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Medicare Issues and Highmark Webinars/Teleconference
July 7, 2010

Medicare Physician Fee Schedule Cuts Prevented
The Preservation of Access to Care for Medicare Beneficiaries and Pension Relief Act of 2010 was signed June 25. The act provides a 2.2 percent update to the Medicare Physician Fee Schedule payment rates effective retroactively from June 1 through November 30. The Centers for Medicare and Medicaid Services (CMS) instructed contractors to temporarily hold claims for services provided June 1 and later until the new update rates can be processed, which is anticipated to be no later than July 1. Claims for dates of service of June 1 and later that have been processed with a “negative update” rate will be reprocessed as quickly as possible. Those submitted with charges greater than or equal to the 2.2 percent update rates will be automatically reprocessed. Providers who submitted claims for services rendered June 1 and later with charges less than the 2.2 percent update rates must contact the Medicare contractor to request an adjustment. Providers should not resubmit claims that were already submitted to the Medicare contractor. The July update to the Medicare Physician Fee Schedule is available at http://www.cms.gov/MLNMattersArticles/downloads/MM6974.pdf.

Proposed Rule Expands Medicare Preventive Services
CMS issued a proposed rule to implement requirements of the Patient Protection and Affordable Care Act of 2010 that expand preventive services for Medicare, improve payments for primary care services, and promote access to health care services in rural areas. The proposed rule impacts payment under the Medicare Physician Fee Schedule for services provided from January 1, 2011. Medicare will cover an annual wellness visit to develop a more comprehensive approach to health maintenance and reduction of chronic disease. Specialized preventive services based on individual risk factors will be included in addition to general, preventive services.  An incentive payment for primary care services provided by physicians, nurse practitioners, clinical nurse specialists, and physician assistants is intended to promote access to services. CMS will accept comments on the proposed rule through August 24. The final rule is to be issued around November 1 and will be effective for services provided on or after January 1, 2011. The proposed rule, Medicare Program; Payment Policies Under the Physician Fee Schedule and Other Revisions to Part B for CY 2011, is available for preview on the Federal Register web site (http://www.federalregister.gov/OFRUpload/OFRData/2010-15900_PI.pdf) and will soon be published in the Federal Register. On June 25 CMS also issued a Fact Sheet available at http://www.cms.gov/apps/media/fact_sheets.asp.

Changes to Medicare and Medicaid Enrollment, Ordering/Referring, and Documentation Begin
July 6 is the effective date of CMS interim final rule with comment period, Medicare and Medicaid Programs, Changes in Provider and Supplier Enrollment, Ordering and Referring, and Documentation Requirements, and Changes in provider Agreements. The rule implements sections of the Patient Protection and Affordable Care Act that require providers that qualify for a National Provider Identifier (NPI) to include it on all enrollment applications for Medicare and Medicaid programs and on all claims for payment under these programs. The rule also requires all physicians and professionals eligible to order and refer Medicare covered items and services to be enrolled in Medicare. Providers, physicians, and suppliers will also be required to provide documentation on referrals to programs at high risk for waste and abuse, such as durable medical equipment and home health services. Comments will be accepted by CMS through July 6. Instructions for submitting comments are included in the interim final rule available in the May 5 Federal Register (http://edocket.access.gpo.gov/2010/pdf/2010-10505.pdf). On June 30 CMS issued a statement that they will not implement changes that would automatically reject claims based on orders, certifications, and referrals made by providers that have not yet had their applications approved by July 6, since some providers have had difficulty with enrollment in the Provider Enrollment, Chain and Ownership System (PECOS). Providers should continue to submit claims that will be processed and paid as usual. CMS will implement a contingency plan to meet requirements of the Affordable Care Act that written orders and certifications are only issued by eligible professionals as of July 1.

Common CERT Errors
Each quarter Highmark Medicare Services publishes common errors identified in the Comprehensive Error Rate Testing (CERT) Program (https://www.highmarkmedicareservices.com/cert/index.html). Providers may want to use the listing for quality improvement purposes.

Medicare Teleconferences/Webinars

 

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