Medicare RAC court case keeps collections on uncertain footing The U.S. Court of Appeals for the Federal Circuit issued a decision in early March in a case filed by one of the Medicare Recovery Audit Contractors (RAC) after the Centers for Medicare and Medicaid Services (CMS) changed the timing for the payment of contingency fees on collections. The decision means the auditing program will be put on hold until CMS determines how to contract with its RACs. The RAC program is responsible for identifying fraud and waste in the Medicare system by detecting improper Medicare payments. Since 2008, when ... March 18, 2015 Medi-Cal, Medicare Centers for Medicare and Medicaid Services, Medicare, Recovery Audit Contractor, Audits 0 0 Comment Read More »
Is your Medicare practice information up-to-date? The February issue of CMA Practice Resources (CPR) contained an article discussing the importance of maintaining up-to-date practice demographic information with contracted managed care payors (see “Ensure your practice information is up-to-date with contracted payors”). This advice applies equally to government payors, such as Medicare, that you are enrolled in. Medicare administrative contractors (MAC), such as Noridian in California, obtain practice contact information from a practice’s Medicare enrollment application, from either the Internet-based Provider Enrollment, Chain and Ownership System (PECOS), or through a paper application. The MAC may contact ... March 17, 2015 Medicare Practice Resources, Medicare 0 0 Comment Read More »
CMA leaders converge on Capitol Hill to advocate for Medicare fix This week, 25 California Medical Association (CMA) physician leaders were in Washington, D.C., as part of the American Medical Association’s Legislative Week to urge Congress to enact the bipartisan, bicameral legislation that would repeal the Medicare sustainable growth rate (SGR) and institute a new payment system. The group also asked Congress to reauthorize the State Children’s Health Insurance Program, formerly known as Healthy Families, which is set to expire September 2015. Medicare SGR Last year, both houses of Congress were very close to a permanent repeal of the badly broken SGR ... March 2, 2015 Medicare Federal Legislation, Medicare, SGR, Advocacy, Sustainable Growth Rate 0 0 Comment Read More »
CMS extends meaningful use EHR attestation deadline to March 20 The Centers for Medicare and Medicaid Services (CMS) has extended the deadline for physicians to attest to meaningful use for the Medicare Electronic Health Record (EHR) Incentive Program 2014 reporting year. While the original deadline was February 28, physicians now have until 11:59 p.m., EST, on March 20, 2015, to attest. CMS extended the deadline to allow providers extra time to submit their meaningful use data, but urges providers to begin attesting for 2014 as soon as they can. This extension also allows eligible professionals, who have not already used their ... March 2, 2015 Medi-Cal, Medicare EHR, Meaningful Use, Medi-Cal, Medicare, PQRS, CMS 0 0 Comment Read More »
CMS to hold Medicare claims for first two weeks of January Last week the Centers for Medicare and Medicaid Services (CMS) announced it would hold claims for services paid under the 2015 Medicare physician fee schedule due to technical errors discovered after the new fee schedule was published. Medicare Administrative Contractors (MACs) will hold claims containing 2015 services for the first 14 calendar days of January 2015 (Thursday January 1 through Wednesday January 14) to allow time for CMS to correct the errors. The hold should have minimal impact on provider cash flow as, under current law, clean electronic claims are ... January 6, 2015 Medicare Medicare, Centers for Medicare and Medicaid Services 0 0 Comment Read More »
CMA creates new resource summarizing Medicare incentive and penalty programs Over the past few years, Congress has created a number of programs that call for payment incentives and reductions (referred to as “adjustments” by the Centers for Medicare and Medicaid Services) that impact physicians and their practices. At their inception, most of these programs offered an incentive to participate. However, most of the programs are entering their penalty phases, with complex and potentially conflicting requirements and implementation processes. To help physicians understand how these programs will affect their practices, the California Medical Association (CMA) has created a new resource, “Medicare ... December 18, 2014 Medicare Medicare, Incentive Programs 0 0 Comment Read More »
Congress passes a number of health care provisions in the current budget Congress narrowly passed a $1.1 trillion federal budget that will fund most of the federal government through September 2015. Below is a summary of key health care provisions in the bill. Within the bill, Congress expressed concern that there had not been adequate opportunity for public comment on bundling of surgical codes in the final rule of the Medicare Physician Fee Schedule. The budget bill says that the appropriate methodology has not been tested to ensure that patient care and patient access are not negatively impacted ... December 16, 2014 General, Medicare Advocacy, Federal Legislation, Medicare, Prescription Drugs, CDC, Ebola, Recovery Audit Contractor 0 0 Comment Read More »
Lame duck session of Congress adjourns, leaving SGR reform until 2015 In the final hours of the lame duck session, Congress passed a $1.01 trillion spending bill that will keep most of the federal government funded through next September, but it failed to pass a fix for the Medicare sustainable growth rate (SGR). Congress will leave it to be addressed before the April 1 deadline next year, when physicians will be faced with a 21 percent payment cut. Unfortunately, Congress will begin anew with many new members who have not been a part of the bipartisan, bicameral SGR Repeal and Medicare ... December 16, 2014 Medicare SGR, Sustainable Growth Rate, Medicare, U.S. Congress 0 0 Comment Read More »
Potential Medicare pay cuts coming in 2015; participation selections due Dec. 31 It's that time of year again – time for physicians to decide about their participation in Medicare. Physicians have until Dec. 31, 2014, to make changes to their status for 2015. In addition to the annual threat of steep payment cuts as a result of the sustainable growth rate (SGR) formula, another factor for physicians to consider is that 2015 will be the first year that the Centers for Medicare & Medicaid Services (CMS) will impose penalties under the value-based modifier (VBM) program for large medical groups of 100 ... December 16, 2014 Medicare , SGR, Sustainable Growth Rate, Medicare, Value-Based Payment Modifier 0 0 Comment Read More »
CMS announces new rules to curb Medicare fraud The Centers for Medicare and Medicaid Services (CMS) announced new rules will improve CMS’ ability to deny or revoke the enrollment of entities and individuals that pose a program integrity risk to Medicare. According to a press release, the “new safeguards are designed to prevent physicians and other providers with unpaid debt from re-entering Medicare and remove providers with patterns or practices of abusive billing." These changes are expected to save more than $327 million annually. CMS announced it has already removed nearly 25,000 providers from Medicare. Its strategy for ... December 16, 2014 Medicare CMS, Fraud and Abuse, Medicare, Centers for Medicare and Medicaid Services 0 0 Comment Read More »
