Congress Passes Two Month Rate Freeze

Thanks to all the political pressure, including those of you who reached out to your Representatives this week, the House Republicans joined the rest of the House to pass the Senate bill extending the payroll tax cut for two months. This bill also freezes the current Medicare rates and avoids the 27% cut (at least until March).
The President is expected to sign the bill today. This means that a House-Senate conference committee will be established to negotiate a longer-term patch on the payroll tax cut and the Medicare payment rate. House leaders have already named the members of that committee (below). Senate appointees will be made in the coming week or so.
For us this means Medicare reimbursement rates will be frozen at current rates and the 27% cut scheduled for January will not take effect until March unless a new deal is reached between now and then. However, the therapy cap exceptions process is not part of this two month bill and as of now still expires January 1. Therefore, we will need to lobby the conference committee to include it in the year-long package.

Relaxation of Version 5010 Testing Review Requirement

The Centers for Medicare & Medicaid Services (CMS) announced on Friday, December 23, that it would allow Medicare Administrative Contractors (MACs) to have the ability to relax the testing review requirement stated in the Medicare Claims Processing Manual, Chapter 24 General EDI and EDI Support Requirements, Section 50.5 EDI Testing Accuracy.  This announcement allows trading partners to request transition into version 5010 production status without the full review of electronic test claims.


CMS announces policy, payment rate changes for the Physician Fee Schedule in 2012

The Centers for Medicare and Medicaid Services (CMS) today issued a final rule with comment period that updates payment policies and rates for physicians and nonphysician practitioners (NPPs) for services paid under the Medicare Physician Fee Schedule (MPFS) in calendar year (CY) 2012. More than 1 million providers of vital health services to Medicare beneficiaries – including physicians, limited license practitioners such as podiatrists, and NPPs such as nurse practitioners and physical therapists – are paid under the MPFS. CMS projects that total payments under the MPFS in CY 2012 will be approximately $80 billion.  (go to link below for more info)

Beneficiary Cost-Sharing for Medicare-Covered Preventive Services Under the

Effective for Dates of Service (DOS) on or after January 1, 2011, Medicare
provides 100 percent payment (in other words, waives any deductible,
coinsurance or copayment) for many Medicare-covered preventive services.
This article serves as a reminder and quick reference for the changes to
deductibles, copayments, or coinsurances for preventive services. Please
share with appropriate staff.

2011 Version of Advance Beneficiary Notice of Noncoverage Must Be Used Beginning Sunday, January 1, 2012

In May 2011, the Centers for Medicare and Medicaid Services (CMS) released an updated version of the Advance Beneficiary Notice of Noncoverage (ABN) (form CMS-R-131), which will replace the 2008 version of this form.

National Provider Call Re: Revalidation

CMS will hold a National Provider Call on October 27, 3011, to discuss the
revalidation of Medicare provider enrollment information. Most providers
and suppliers who are enrolled in the Medicare program will have to
revalidate their enrollment which will be reviewed under the new risk
screening criteria required by the Affordable Care Act Section 6401(a).
Learn what you can expect and how to prepare for this process.

Applies to:
Jurisdiction 11 Home Health and Hospice//General
Jurisdiction 11 Part A//General
Jurisdiction 11 Part B//General
Jurisdiction 1//J1 Part A: General
Jurisdiction 1//J1 Part B: General

Discontinuance of Verification of Foreign Born Status in Provider Enrollment

Effective immediately, providers are no longer required to provide information which verifies the legalized status of enrollment applicants including those individuals referenced in any ownership related information. This is part of an ongoing Centers for Medicare and Medicaid Services (CMS) review of current enrollment requirements to eliminate unnecessary burden on providers as well as delays in the enrollment process. The instructions in Program Integrity Manual Chapter 10, Section 5.7.2 will be updated in the near future.

New Information about the Primary Care Incentive Payment Program’s Special Incentive Remittance

Payments under the Primary Care Incentive Payment Program (PCIP) are often electronic, followed-up with a paper report called the Special Incentive Remittance. The remittance is detailed, identifying all of the PCIP-eligible services for the previous quarter from which the Centers for Medicare and Medicaid Services (CMS) calculated the PCIP bonus payment. In 2012, the remittance will be modified to include a summary statement, sorted by practitioner and incentive. Stay tuned for an upcoming Change Request (CR) for more information.

Provider Enrollment Revalidation – Wait Until You Hear From Your Medicare Administrative Contractor (MAC)

All providers and suppliers who enrolled in the Medicare program prior to Friday, March 25, 2011, will be required to submit their enrollment information so they can be revalidated under new risk screening criteria required by the Affordable Care Act (section 6401a). Providers/suppliers who enrolled on or after Friday, March 25, 2011 have already been subject to this screening, and need not revalidate at this time.

Do NOT submit your revalidation until you are notified to do so by your MAC. You will receive a notice to revalidate between now and March 2013.

This will allow MACs to process revalidations in a timely fashion and allow providers to take advantage of innovative technologies and streamlined enrollment processes now under development. Updates will be shared with the provider community as these efforts progress.

For more information about provider revalidation, review the Medicare Learning Network’s Special Edition Article #SE1126, titled “Further Details on the Revalidation of Provider Enrollment Information.

2010 Medicare Electronic Prescribing (eRx) Incentive Program Payment Update

The Centers for Medicare and Medicaid Services (CMS) is pleased to announce that incentive payments for the 2010 Medicare Electronic Prescribing (eRx) Incentive Program has begun for eligible professionals who met the criteria for successful reporting. Distribution of 2010 payments Medicare Electronic Prescribing (eRx) Incentive is scheduled to be completed by August 31, 2011.

Effective January 2010, CMS revised the manner in which incentive payment information is communicated to eligible professionals receiving electronic remittance advices. CMS has instructed Medicare contractors to use a new indicator of LE to indicate incentive payments instead of LS. LE will appear on the electronic remit. In an effort to further clarify the type of incentive payment issued (either PQRI or eRx incentive), CMS created a 4-digit code to indicate the type of incentive and reporting year. For the 2010 eRx incentive payments, the 4-digit code is RX10. This code will be displayed on the electronic remittance advice along with the LE indicator. For example, eligible professionals will see LE to indicate an incentive payment, along with RX10 to identify that payment as the 2010 eRx incentive payment. Additionally, the paper remittance advice will read, “This is an eRx incentive payment.” The year will not be included in the paper remittance.