RCPA - Rehabilitation and Community Providers Association


Medicare Update
January 4, 2009

The Centers for Medicare and Medicaid Services (CMS) and Highmark Medicare Services have distributed several documents that may be of interest to PCPA members.

CMS to Hold Early January Claims
CMS has instructed contractors, including Highmark Medicare Services, to hold claims for services paid under the Medicare Physician Fee Schedule (MPFS) and rendered in January until January 15. All claims for services delivered through December 31, 2009, will be processed and paid as usual. After January 15 contractors will process claims under the current law. CMS will automatically reprocess claims that are greater than the MPFS values. Physicians who submit claims that are less than or equal to the MPFS amounts must request adjustment.

CMS has extended the 2010 annual Medicare Participation Enrollment Program deadline from January 31 to March 17. However, the enrollment period will be in effect January 1 through December 31.

Fee Schedule Issued
According to Highmark Medicare Services, President Obama signed the Department of Defense Appropriations Act of 2010, which includes a two-month zero percent update to the 2010 Medicare Physician Fee Schedule effective for dates of service January 1 – February 28. The MPFS has been posted to the Highmark Medicare Services web site (www.highmarkmedicareservices.com/partb/index-feeinfo.html).

MPFS Guidance Released
MLN Matters (MM6756 Revised), Summary of Policies in the 2010 Medicare Physician Fee Schedule and the Telehealth Originating Site Facility Fee Payment Amount, with implementation date of January 4 was issued. The article is based on Change Request (CR) 6756. The Social Security Act (SSA) requires CMS to provide fee schedules each year to establish payment amounts for physician services in the coming year. The SSAalso established the payment amount for the Medicare telehealth originating site facility fee for telehealth services provided October 1, 2001 – December 21, 2001. For each subsequent year the fee has increased by the Medicare Economic Index (MEI). The MEI for calendar year 2010 is 1.2 percent. The telehealth originating site facility fee (HCPCS code Q3014) is 80 percent of the lesser of the actual charge or $24. The MPFS final rule also eliminated the use of all consultation codes (inpatient and office/outpatient consultation codes), with the exception of telehealth consultation G codes. More information on the elimination of consultation codes is found in Transmittal 1875, CR 6740 and MLN Matters, MM 6740, Revisions to Consultation Services Payment Policy, available at www.cms.hhs.gov/MLNMattersArticles/downloads/MM6740.pdf. CR 6756 also addresses the inequitable copayment rates for Medicare outpatient psychiatric services. For 2010, CMS will pay 55 percent of the approved amount for outpatient psychiatric services, beginning the transition to the same payment level as for physical health services by 2014.


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