Notice From Medi-Cal on Recoupment of Professional Fees in Hospital Setting
We have heard from
several groups about a letter from HP, the Medi-Cal Fiscal Intermediary,
indicating a recoupment on claims paid to physicians in hospitals that have contracted
for per diem payments with DHCS for Medi-Cal patients. Typically the hospital
per diem contract rates do not include the professional component of physician
services like pathology or radiology which are separately billed by the
physician group.
The letter states that
claims for professional services were erroneously paid beginning in 2007
through March 2010 when those fees were included in the hospital per diem
payment pursuant to the contract. If your group has received such a letter we
would like to hear from you. Please contact the CRS office at 916.446.2028.
PECOS Enrollment Required for Medicare Electronic Health Record
(EHR) Incentive Program - One More Reason to Establish Your Enrollment Record
in PECOS
The Recovery Act of 2009 established CMS programs under Medicare
and Medicaid to provide incentive payments for the "meaningful use"
of certified EHR technology. These EHR incentive programs will provide
incentive payments to eligible professionals and eligible hospitals as they
demonstrate adoption, implementation, upgrading or meaningful use of certified
EHR technology.
While more detail on the EHR incentive program is forthcoming in
the an impending final rule, CMS is announcing that Provider
Enrollment, Chain and Ownership System (PECOS) records will be used to verify
Medicare enrollment prior to making Medicare EHR incentive payments. Your
enrollment information must be in PECOS, so act now if you do not have
an enrollment record in this system.
Enrolled in Medicare before November 2003?
If you are a physician
who enrolled in Medicare before November 2003 AND have not updated your
Medicare enrollment information since then, you do NOT have an
enrollment record in PECOS . Act now to establish your
enrollment record in PECOS. For instructions, go to www.cms.hhs.gov/MedicareProviderSupEnroll, click on "Tips to Facilitate the Medicare
Enrollment Process" under "Downloads."
If you enrolled in
Medicare after November 2003, or if you enrolled before November 2003 and have
updated your Medicare enrollment information since November 2003, no further
action is required.
If you are unsure, here are ways to verify that you have an
enrollment record in PECOS:
1.
Check the Ordering
Referring Report on the CMS website. If you are on that report, you have a current
enrollment record in PECOS. Go to http://www.cms.gov/MedicareProviderSupEnroll, click on "Ordering Referring Report"
on the left.
2.
Use Internet-based PECOS
to look for your PECOS enrollment record. (You will need to first set up your access
to Internet-based PECOS). If no record is displayed, you do not have an enrollment
record in PECOS. Go to http://www.cms.gov/MedicareProviderSupEnroll, click on "Internet-based PECOS" on
the left, for information on using Internet-based PECOS.
3.
Contact your designated
Medicare enrollment contractor and ask if you have an enrollment record in
PECOS. Go to http://www.cms.gov/MedicareProviderSupEnroll, click on "Medicare Fee-For-Service
Contact Information" under "Downloads."
Note: If you have
submitted an enrollment application within the last 90 days, and your enrollment application has been
accepted for processing by the carrier or A/B MAC, you need not take any
additional actions based on this listserv message.
NOTE for physicians who
reassign all their Medicare benefits to a group/clinic: If you reassign all of your Medicare benefits to
a group/clinic, the group/clinic must have an enrollment record in PECOS in
order for you to enroll using Internet-based PECOS. You should check with the
officials of the group/clinic or with your designated Medicare enrollment
contractor if you are not sure if the group/clinic has an enrollment record in
PECOS. If the group/clinic does not have an enrollment record in PECOS, you
will not be able to use Internet-based PECOS to submit your enrollment
application to Medicare You will need to submit a paper enrollment application
(CMS-855).
Information on how to establish an enrollment record in PECOS can
be found at http://questions.cms.hhs.gov/app/answers/detail/a_id/9909 on the CMS website.
The Medicare &
Medicaid EHR incentive programs are designed to support providers in this
period of Health IT transition and instill the use of EHRs in meaningful ways
to help our nation to improve the quality, safety and efficiency of patient
health care. More information on Medicare & Medicaid EHR incentive programs
can be found at http://www.cms.hhs.gov/Recovery/11_HealthIT.asp.
