Medicaid/Medicare

Update

2012 Medicare e-Prescribing Penalty Exemptions: The AMA has secured an opportunity for more physicians to be exempted from the 2012 Medicare e-prescribing penalty. Read more.

CMS Releases EHR Incentive Appeals Process Info: The Centers for Medicare & Medicaid Services (CMS) recently released guidance on the appeals process for this incentive program. The agency has added to its attestation Web site new information about the appeals process for the incentive program to adopt electronic health records.

2011 Medicare Online System User ID Recertification: The Centers for Medicare & Medicaid Services requires National Government Services to conduct an annual recertification of all current Medicare online system users for:

  • Part A Fiscal Intermediary Standard System (FISS)/Direct Data Entry (DDE) providers;
  • Medicare Part B Professional Provider Telecommunications Network (PPTN) providers; and
  • Durable medical equipment (DME) Claim Status Inquiry (CSI) supplier entry.

This process will recertify all user IDs used by your employees or third parties whom you have authorized to access National Government Services systems on your behalf. This recertification must be completed by November 30, 2011. Failure to complete recertification by the November 30, 2011 deadline date will result in a disruption of your Medicare online system access. More

New CMS Proposal: The Centers for Medicare & Medicaid Services (CMS) has proposed to add alcohol screening and behavioral counseling, and screening for depression, to the comprehensive package of preventive services now covered by Medicare.

CMS to track payer ACA compliance: The Centers for Medicare and Medicaid Services announced this week that it plans to build a Health Insurance Assistance Database to analysis inquiries and reports of payer activities by consumers related implementation of the Affordable Care Act. Plans for the database were announced in the Federal Registry.

National Government Services Medicare Part B 101 Manual (2011). Click here and complete 'About Me', then, click here to view manual.

E-prescribing Requirements Unreasonable
The AMA reports that the Federal Government Accounting Office agrees with physician groups that the 1% eprescribing penalty linked to the CMS requirement to eprescribe for 10 visits between January 1-June 30, 2011 is unreasonable. Read more about the GAO report.

CMS introduces New Center for Medicare and Medicaid Innovation
Calls it “a new engine for revitalizing and sustaining the Medicare, Medicaid and CHIP programs and ultimately to help to improve the healthcare system for all Americans." Log onto www.innovations.cms.gov

Registration Numbers Growing for EHR Incentive Programs
According to CMS, as of February 11, more than 45,000 physicians and other providers requested information or registration help from 62 regional extension centers. Registration opened on Jan. 3.

Primary Care Incentive Program (PCIP)
For primary care services furnished on or after January 1, 2011 and before January 1, 2016, a 10 percent incentive payment will be provided to primary care practitioners. To qualify for the bonus, a physician must be self-designated in a primary care specialty and a substantial portion (60 percent) of their Medicare billings must be for the designated primary care services.

New resources explains Medicare preventive care
A new brochure from the AMA helps physicians and their patients take advantages of new Medicare preventive care services called for in the Patient Protection and Affordable Care Act of 2010. According to a Feb. 4 news release from the AMA, the new rules on Medicare benefits mean that more beneficiaries will have access to preventive services at a more affordable cost.

CMS launches physician compare website
CMS launched the first phase of a searchable online physician directory for Medicare patients called Physician Compare and located at www.medicare.gov/find-a-doctor. The site is publicly available for non-Medicare patients to peruse. Patients may use the site to search for physicians in their area, find information on other health care professionals who work with Medicare beneficiaries, search by gender, and elect a preference for providers who accept Medicare approved amounts as payment in full.  The site also lists whether a physician participates in the Physician Quality Reporting System.  Future iterations of the site will incorporate data about the quality of care received by Medicare patients from that individual. The MCMS urges physicians and practices to access Physician Compare and confirm the accuracy and completeness of the information that is available.

PECOS enrollment deadline is January 3, 2011
Medicare claims received on or after January 3, 2011, will not be paid if the ordering or referring provider is not enrolled in PECOS (Provider Enrollment, Chain and Ownership System). Physicians should also be aware that PECOS enrollment is required to receive federal EHR incentives under the Medicare program. Beginning in 2011, Medicare providers who demonstrate “meaningful use” of an EHR stand to receive up to $44,000 in incentive payments over five years.

AMA Summary of Medicaid/ Medicare physician payment policies