March 12, 2013
Issue No. 1
In This Issue
Medicare's 2% Sequester CutReview
New Multiple Procedure Payment Reduction
New Medicare POS Policy
2014 e-prescribing Policy
2014 eRx Penalty
Medicare Now Demands Exact Name Match
Quick Links
 Hardship Exemption Request Online

Newsletter Archive 

Want to read a back issue of IPC's newsletter?
 Click here! 

Medicare news that affects your practice.

Medicare's 2% Sequester Cut 
  Medicare's 2% sequester-mandated reduction applies to services provided on or after April 1st. The reduction will apply to the amount Medicare will actually pay to the provider AFTER the appropriate deductible or copayment has been calculated. By calculating the 2% reduction on the payment amount instead of the allowed amount, the impact on providers will be softened a bit.     
Cardiologists and Ophthalmologists will be impacted by new Multiple Procedure Payment Reduction (MPPR)

 Beginning January 1, 2013, Medicare expanded the Multiple Procedure Payment Reduction (MPPR) policy to the technical component (TC) of diagnostic cardiovascular and ophthalmology procedures. The reduction applies to the TC of multiple services furnished to the same patient on the same day. The MPPRs do not apply to the professional component of the service.


 Medicare makes full payment for the TC of the service with the highest payment under the Medicare Physician Fee Schedule (MPFS) and payment for subsequent TC services at 75% of the MPFS.  


  For more information see Change Request (CR) 7848, located on the CMS website at http://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/Downloads/R1149OTN.pdf. The CR lists all cardiovascular and ophthalmology services affected by the MPPR. 
New Medicare Place of Service (POS) Policy goes into effect April 1st

If you provide the professional component (PC) of a service, i.e. reading of a diagnostic test, and the technical component (TC) of the service was provided in a different location from your reading, a new Medicare policy will affect you. As of April 1, 2013, you must report the POS of your reading as the location where the patient's face-to-face service was rendered. For example, if the patient had the TC of a test in the outpatient department of the hospital and you are reading the results in your office, the POS of your services will be the same as the patient's - the outpatient department of the hospital.


There are nuances to Medicare's new policy that might complicate how we bill. Rather than explain it in this article, please let IPC Billing know when you are providing the interpretation of a diagnostic test in which the technical component has been performed in a different location.

Avoiding the 2014 e-prescribing penalty

 If you are e-prescribing, you should be well on your way to meeting your required number of e-Rx claims (10 valid claims for the first half of this year) to prevent the 2% penalty in 2014. If you are not e-prescribing (either with or without an EMR), it is imperative that you determine if you qualify for a hardship. It is your responsibility to either add the hardship codes to your encounters or file online.   Refer to the CMS website for more complete information about the e-Rx incentives and penalties.


 Note: If you are eprescribing through your EMR you may have different requirements. You may be exempt from the 2014 penalty if you achieve Meaningful Use for a 90 day continuous period that falls within Jan 1, 2012-June 30, 2013, or for an EHR reporting period that is the full 2012 calendar year. Also, you may be exempt if you register for Meaningful Use between Jan 1, 2013-June 30, 2013 and adopt Certified EHR Technology. Your best bet is to contact you EMR vendor for advice in avoiding the EMR penalty.

2014 eRx Penalty and Hardship Exemption Requests

 CMS may exempt individual eligible professionals from the 2014 eRx payment penalty if it is determined that compliance with the requirement for being a successful electronic prescriber would result in a significant hardship.


Hardship Exemptions

  • Inability to electronically prescribe due to state, or federal law, or local law or regulation
  • The eligible professional prescribes fewer than 100 prescriptions during a 6-month payment adjustment reporting period
  • The eligible professional practices in a rural area without sufficient high-speed Internet access (reportable via claims as G8642)
  • The eligible professional practices in an area without sufficient available pharmacies for electronic prescribing (reportable via claims as G8643)


 To enter an hardship exemption request online: https://www.qualitynet.org/portal/server.pt/community/communications_support_system/234

Important for Front Desk Staff: Medicare now demands an exact name match

 Medicare has begun denying claims where the name is not an exact match to their beneficiary records.   As we receive these denials, IPC staff will be correcting the patients' names on Healthpac. To avoid the possibility of duplicate patients being added to Healthpac, please have your staff search by both name AND Date of Birth, if your practice is using our scheduler.


Example: Smith-Jones

               Used to be entered as one word: SMITHJONES

               Now will be entered as SMITH JONES to match Medicare  

(with space between names - do not enter a "-")

About Us
If you have any questions regarding this newsletter, you can contact us at:

         Mary Ellen Duffy
         Patricia Nevala pat@ipcbilling.com

or call us at 616-459-6867 or 800-606-1455

Please feel free to forward this newsletter to your staff and peers.


Innovative Practice Concepts, LLC -- A full service medical billing company
Your Bottom Line is our Top Priority!