughout the next year the OCR plans to conduct about 150 audits of Health services providers, Health Plans and Clearinghouses. The purpose is to ensure that covered entities and their business associates are complying with the HIPAA Privacy and Security Rules and Breach Notifications.

The entities selected for audit will be asked to provide documentation of their privacy and security efforts. The audit will include a site visit, interviews with key personnel, observation of office processes and operations and development of a draft report which will be shared with the entity being audited. Those audited will be notified 30-90 days prior to the site visit that they have been selected. The visit will take place over 3-10 business days. There is no timeline for development of the report, but once received the entity would have 10 business days to review and comment on the findings.

The OCR considers these audits to be compliance improvement activities and will use the results to determine what types of technical assistance to develop and the corrective actions that are considered the most effective. They will not be posting any lists of audited entities nor individual audit finding. More information can be found at: http://www.hhs.gov/ocr/privacy/hipaa/enforcement/audit/index.html

 
 


Update Effective January 1, 2012 - Changes to the Connecticut Medical Assistance Program


Beginning January 1, 2012, HUSKY, A, HUSKY B and Charter Oak benefits will no longer be provided by CT Medicaid Managed Care plans.


State of CT Medicaid is ending their HUSKY A, HUSKY B and Charter Oak Managed Care Organization contracts with Community Health Netwrok (CHN), Aetna Better Health and AmeriChoice. 


These 3 Managed Care Organizations and their subcontractors will only pay claims for dates of service through December 31, 2011


Starting January 1, 2012 CT Medicaid programs will be maintained under the new CT DSS medical administrative services organization (ASO), not yet named


Hewlett-Packard Enterprise, will process the claims (current DSS fiscal agent processing Medicaid claims)


Providers who are currently paid directly by HP for services provided to Connecticut Medicaid clients are enrolled with DSS and do not need to take action at this time.


Providers currently enrolled only in HUSKY and Charter Oak Managed Care (CHN, ABH, AmeriChoice) plans, and wish to continue receiving reimbursement for services under the new HUSKY program, must enroll with DSS as a Connecticut Medical Assistance Provider (CMAP). 


DSS will release more detailed information in the coming months, which will include who the new ASO will be.


For CT DSS bulletin go to:

https://www.ctdssmap.com/CTPortal/Information/Get%20Download%20File/tabid/44/Default.aspx?Filename=pb11_77.pdf&URI=Bulletins/pb11_77.pdf


Providers must use NEW Medicare ABN forms by November 1, 2011
 

The Centers for Medicare and Medicaid Services (CMS) is encouraging providers to use a new Advanced Beneficiary Notice of Noncoverage (ABN) form now, and the new forms must be used beginning Nov. 1, 2011. The instructions and latest version of the ABN (with the release date of 3/2011 printed in the lower left hand corner) are available for immediate use. All ABNs with the release date of 3/2008 that are issued on or after Nov. 1 will be considered invalid. 

Source: www.NGSmedicare.com
 


NOTICE FROM NGS - MEDICARE
 

Reminder: Read Overpayment Letters Thoroughly to Avoid Misdirecting Repayments 
On August 4, 2011, National Government Services notified providers of a formatting issue that was resulting in providers mailing repayments to an incorrect address for processing. Although the formatting issue was corrected on September 13, [NGS] continues to receive an unusually high number of checks in the incorrect P.O. Box. 

If you receive an overpayment collection letter from National Government Services, please read the letter carefully and consult page 2 for the correct mailing address for repayments. That address is as follows:

National Government Services, Inc.
P.O. Box 809645
Chicago, IL 60680-9645

In addition, please update your files with the correct address to avoid misdirecting future repayments.

Source: e-mail from NGS Jurisdiction 13 MAC News


OIG is Watching…


If you code procedures that can be done in the office as well as hospital outpatient or ASC facilities you should be aware that CMS is looking at claims billed with place of service 11 (office). For the last three years, 2007-2009, the OIG has audited procedures billed with POS 11 and has determined that physicians very often bill these incorrectly. Some of the reasons listed in the OIG reports for the incorrect POS were 


1. Billing staff confused about the definition of physician office or other non-facility location


2. Billing staff was unaware of payment differences for procedures performed outside of the office


3. Data entry errors and


4. Flaws in billing systems that caused all claims to be submitted with non-facility POS.


If your office bills for procedures that can be done in another facility make sure you and your staff are up to date with CMS guidelines and place of service codes. Clearly document the location where any procedure is performed and verify that your billing system is configured to bill claims with the correct POS. Develop office policies to insure compliance and establish procedures for correcting any errors found. In this era of continued and increasing scrutiny by Federal and Third Party Payers it’s in your best interest to stay ahead of the game.

Doreen Clark, CPC
Medical Auditing Specialist

Posted 9/22/11  
 


Incentive Payment Information from National Government Services for Part B Providers

 

This is information from NGS that may answer some of your questions regarding when to expect incentive payments and what to look for on the remittance advice. If you are not already participating in these programs see the Medicare links below for more information. 

Payments for the PCIP and the HSIP Incentive programs will be made on a quarterly basis issued with the HPSA bonus payments. You will receive a remittance advice indicating the amount for each incentive. This remittance advice will be entitled the Special Incentive Remittance Advice. To find out if you qualify for the PCIP incentive payment, please enter your NPI in the PCIP Lookup Tool. Primary care providers that have newly enrolled with Medicare in 2010 can determine their eligibility by accessing this tool on or after November 28, 2011. 

Payments are expected for the 2010 ERx Incentive Program between August and September of 2011. On your remittance you will see RX10 or the statement “This is an eRx incentive payment,” see Remittance section below for more information. Please also review the CMS guides for the incentive payment and feedback reports for ERx:

 

Payments are expected for the 2010 PQRS Incentive Program between September and October of 2011. On your remittance you will see PQ10 or the statement “This is an PQRS incentive payment,” see Remittance section below for more information. Please also review the CMS guides for the incentive payment and feedback reports for PQRS:


In 2011, the ERx and PQRS incentive payments and feedback reports will be issued separately. CMS is making every effort to ensure the feedback reports are issued as close as possible to the incentive payments. E-mail Updates will be issued to all providers as soon as the feedback reports are available. To stay informed, please use this opportunity to sign up for the E-mail Updates.

The EHR Incentive program has begun in 2011. Information is not available as of yet regarding the payment timeframes. For information relating to the EHR program, please access the Web site at
http://www.cms.gov/EHRIncentivePrograms/.

Remittance Advice Information
 

Below are example remittance advices to help you identify an incentive payment once it has been received by your practice. Please note the following key elements:

  • All incentive payments will have a PLB Reason Code of “LE” to indicate a “Lump Sum” payment. The definition for “LE” will also be located in the Glossary section of your remittance advice.

  • Incentive payments will often appear on your remittance advice as a negative amount. This is due to accounting principles.

  • For PQRS and ERx incentive payments, the last four (4) characters of the Financial Control Number (FCN) will indicate the type of payment and the year that the payment is for.

    • “PQ” will indicate a PQRS payment, and “10” will indicate it was for PQRS measures submitted in 2010. 

    • “RX” will indicate an ERx payment, and “10” will indicate it was for ERx measures submitted in 2010. 

    • Paper Remittances may also contain the statements “This is an eRx incentive payment” or “This is a PQRS incentive payment”. 

  • EHR information for the remittance advice is not currently available. 

  • The Special Incentive Remittance Advice for HSIP and PCIP incentive payments will be issued quarterly. All incentives payments will be outlined appropriately on that remittance advice.


If you do not currently participate in the Medicare incentive programs and would like more information check out the following Medicare links:

Before calling National Government Services about the ERx or PQRS Program, [Medicare asks that you] please ensure you have visited the Help Desk Support Web site to identify the contractor that may accurately resolve your concerns. Please note, National Government Services is not able to answer inquiries related to the EHR Incentive program.


Source: www.NGSMedicare.com


CMS notice: Proposed Rule Changes to the 2011 eRx Incentive Program
 

These are only proposals and Medicare is not accepting exemption requests at this time.
 

The 2012 eRx Payment Adjustment
 

The reporting period for reporting the electronic prescribing measure for purposes of the 2012 payment adjustment ended on June 30, 2011. All applicable claims for dates of service between January 1, 2011 and June 30, 2011 must be processed by July 29, 2011.
 
However, on May 26, 2011, CMS released a proposed rule entitled “Proposed Changes to the 2011 Electronic Prescribing Incentive Program” to address concerns stakeholders have expressed regarding the implementation of the 2012 eRx payment adjustment. 

The proposed rule proposes to do the following:
 

  1. Modify the existing electronic prescribing measure to allow for the use of certified Electronic Health Record (EHR) technology as defined at 45 CFR 170.102.

  2. Provide the following additional significant hardships to the 2012 eRx payment adjustment: 

    1. Eligible professionals who register to participate in the Medicare or Medicaid EHR Incentive Program and adopt certified EHR technology;

    2. Inability to electronically prescribe due to local, state, or federal law or regulation;

    3. Limited prescribing activity; or

    4. Insufficient opportunities to report the electronic prescribing measure due to limitations in the measure’s denominator.

 Allow eligible professionals until October 1, 2011 to submit a request for a significant hardship exemption. 

 

Please note that CMS is not currently accepting exemption requests based on the proposed significant hardship exemptions stated above. If finalized, CMS will provide instructions for submitting significant hardship requests in a final rule.

The proposed rule may be viewed at 2011 eRx Proposed Rule -- CMS-3248-P (224 KB). The public has until July 25, 2011 to provide comments on the proposed rule. Upon consideration of the public comments received, CMS will publish a final rule before these proposed changes would go into effect.
 


ALERT! Regarding Medicare Paper Checks


The Centers for Medicare & Medicaid Services (CMS) has converted its banking contracts with JP Morgan and U.S. Bank to Federal Acquisition Regulation (FAR) contracts. These banks serve all the Medicare contractors. Accordingly, CMS has instructed the banks to close all bank accounts and letters of credit associated with the old configuration and contracts.

Normally, Medicare checks are valid for a 12-month period after the payment date on the check and then they are automatically stale-dated, at which point they become void. CMS needed to close some of the old bank accounts prior to the end of the 12-month period due to contractual requirements. Some checks drawn on these old bank accounts may be presented for payment within the next two to three months, but will be returned and annotated “account closed.” If providers encounter this situation, they may contact the Provider Contact Center and have the checks reissued under a new appropriate account number. If the provider receives a fee for the check being returned as unpaid please bring that to the attention of the Provider Contact Center and they will address that issue as well for the provider. While we do not anticipate this being a large impact for providers it is important that you are aware of what to do if the situation arises.

Please visit our Web at www.NGSMedicare.com for the Provider Contact Center information located at Resources > Contact Us > Provider Contact Center.
 


Medicare: 2011 Electronic Prescribing (eRx) Incentive Program Reminder – Avoiding the Adjustment

In November, the Centers for Medicare & Medicaid Services (CMS) announced that, beginning in calendar year 2012, eligible professionals who are not successful electronic prescribers based on claims submitted between January 1, 2011 – June 30, 2011, may be subject to a payment adjustment on their Medicare Part B Physician Fee Schedule (PFS) covered professional services. Section 132 of the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA) authorizes CMS to apply this payment adjustment whether or not the eligible professional is planning to participate in the eRx Incentive Program.

From 2012 through 2014, the payment adjustment will increase each calendar year. In 2012, the payment adjustment for not being a successful electronic prescriber will result in an eligible professional or group practice receiving 99% of their Medicare Part B PFS amount that would otherwise apply to such services. In 2013, an eligible professional or group practice will receive 98.5% of their Medicare Part B PFS covered professional services for not being a successful electronic prescriber in 2011 or as defined in a future regulation. In 2014, the payment adjustment for not being a successful electronic prescriber is 2%, resulting in an eligible professional or group practice receiving 98% of their Medicare Part B PFS covered professional services.

The payment adjustment does not apply if <10% of an eligible professional’s (or group practice’s) allowed charges for the January 1, 2011 through June 30, 2011 reporting period are comprised of codes in the denominator of the 2011 eRx measure.

Please note that earning an eRx incentive for 2011 will not necessarily exempt an eligible professional or group practice from the payment adjustment in 2012.

How to Avoid the 2012 eRx Payment Adjustment

  • Eligible professionals - An eligible professional can avoid the 2012 eRx Payment Adjustment if (s)he:

    • Is not a physician (MD, DO, or podiatrist), nurse practitioner, or physician assistant as of Jun 30, 2011 based on primary taxonomy code in NPPES;

    • Does not have prescribing privileges. Note: (S)he must report (G8644) at least one time on an eligible claim prior to June 30, 2011;

    • Does not have at least 100 cases containing an encounter code in the measure denominator;

    • Becomes a successful e-prescriber by reporting the eRx measure for at least 10 unique eRx events for patients in the denominator of the measure. For successful reporting under the 2011 eRx Incentive Program, a single quality-data code (G8553) should be reported for denominator eligible visits.

  • Group Practices - For group practices that are participating in eRx GPRO I or GPRO II during 2011, the group practice MUST become a successful e-prescriber.

    • Depending on the group’s size, the group practice must report the eRx measure for 75-2,500 unique eRx events for patients in the denominator of the measure.

 

For additional information, please visit the “Getting Started” Web page at http://www.cms.gov/erxincentive << OLE Object: Picture (Device Independent Bitmap) >> on the CMS Web site for more information; or download the Medicare’s Practical Guide to the Electronic Prescribing (eRx) Incentive Program under Educational Resources.

Source: www.ngsmedicare.com


Maintain your Balance!!

In this climate of payer audits, specifically Medicare auditing via the RAC agencies, some physicians are opting to do what they feel is “playing it safe”. Specifically, they are undercoding their E&M services, rationalizing that they will stay under the audit radar by opting to bill lower code levels. Not so fast!! This may have a counterproductive effect. Undercoding not only results in less reimbursements for the provider, but it can also raise red flags due to becoming an outlier in the other direction. When Medicare or other payers apply bell curve surveys, the provider who codes too low will stick out just as much as the one that codes too high. The idea is to not get noticed at all and furthermore, undercoding is just a deterrent to learning the rules that the payers play by. So take the time to learn those rules – they will serve you well in optimizing your reimbursement while at the same time maintaining compliant practices. IPMS Coding and Auditing experts are ready to assist providers who desire to become more audit-proof !

Sharon S. Donelli, CPC, CPMA
Integrated Physicians Management Services
Administrative Officer/Director of Coding & Compliance
 

Medicare and Medicaid Electronic Health Records Registration Now Open

The Centers for Medicare & Medicaid Services (CMS) encourages eligible professionals, eligible hospitals and critical access hospitals to register for the Medicare and/or Medicaid electronic health record (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).
The Registration and Attestation page on the EHR Web site now contains:

  • instructions to promote a smooth registration process,

  • user guides, and

  • a link to the registration site.

http://www.cms.gov/EHRIncentivePrograms/20_RegistrationandAttestation.asp

Posted 01/06/2011
Source: www.ngsmedicare.com


Signature on Requisitions for Clinical Diagnostic Laboratory Tests


In the November 29, 2010, Medicare Physician Fee Schedule final rule, the Centers for Medicare & Medicaid Services (CMS) finalized its proposed policy to require a physician’s or qualified nonphysician practitioner’s (NPP) signature on requisitions for clinical diagnostic laboratory tests paid under the clinical laboratory fee schedule effective January 1, 2011. A requisition is the actual paperwork, such as a form, which is provided to a clinical diagnostic laboratory that identifies the test or tests to be performed for a patient.
Although many physicians, NPPs, and clinical diagnostic laboratories may be aware of, and are able to comply with, this policy, CMS is concerned that some physicians, NPPs, and clinical diagnostic laboratories are not aware of, or do not understand, this policy. As such, CMS will focus in the first quarter of next year on developing educational and outreach materials to educate those affected by this policy. As they become available, CMS will post this information on their Web site at http://www.cms.gov/ClinicalLabFeeSched/ and use the other channels they have to communicate with providers to ensure this information is widely distributed. Once the first quarter educational campaign is fully underway, CMS will expect requisitions to be signed.
Posted 01/06/2011

Reminder – Medicare Claim Timely Filing
 

Medicare Fee-For-Service physicians, providers and suppliers submitting claims to Medicare for payment, claims for services furnished on or after January 1, 2010, must be filed with your Medicare contractor no later than one calendar year (12 months) from the date of service – or Medicare will deny them.

If you have Medicare Fee-For-Service claims with service dates from January 1, 2009 through December 31, 2009, those claims must be filed by December 31, 2010 or Medicare will deny them. 

Per Medicare, the start date for determining the one-year timely filing period is the date of service or “From” date on the claim. For institutional claims that include span dates of service (i.e., a “From” and “Through” date on the claim), the “Through” date on the claim is used for determining the date of service for claims filing timeliness. For claims submitted by physicians and other suppliers that include span dates of service, the line item “From” date is used for determining the date of service for claims filing timeliness.

Source: www.ngsmedicare.com
 

 

Partial Code Freeze Prior to ICD-10 Implementation

At the ICD-9-CM Coordination & Maintenance Committee Meeting, September 15, 2010, it was announced that the committee had finalized the decision to implement a partial freeze for both ICD-9-CM codes and ICD-10-CM and ICD-10-PCS codes prior to implementation of ICD-10 on October 1, 2013. There was considerable support for this partial freeze.


The partial freeze will be implemented as follows:

  • The last regular annual update to both ICD-9 and ICD-10 code sets will be made on October 1, 2011.

  • On October 1, 2012 there will be only limited code updates to both ICD-9-CM and ICD-10 code sets to capture new technology and new diseases.

  • There will be no updates to ICD-9-CM on October 1, 2013 as the system will no longer be a HIPAA standard.

On October 1, 2014 regular updates to ICD-10 will begin. The ICD-9 Coordination & Maintenance Committee will continue to meet twice a year during the freeze. At these meetings the public will be allowed to comment on whether or not requests for new diagnosis and procedure codes should be created based on the need to capture new technology or disease. Any code requests that do not meet the criteria will be evaluated for implementation within ICD-10 on or after October 1, 2014, once the partial freeze is ended.

Source: www.ngsmedicare.com

 

EHR Incentive Program: Certified Health IT Product List


Providers must use certified Electronic Health Record (EHR) technology in order to earn incentives under the Medicare and Medicaid EHR Incentive Programs. How can you be sure which EHR technology has been certified?

The Office of the National Coordinator for Health Information Technology (ONC) has published the Certified Health IT Product List (CHPL), a comprehensive listing of Complete EHRs and EHR Modules that have been tested and certified under the Temporary Certification Program. Each Complete EHR and EHR Module included in the CHPL has been tested and certified by an ONC-Authorized Testing and Certification Body (ATCB), and reported to ONC by an ONC-ATCB, with reports validated by ONC. Only those EHR technologies appearing on the ONC-CHPL may be granted the reporting number that will be accepted by CMS for purposes of attestation under the EHR Incentive Programs.

The listing will be updated as additional products are certified by ONC-ATCBs and reported to ONC for validation. For more information about this product listing, please visit http://healthit.hhs.gov/CHPL. For more information on the Medicare and Medicaid EHR Incentive Programs, visit http://www.cms.gov /EHRIncentivePrograms.

Note: If you have problems accessing any hyperlink in this message, please copy and paste the URL into your Internet browser.

Source: www.ngsmedicare.com

You Preparing for Version 5010 and ICD-10?


Now is the time to prepare for the Version 5010 and ICD-10 transition. Go to Medicare's website http://www.cms.gov/icd10/ to find transition resources for providers, payers and vendors and the latest CMS news about Version 5010 and ICD-10.

 Final Rule: “Meaningful Use” of Electronic Health Records

On July 13, 2010 U.S. Department of Health and Human Services Secretary Kathleen Sebelius announced the final rules to support “Meaningful Use” of Electronic Health Records.

“Under the Health Information Technology for Economic and Clinical Health (HITECH) Act of 2009, eligible health care professionals and hospitals can qualify for Medicare and Medicaid incentive payments when they adopt certified EHR technology and use it to achieve specified objectives. One of the two regulations announced defines ‘meaningful use’ objectives that providers must meet to qualify for the bonus payments and the other regulation identifies the technical capabilities required for certified EHR technology.”

Learn more about “Meaningful Use” and the CMS EHR Incentive Programs at http://www.cms.gov/EHRIncentivePrograms/ and http://www.healthit.hhs.gov/

Source: http://www.cms.gov/EHRIncentivePrograms/



 

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Phone: (860) 282-4124
Fax: (860) 282-0170
Email: contact@ipmscorp.com

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Attention Health Professionals: 2012 Annual Participation Enrollment Program Extension

The Centers for Medicare & Medicaid Services (CMS) is anticipating Congressional action to avert the negative update for the 2012 Medicare physician fee schedule (MPFS). Therefore, CMS is extending   Read More