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 CSP at 916.446.6001.
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.
