May 2014

Health professionals caught up in tax fraud scheme

There have been a number of recent news reports in several regions of the country about physicians who have been the latest victims of tax refund identity fraud during this year's tax filing period.

The Internal Revenue Service (IRS) has seen a significant increase in refund fraud that involves thieves who file false tax returns by stealing and using an individual's Social Security number. When the individual attempts to file his or her legitimate tax return, it gets rejected because the thieves have already filed and collected on the false return. The American Medical Association reports that this year's scam has ensnared hundreds of physicians and other health professionals across the country. In addition to the IRS, the Secret Service is leading an investigation of this year's tax refund identity fraud. The AMA is working with federal officials who are investigating this tax fraud scheme.

Physicians who are victims of this scam should have received a 5071C letter from the IRS with instructions to contact the IRS identity theft website (click here). Physicians can also call the IRS at (800) 830-5084 to let agency officials know that they did not file the return referred to in the IRS' letter.

If a physician did not receive a 5071C letter or has already received confirmation that their legitimate tax return was accepted, it is unlikely he or she is a victim of this scam. Physicians who are victims will need to file a paper return if they have not already done so, and should attach a Form 14039 Identity Theft Affidavit to explain what happened. Also, copies of any notices on this issue received from the IRS, like the 5071C letter mentioned earlier, should be attached. The AMA will provide updates on this matter as additional information becomes available.

Verify grace-period status electronically for patients with Anthem BCBS

Under the Affordable Care Act, patients who receive federal subsidies to purchase plans through the state health insurance exchange have a 90-day grace period for non-payment of premiums. During the first 30 days the health insurer must pay for claims as if the patient were eligible, but in the last 60 days they can suspend claims, potentially putting the physician on the hook for collecting from patients.

The ACA requires that the carrier notify the enrollee's physician and other health care providers when a patient enters into the second and third month of the grace period, but there has been some confusion about the notification requirement, such as when and how notification must be made.

Anthem Blue Cross and Blue Shield (Anthem) recently announced that providers can now determine if an Anthem member is in the second or third month of an ACA-mandated three-month grace period by using their real-time electronic 271 eligibility and benefit transaction available via Availity or EDI. Click here for more information.

Fact sheet: How to avoid the 2016 PQRS Payment Adjustment

Eligible professionals or those who are part of a group practice participating in the Physician Quality Reporting System (PQRS) must satisfactorily report data on quality measures during 2014 to avoid the 2016 payment adjustment. Click here to review a new fact sheet from the Centers for Medicare and Medicaid Services for guidance on how to avoid the 2016 PQRS Payment Adjustment.

You can avoid the 2016 payment adjustment by meeting one of the following criteria during the one-year 2014 reporting period (Jan. 1 - Dec. 31):

If participating as an Individual Eligible Professional: Meet the criteria for satisfactory reporting adopted for the 2014 PQRS incentive. Or, participate in PQRS via qualified clinical data registry, qualified registry, or claims reporting and report at least three measures covering one National Quality Strategy (NQS) domain for at least 50 percent of your Medicare Part B Fee-For-Service (FFS) patients.
If Participating as a Group Practice: Meet the Group Practice Reporting Option (GPRO) requirements for satisfactory reporting. Or, participate in PQRS via qualified registry reporting and report at least three measures covering one NQS domain for at least 50 percent of your group practice's Medicare Part B FFS patients.

For more, click here to visit the PQRS website.

News and tools from Novitas Solutions

Novitas has many interactive apps to help answer your questions and give you access to information you need, when you need it, without having to pick up the phone. Here are some of the self-service tools they offer:

Appeals Status Tool - This app shows details on the appeals you've submitted to Medicare.
Enrollment Status Tool - Check the status of an enrollment application or revalidation.
Fee Schedule Lookup App - This app provides quick access to fee rates for CY 2012, 2013, and 2014.
Secondary Liability Calculator - This tool helps you calculate what Medicare's liability would be when there is another primary insurer.
Patient Responsibility Calculator - This tool helps you determine if there is a balance due from the patient.

If you can't find the information you're looking for with the tools above, review Novitas' Interactive Voice Response Unit (IVR) user guide. The IVR will also give you comprehensive information on claim status and patient eligibility. You can also find out check status, order a duplicate remittance, or get a patient account number.

Novitas has updated their online status tool to include the status of Phase 3 revalidation applications (for requests issued after Sept. 20, 2013). They request that you utilize the online tool as your source of information for application status so their customer service representatives can be utilized for more complex inquiries.

Finally, effective April 15, 2014, paper claims that were submitted to the old Novitas Solutions mailing addresses are no longer being forwarded by the postal service. The 1500 claim forms are being mailed back to the provider and will need to be resubmitted to the correct mailing address. The correct Novitas mailing address for paper claims is:

Novitas Solutions
Attn: Part B Claims
PO Box 3107
Mechanicsburg, PA 17055-1823.

AMA virtual credit card resource

To eliminate inefficiencies in health plan payment processes, the American Medical Association has created a resource detailing the effects that virtual credit cards can have on physician practices. Click here to access this resource (member log-in required).

Virtual credit cards are an increasingly utilized, electronic form of payment whereby a payer will send a physician practice (via fax, mail, or e-mail) information that needs to be punched into a credit card POS system in order to receive contractual payments. The effect of health plan virtual credit card payments on physician practices details potential concerns regarding virtual credit cards and provides useful information about the benefits of standardized electronic funds transfer using the automated clearinghouse network.

If you have any questions or concerns, contact Terrence Cunningham at [email protected]. For additional information on the AMA's Administrative Simplification Resources, go to www.ama-assn.org/go/simplify.

New to EHR meaningful use?
July 1 is the day for deadlines

First-time participants in the Medicare and Medicaid meaningful use electronic health records (EHR) program should begin the 90-day reporting period or submit a hardship exception no later than July 1 to avoid payment penalties in 2015.

Physicians who attest to meaningful use for the first time by Oct. 1 are eligible for an incentive payment and can avoid payment penalties for the following year. Physicians who miss the Oct. 1 attestation deadline but still attest to meaningful use in 2014 are eligible for an incentive payment, but will be subject to a 1 percent payment adjustment in 2015.

Physicians who begin participation in the program this year can earn up to $11,760 if they demonstrate 90 days of Stage 1 meaningful use. Successful demonstration of meaningful use each year, beginning in 2014, could earn a physician up to $23,520, according to the Centers for Medicare and Medicaid Services.

Physicians who did not attest to meaningful use (MU) of electronic health records (EHR) in 2013 have until July 1 of this year to apply for a hardship exception so they can avoid a financial penalty in 2015. Physicians who attested in previous years but don't attest to MU stage 2 this year have until July 1, 2015, to apply for a hardship exception to sidestep a penalty in 2016.

Click here to visit the American Medical Association's Medicare/Medicaid EHR incentive program webpage to learn more about meaningful use and access resources that can help you get started. Click here to read more from the Centers for Medicare and Medicaid Services about the hardship exception.

Ordering and referring denial edits will apply to certifying physicians for HHAs beginning July 7

Effective July 7, 2014, the Centers for Medicare and Medicaid Services will apply Phase 2 ordering and referring denial edits to certifying physicians of Part A Home Health Agencies (HHAs). Currently the edits only apply to the attending physician of an HHA. The edits will ensure that in addition to the attending physician, the certifying physician meets the following requirements: