 Colorado Medical Society Health Care Financing Division
PHONE: (720) 858-6321
FAX: (720) 859-7509
[email protected] |
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Reminder: Medicare eRx penalties start this year !
| Beginning 2012 eligible professionals who are not successful electronic prescribers under the Medicare 2011 eRx Incentive Program will see their payments cut 1 percent. This amount will increase to 1.5 percent in 2013 and 2 percent in 2014.
The Centers for Medicare and Medicaid Services has posted several resources on its website, including this Quick Reference Guide to the 2012 eRx payment adjustment.
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Medicare eRx hardship exemptions under review
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(From AMA)
Last fall, physicians had the opportunity to seek hardship exemptions and avoid penalties for failing to successfully participate in Medicare's e-prescribing program.
The Centers for Medicare & Medicaid Services (CMS) is reviewing each hardship exemption request on an individual basis and has not yet completed its analysis. Therefore, it is possible that some physicians will be subjected to a 1 percent Medicare payment penalty inappropriately until the backlog of exemption requests is reviewed. Ultimately, CMS will reprocess the claims.
Read more information on the penalty program here.
Find additional electronic prescribing information and resources on the AMA website.
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Important information about Medicaid PAR
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Effective Feb. 1, prior authorization requests (PARs) may no longer be sent through the Colorado Medical Assistance Program Web Portal.
Medicaid issued a Special PAR Bulletin with a summary of where to send PARs. You may access it here.
For questions or additional assistance, contact the ColoradoPAR Program information line at 1-888-454-7686 or visit
ColoradoPAR.com.
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2012 PQRS resources
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The Centers for Medicare and Medicaid Services has posted educational products for the 2012 Medicare Physician Quality Reporting System (PQRS) and electronic prescribing (eRx) programs.
To access the 2012 PQRS System educational products, along with measure specifications, visit the Spotlight page. Further information on the 2012 PQRS may also be found on AMA's website, located at www.ama-assn.org/go/PQRS.
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New program to assist physician ID theft victims
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(From amednews)
Physician who have been the victim of identity theft now have a federal option to restore his or her financial integrity and clear bad debts.
The Centers for Medicare & Medicaid Services has created the provider victim validation/remediation initiative for physicians whose identification has been stolen and used to defraud federal health programs.
Physicians can seek resolution from Medicare program safeguard and zone program integrity contractors through the new initiative. These contractors, which operate according to region and state, can investigate instances of identity theft after being notified by a potential victim.
(See a list of contractors here).
These contractors would investigate a physician's complaint and generate a report to CMS for "a final decision whether to relieve providers of liability based upon the evidence."
Physicians who believe they are victims of identity theft but have not yet suffered any financial liability should call their Medicare administrative contractors or the HHS Office of Inspector General. The OIG hotline is 800-HHS-TIPS.
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ICD-10 Coding Corner
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Save the Date!
Tuesday, Feb. 21 at Noon
For the next webinar in the ICD-10 series:
"ICD-10 - Start
with a plan"
Watch for registration details
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| Medicare 2012 fee schedule update | |
(From the Centers for Medicare and Medicaid Services)
On Dec. 23, 2011, President Obama signed into law the Temporary Payroll Tax Cut Continuation Act of 2011 (TPTCCA). This new law prevents a scheduled payment cut for physicians and other practitioners who treat Medicare patients from taking effect immediately. While the negative update for the 2012 Medicare Physician Fee Schedule is now scheduled to take effect on March 1, 2012, the Administration remains strongly opposed to letting this cut take effect. As he has repeatedly made clear, President Obama is committed to a permanent solution to eliminating the Sustainable Growth Rate's cut. We will continue to work with Congress to achieve this goal.
Physician Payment Update:
Section 301 of the TPTCCA prevents a payment cut for physicians that would have taken effect on January 1, 2012. An update of zero percent is effective for claims with dates of service January 1, 2012, through February 29, 2012. While the physician fee schedule update will be zero percent, other changes to the relative value units used to calculate the fee schedule rates must be budget neutral. To make those changes budget neutral, the conversion factor must be adjusted for 2012. CMS is currently developing the 2012 Medicare Physician Fee Schedule (MPFS) to implement the zero percent update.
As previously advised, Medicare claims administration contractors will be holding new, January 2012 claims for up to 10 business days in order to effectively test and implement the new 2012 MPFS. We expect these claims to be released into processing no later than January 18, 2012. Claims with dates of service prior to January 1, 2012, are unaffected.
Other key changes:
The Centers for Medicare & Medicaid Services (CMS) has also recently implemented several important changes for Medicare providers and beneficiaries for 2012. For many of your patients, Medicare costs will go down. Medicare cost-sharing for Part B services will decline in some cases and, for the first time, the Part B deductible will decrease, by $22, to $140.
Additionally, health care professionals will be paid more to provide certain important services for people with Medicare. CMS has increased the payment amount for the initial and annual wellness visit - which has no cost sharing for patients -- to account for the introduction of health risk assessment (HRA). CMS believes it is important to balance the comprehensiveness of the HRA with the potential burden on patients and health professional time constraints. As such, in 2012, CMS will allow for variation in the content of the HRA.
We also wish to remind physicians and practitioners about the Primary Care Incentive Program. Again in 2012, primary care physicians, nurse practitioners, clinical nurse specialists, and physician assistants may be eligible to receive an incentive payment equal to 10 percent of their allowed charges for primary care services under Medicare Part B. This incentive is paid in addition to any physician incentive payments for services furnished in Health Professional Shortage Areas. Please remember that if a practitioner has reassigned his or her benefits to another entity, such as a group practice, Medicare will pay that entity and not the individual practitioner.
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| New ICD-10 Training Coalition to provide ongoing training, resources | |
The Colorado Medical Society has organized the formation of a statewide training coalition to help Colorado physician practices prepare for the implementation of ICD-10 on Oct. 1, 2013.
The Colorado ICD-10 Training Coalition will make ICD-10 resources and training accessible to physicians and their staff via an organized multimedia educational campaign. Through a modular approach the coalition will provide a progressive training curriculum beginning January 2012 and running through October 2013.
Each month on the third Tuesday a new program or resource will be made available to help practices prepare for the transition. A modular approach will allow practices to do much of the preparatory work now, such as project planning, impact analysis and documentation evaluation. It does not replace the need for intensive coding training, but it can be "put off" until early 2013 when the actual implementation is closer. (Think of ICD-10 as a new language; you want to be able to use it or you will or you won't remember it).
The coalition will establish a dedicated ICD-10 Training Resource web page that will spotlight a calendar of upcoming events and archived program recordings. This page will also centralize and categorize resources developed by the coalition and other publicly available ICD-10 information. The web page will be delivered via Facebook, so watch for more information coming soon.
There will be a link on the Colorado Medical Society website. Check it out and "like us."
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| HIPAA 5010 enforcement FAQs | |
In December, the Centers for Medicare and Medicaid Services announced a 90-day discretionary enforcement period for the Jan. 1 deadline for HIPAA Version 5010 transactions.
TrailBlazer recently issued a notice stating it will not reject compliant ASC X12 Version 4010A1 transactions prior to April 1. (The exact date and time that 4010 transactions will be rejected will be published at a later date).
Trading partners that have tested and been approved for 5010, but are still submitting 4010A1 transactions, have 30 days to complete their cutover to submitting Version 5010 production transactions, TrailBlazer said. All submitters must have tested and been moved into production for submitting 5010 transactions prior to April 1, 2012.
From AMA: What you can do if you are experiencing claims processing issues
Since the deadline on Jan. 1 some physicians have been experiencing issues with their claims processing, resulting in lack of payments. The AMA is aware of issues with claims processing related to the 5010 transition and is addressing these issues directly with the Centers for Medicare and Medicaid Services (CMS).
Please inform the AMA and CMS of your issues:
* Report the problems you are having to the AMA with this form.
* Visit www.ama-assn.org/go/clickandcomplain to access additional complaint forms, including the Centers for Medicare and Medicaid Services complaint form.
* Submit your problem to [email protected] for issues you are having with Medicare. Until these issues are resolved, the following are action items that physician practices can take if they are having issues with their claims and interruptions in their cash flow: * If using a billing service or clearinghouse, contact the billing service or clearinghouse to understand where the problem is occurring. Is it related to the data you are submitting? Is it due to the payers' processing of the claims? * If you identify a problem with your practice management system, contact your vendor to have the problem resolved. * If you submit your claims directly to the payer, contact the payer to understand where the problem is occurring. Is it related to the data you are submitting? Is it related to problems within their adjudication system? * Contact a financial institution about establishing a line of credit. * Consider submitting paper claim forms to those payers that will accept them. Physicians who are AMA members and are having financial troubles due to lack of payment may also consult the AMA's member benefits website for information on collaborative arrangements with certain financial institutions who may offer priority financial options for physician AMA members. For additional AMA financial management resources, please visit the Physician Services website at www.ama-assn.org/go/yps.
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Help with EHR "meaningful use"
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Did your practice receive a 2011 incentive for meaningful use of an electronic health record (EHR)? Do you have a plan to earn the incentive in 2012?
The Colorado Medical Society, CO-REC (Colorado Regional Extension Center) and the Centers for Medicare and Medicaid Services have several tools that will help.
Online portal: This free, self-guided educational tool takes physicians and their staff through step-by-step training and educational models to help with selection, implementation and meaningful use of certified EHR technology. These tools include an EHR readiness assessment, selection criteria assessment, contract considerations and checklists for successful implementation. The portal is available to all Colorado physicians or practice staff members by clicking here. For more information click here.
Path to Payment: This web page from the Centers for Medicare and Medicaid Services will help you determine if you are eligible for the incentives, and which incentive program - Medicare or Medicaid - will be most beneficial for you. You may also download a Beginners Guide to the EHR incentive program.
Colorado's Medicaid EHR Incentive: Colorado has launched the website for its incentive program. While the program is not yet accepting registrations, information and tools are available here.
Many additional resources are available on the CO-REC website and the Centers for Medicare and Medicaid Services EHR Incentive Program website.
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About Us
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The Colorado Medical Society is the largest organization of physicians in the state of Colorado. This newsletter is published by the CMS Health Care Financing Division, which works with physicians, practice managers and other office staff to help practices remain viable and thrive. If you have questions about practice viability, please visit our website or email [email protected].
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