Will You Continue to Receive Claim Payments after July 1, 2012?
Posted 5-17-12
Fact
The Centers for Medicare & Medicaid Services (CMS) will soon initiate enforcement action with respect to compliance with the Accredited Standards Committee (ASC) X12 version 5010 and National Council for Prescription Drug Program (NCPDP) D. 0....
>> Story Continues >>
Medicare Electronic Prescribing 2013 Hardship Exemption
Posted 4-3-12
Centers for Medicare & Medicaid Services (CMS) has reopened the Quality Reporting Communications Support Page to allow individual eligible professionals the opportunity to request a significant hardship exemption for the 2013 Electronic Prescribing (eRx) payment adjustment. The exemptions available must be supported by justification for the hardship exemption....
>> Story Continues >>
HIPAA 5010: another extension
Posted 4-3-12
On March 15, 2012, the Centers for Medicare & Medicaid Services (CMS) announced they would again extend the enforcement discretionary period, allowing practices an additional 90 days to become fully compliant with the use of HIPAA 5010 transaction standards.
What this means for physicians is that while the implementation date of January 1, 2012 is still in effect, contractors will not reject claims submitted in the 4010 electronic formats until July 1, 2012....
>> Story Continues >>
Medicare physician pay cut delayed 10 months
February 22, 2012
On Tuesday, February 14, 2012, a $20 billion deal on the sustainable growth rate (SGR) was struck, which would protect physicians from the 27. 4 percent rate cut to Medicare fee-for-service reimbursement slated to go into effect on March 1, 2012....
>> Story Continues >>
Medicare Proposes New Steps to Recover Overpayments
February 16, 2012
On Tue Feb 14, CMS proposed that providers and suppliers must report and return self-identified overpayments either within 60 days of the incorrect payment being identified or on the date when a corresponding cost report is due, whichever is later.
The new announcement is one in a series of steps Medicare is taking to protect taxpayer dollars, including efforts to prevent overpayments from occurring....
>> Story Continues >>
Revalidation Deadline Extended
Posted 11-7-11
The Centers for Medicare & Medicaid Services (CMS) has reevaluated the revalidation requirement in the Affordable Care Act, and believe it affords the flexibility to extend the revalidation period for another 2 years. This will allow for a smoother process for provider and contractors....
>> Story Continues >>
E-RX Exemption Deadline Extended
Posted 11- 2-11
Deadline to apply for Medicare e-prescribing hardship exemption extended a week!
Many physicians had reported difficulty logging on to the Centers for Medicare & Medicaid Services (CMS) Communication Support Page to activate their e-prescribing hardship extension. Because of this difficulty, CMS has pushed back its deadline to apply for an exemption until Tuesday, November 8, 2011....
>> Story Continues >>
Electronic Prescribing (eRx) Payment Adjustments
Begin January 1, 2012
Posted 10-21-11
Are You Affected
Beginning January 1, 2012, eligible professionals who have not successfully met the requirements of the electronic prescribing (eRx) incentive program, or alternately qualify for a significant hardship exemption, will be subject to the 2012 eRx payment adjustment. The adjustment will reduce Medicare payment rates by 1 percent of the provider’s allowable Medicare Part B charges....
>> Story Continues >>
2011 Version of ABN Must Be Used Beginning
January 1, 2012
Posted 10-20-11
In May 2011, 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. The 2011 version contains no substantive changes from the 2008 version of the notice and was approved by the Office of Management and Budget....
>> Story Continues >>
Medicare begins mailing provider enrollment
revalidation notices
Posted 10-18-11
Physicians who enrolled in th Medicare program prior to March 25, 2011, will be required to revalidate their enrollment by March 25, 2013, under new risk screening criteria required by the federal health reform legislation. California's Medicare contractor, Palmetto GBA, has recently began notifying physicians via mail of this requirement....
>> Story Continues >>
Medicare Revalidation of Provider Enrollment Information
Posted 8-25-11
All providers and suppliers who enrolled in the Medicare program prior to Friday, March 25, 2011, will be required to revalidate their enrollment by March 25, 2012 under new risk screening criteria required by the Affordable Care Act (section 6401a). Those providers that may have recently revalidated, but it was prior to March 25, 2011 will have to revalidate again because the new risk screening criteria had not been put into place by CMS....
>> Story Continues >>
First National Version 5010 Testing Day Results Now Available
Posted August 5, 2011
The Centers for Medicare & Medicaid Services (CMS) Version 5010 Team held its first National Testing Day on June 15, 2011. On National Testing Day, 349 Medicare fee-for-service (FFS) trading partners conducted testing using the Version 5010 format that all covered entities are required to use starting January 1, 2012....
>> Story Continues >>
CMS issues proposed 2012 Medicare fee schedule
Posted 7-25-11
The Centers for Medicare & Medicaid Services (CMS) recently released the proposed 2012 Medicare physician fee schedule. As required by law, the fee schedule includes a 29....
>> Story Continues >>
No Date Set for Ordering/Referring Provider Claim Edits
Posted 6-8-11
The Centers for Medicare & Medicaid Services (CMS) has not yet determined when it will begin to apply the expanded edit for ordering/referring provider claims. These edits are applicable to ordering/referring providers that do not have a record in the Provider Enrollment, Chain and Ownership System (PECOS)....
>> Story Continues >>
CMA urges CMS to ensure physicians are not unfairly penalized
by e-prescribing program
Posted 7-26-11
The Center for Medicare & Medicaid Services (CMS) recently proposed significant changes to the e-prescribing penalty program, including the addition of new exemption categories. The California Medical Association (CMA), American Medical Association (AMA), and others in organized medicine recently submitted >> Story Continues >>
General Equivalence Mappings (GEMs) and
Partial ICD-9 and ICD-10 Code Freeze
Posted 6-8-11
General Equivalence Mappings (GEMs)
The Centers for Medicare & Medicaid Services (CMS) and the Centers for Disease Control and Prevention (CDC) created the national version of the GEMs to ensure that consistency in national data is maintained. The GEMs are tools that act mainly as a crosswalk between the ICD–9 and ICD–10 codes....
>> Story Continues >>
CMS Adds New Exemptions For 2012 E-Prescribing Penalty
Posted 5-31-11
The Center for Medicare & Medicaid Services (CMS) issued a proposed rule that makes significant changes to the e-prescribing penalty program by adding more exemptions categories so that physicians are not unfairly penalized.
The previous rules required physicians in individual practices to submit at least 10 Medicare Part B claims with the electronic measure code E-Rx G8553 and an eligible encounter code by June 30, 2011, or face a claims payment reduction of 1 percent in 2012....
>> Story Continues >>
Claims Reprocessing: Questions and Answers for Providers
Note: For these questions and answers, the term 'provider' is used generically to cover all physicians, other practitioners, suppliers, hospitals and others affected by the Affordable Care Act and corrections to the 2010 Medicare Physician Fee Schedule.
1....
>> Story Continues >>
A New Home Health Certification Requirement
A new Medicare home health law goes into effect on January 1st that affirms the role of the physician as the person who orders home health care based on personal examination of the patient. Effective in January, a physician who certifies a patient as eligible for Medicare home health services must see the patient....
>> Story Continues >>
The Meaningful Use Attestation Calculator
Meeting the Requirements for Meaningful Use
This online tool allows providers to test whether or not they would successfully demonstrate meaningful use for the EHR Incentive Programs. Visit the Medicare and Medicaid EHR Incentive Program website for more detailed information about the program, including who is eligible to participate....
>> Story Continues >>
Important Medicare Changes for 2011
The Centers for Medicare & Medicaid Services (CMS) issued a final rule with comment on November 2, 2010, that updates payment policies and Medicare payment rates for physicians' services furnished in 2011. The final rule also addresses a number of provisions of the Affordable Care Act (ACA) that are not directly related to the Medicare payment system....
>> Story Continues >>
Medicare Changes Coming
Timely Claim Filing and Therapy Cap Exceptions
Last month President Obama signed into law the Patient Protection and Affordable Care Act (PPACA), which resulted in some important changes to Medicare rules. The Centers for Medicare and Medicaid Services (CMS) is announcing the changes that have the most immediate impact, and will continue to provide notice as implementation rules are developed....
>> Story Continues >>
Check eligibility, claim status and more
Online Provider Services (OPS)
Palmetto GBA offers a new online tool for accessing information on claim status, some financial data, remittance notices, and beneficiary eligibility. The new tool is called Online Provider Services....
>> Story Continues >>
Signatures and Documentation
What You Need to Know
ln the past year, Palmetto GBA has seen an escalating number of errors assessed by the Comprehensive Error Rate Testing (CERT) Review Contractor due to signature problems on practitioners' medical records, x-ray reports and laboratory/radiology orders. As Medicare providers, you may be asking yourself, "Why is this important to me?" The discovery of CERT errors may lead to increased scrutiny of future services billed to Medicare....
>> Story Continues >>
CMS - Centers For Medicare & Medicaid Services
Useful Links
EHR - Electronic Health Record
E-RX Incentive (fomerly E-Prescribing)
CCI Edits - National Correct Coding Initiative Edits
Palmetto GBA
Useful Links
