Current Medicare News
Please select the links below for complete Medicare articles and events of the current year. View Medicare Archives
Audit & Enforcement
07.07.10 Clarification regarding date all referring/ordering providers must be enrolled in PECOS
Read details from Cahaba GBA
07.06.10 CMS details new Medicare provisions in the Affordable Care Act of 2010 (ACA)
Read CMS newsletter
07.01.10 CMS to review PECOS enrollment process
Read statement from CMS
06.04.10 Cahaba warns physicians about duplicate Medicare claims
Click here for details
05.25.10 CMS provider enrollment and upcoming PECOS deadline
The American Medical Association says that any physician who refers or orders services (DMEPOS, home health, specialist services [not defined by CMS], lab, or imaging) will need to be enrolled with Medicare in the PECOS system by July 6, 2010. This includes any physician who has not submitted an updated enrollment application to Medicare in the past six years or has had a change to their enollment information during this time but has not reported the change. If they are not enrolled by July 6, the physicians who they refer patients to (and thus must list the name and NPI of the physician they referred/ordered) could see their claims reject. The AMA says that this goes beyond what is in the new health system reform law which says that by July 1 all physicians who refer/order home health and DMEPOS must be enrolled. The law does provide allow for the Secretary to require physicians who order/refer other services to be enrolled later but CMS decided to require them all to be enrolled in PECOS by July 6.
Also, under the new CMS policy physicians who have opted-out of Medicare will not be required to enroll in PECOS - they must just have the correct paperwork filed with CMS indicating this status. However, there is no description of what this means (i.e., a specific form) in the rule. Physicians who have opted-out should call their contractor to see if they are listed.
Click here for a complete list of who must enroll (see page 24443-24444)
04.06.10 CMS responds to MAG inquiry on Medicare Advantage requests, audits
Click here for response
Coding
06.30.10 CMS and Cahaba reconciling Medicare fee schedule error
Click here for 'News from MAG' article
06.07.10 Revised payment files for the 2010 Medicare Physician Fee Schedule Database (MPFSDB)
According to Cahaba GBA, the change request (CR) 6973 was released to Medicare contractors on May 10 releasing updated Physician Fee Schedules retroactive to January 1, 2010. Due to an oversight when CMS created the new files, there were some entries to the files that were omitted.
CPT Codes 78811-78816 and 78811 TC - 78816 TC did not contain the CMS capped rate, and since May 24 these codes have generated overpayments. A temporary fix was installed into the Cahaba GBA system on June 3 to avoid additional overpayments from being generated on claims received June 4 to July 5.
CMS said it plans on correcting the Physician Fee Schedule File with the July release, being installed on July 6. Once all the claims that generated the overpayments have completed processing, Cahaba GBA will initiate the overpayment recovery for the codes mentioned above that generated the overpayments.
05.10.10 Top 5 Reasons for Claims Rejections in April
View PDF
04.24.10 CMS issues signature guidelines for medical review purposes
The Centers for Medicare & Medicaid Services (CMS) have issued a change request (CR 6698) to clarify for providers how Medicare claims review contractors review claims and medical documentation submitted by providers. CR 6698 outlines the new rules for signatures and adds language for e-prescribing.
Click here for details from CMS
04.14.10 AMA payment policy committee prepares chart showing how private health plans intend to treat consultation codes eliminated by Medicare
Click here for chart
04.12.10 Top 5 Reasons for Claims Rejections in March
View PDF
02.19.10 Medicare claims crossover to supplemental payer problem
Read news article
02.11.10 Top 5 Reasons for Claims Rejections in January
View PDF
01.25.10 CMS delays implementation of ordering referring report
Click here for details from CMS
01.08.10 Top 5 Reasons for Claims Rejections in December
View PDF
Payment
06.04.10 21.3 percent Medicare payment cut in effect
Click here for details
06.03.10 MPFS claims on hold for 10 business days
Read statement from CMS
05.28.10 Bill with Medicare SGR "patch" not expected to pass House
MAG has learned that the U.S. House of Representatives will reportedly consider "extender" legislation (H.R. 4213) on Friday, May 28 that contains a $22.9 billion Medicare "patch" - though it's not expected to pass given the overall cost of the bill.
The proposal would increase Medicare physician payment by 2.2 percent for the remainder of 2010 and another 1 percent in 2011 - but it would also then revert to the current SGR formula in 2012, resulting in a cut that's been placed at 30 percent or more.
Given a week-long Memorial Day holiday recess, it's not clear if lawmakers have enough time to pass legislation to stop the 21 percent Medicare physician pay cut that is scheduled to go into effect on June 1, when the most recent extension expires.
Monitor www.mag.org for the latest Medicare SGR developments.
05.26.10 SGR "extender" bill reportedly in works
Read News from MAG article
05.26.10 Understanding Medicare recoupment rules
Read News from MAG article
05.24.10 CMS adjusting PQRI payments for 2008
Click here for details
05.11.10 AMA's 'Understanding New Medicare Recoupment Rules'
Click here for article
04.30.10 Filing requirements for Medicare FFS claims change with H.R. 3590
Click here for full news article
Physician Relations
06.14.10 PECOS enrollment required for Medicare Electronic Health Record (EHR) Incentive Program
Click here for CMS announcement
06.08.10 CMS enrollment applications - Processing status update
Read announcement from Cahaba GBA
05.25.10 Opt-out procedure for physicians who have never enrolled in Medicare
The opt-out procedure for physicians who have never enrolled in Medicare can be found in the Centers for Medicare and Medicaid Services (CMS) Internet-only manuals (Publication 100-2, Chapter 15, Section 40.13). These instructions are as follows...
"40.13 - Physician/Practitioner Who Has Never Enrolled in Medicare (Rev. 92; Issued: 06-27-08; Effective/Implementation Date: 09-29-08)
For a physician/practitioner who has never enrolled in the Medicare program and wishes to opt out of Medicare, the physician/practitioner must provide the carrier with a National Provider Identifier (NPI). The carrier must annotate its in-house provider file that the physician/practitioner has opted out of the program. The carrier can get the full name, address, license number, and tax identification number from the physician's/practitioner's opt out affidavit. All other data requirements should be developed from other data sources (e.g., the American Medical Association, State Licensing Board, etc.). The physician/practitioner must not receive payment during the opt-out period (except in the case of emergency or urgent care services). If the carrier needs additional data elements and cannot obtain that information from another source, it may contact the physician/practitioner directly. It must notify the physician or practitioner that in order to refer or order services for a Medicare patient, the physician or practitioner must have an NPI.
If an opt-out physician/practitioner provides emergency or urgent care service to a beneficiary who has not signed a private contact with the physician or practitioner and the physician/practitioner submits an assigned claim, the physician or practitioner must complete Form CMS-855 and enroll in the Medicare program before receiving reimbursement. Under a similar circumstance, if the physician or practitioner submits an unassigned claim, the carrier must pay the beneficiary directly without requiring a completed Form CMS-855. It may use the information from the affidavit to begin the enrollment process."
The Medicare contractor will establish an "affidavit record" in PECOS for the opt-out physician. This record will allow the physician to order and refer in the Medicare program.
05.07.10 CMS: Medicare reporting requirements for change of address
Read full news article
04.30.10 CMS: Medicare covers key cancer screenings
Read full news article
04.20.10 CMS prepares rules for new HIPAA transaction standards
Read full news article
04.14.10 Cahaba GBA posts online training tool
Cahaba GBA says it recently introduced "Cahaba University" - an online self-service training tool for physicians and their staff. Cahaba GBA says the online university is designed to give health care professionals the information, tools and confidence they need to successfully implement and manage their learning within the Medicare program. Cahaba University members have access to resources and benefits that include coding and reimbursement assistance and practice promotion tools.
Cahaba University for Medicare Part A
Cahaba University for Medicare Part B
02.26.10 Physicians need to choose Medicare participation status by March 17
Click here for details
02.09.10 Georgia not in first phase of Medicare DMEPOS competitive bidding program
The Centers for Medicare & Medicaid Services has announced that Medicare will begin phasing in a competitive bidding program for durable medical equipment, prosthetics, orthotics and supplies (DMEPOS) in 2011. Georgia is not included in the first phase of the transition.
Click here for additional information
01.12.10 CMS offers revised 'Medicare Physician Guide'
The revised Medicare Physician Guide: A Resource for Residents, Practicing Physicians, and Other Health Care Professionals) offers general information on the Medicare program, including how to become a Medicare provider or supplier and Medicare payment policies, is now available in CD-ROM format from the Centers for Medicare & Medicaid Services (CMS) Medicare Learning Network. To place your order, go to www.cms.hhs.gov/MLNGenInfo/, scroll down to "Related Links Inside CMS" and select "MLN Product Ordering Page."
Click here to place your order
Prescription Drug Plan
01.25.10 Annual Physician Injectable Drug List (PIDL) Re-pricing
Medicare recently published its January 2010 Average Sales Price (ASP) rates on the Centers for Medicare and Medicaid Services (CMS) Web site.
Effective for dates of service (DOS) on and after January 1, 2010, the Georgia Department of Community Health (DCH) will expedite its annual re-pricing of the Physician Injectable Drug List (PIDL), using Medicare's January 2010 ASP rates for applicable physician administered injectable drugs. This action serves to ensure compliancy with the 2009 Georgia Legislative mandate and the State Plan.
Click here for full announcement, price list
Related Links
- AMA's 2010 Medicare Physician Payment Schedule
- AMA's 2010 Medicare physician payment cut action kit
- CAHABA GBA and CMS Updates
- CMO hassle factor log sheet
- CMS Medicare Learning Network
- CMS NPI Lookup Function
- Medicare Provider-Supplier Enrollment
- NPI News
*Many of the documents listed here are available in PDF format and can be viewed using Adobe Acrobat Reader.® This free software can be downloaded from the Adobe® site, http://www.adobe.com.