CMS to publicly release Medicare physician payment data The Centers for Medicare and Medicaid Services (CMS) announced yesterday that it would soon begin publishing individual Medicare physician billing data, despite objections from the American Medical Association (AMA) and other provider groups. CMS intends to publicly post the data as early as April 9. The release will cover some $77 billion worth of Medicare Part B payments made to physicians in 2012 and will include physicians’ provider IDs, their charges, their patient volumes and what they received in reimbursements from Medicare. Individual patient level data will not be released. ... April 9, 2014 Medicare CMS, Medicare, Centers for Medicare and Medicaid Services 0 0 Comment Read More »
Congress passes California Medicare GPCI fix After 10 long years of lobbying efforts by the California Medical Association (CMA), Congress has finally passed a bill to update California's outdated Medicare localities. The long overdue fix will update California’s Medicare physician payment regions to the same Metropolitan Statistical Areas (MSA) used to pay hospitals and raise payment levels for urban counties misclassified as rural, while holding remaining rural counties harmless from cuts. The MSAs used to determine payment rates for hospitals are continuously updated, so that reimbursement accurately reflects local costs to deliver care. The physician payment ... April 4, 2014 Medicare Rural Health, Geographic Practice Cost Index, GPCI, Medicare 0 0 Comment Read More »
SGR patched through for another year Today, the U.S. Senate passed a year-long patch to stop the 24 percent Medicare sustainable growth rate (SGR) cut that was to go into effect on April 1. The bill, which already passed the U.S. House of Representatives last week, provides a 0.5 percent physician payment update through December 31, 2014, and then a 0 percent update until April 1, 2015. The bill now goes to President Obama for his signature. Congress was again unable to come to an agreement on how to fund a permanent repeal of the badly ... April 4, 2014 Medicare Federal Legislative Advocacy, Medicare, SGR, Sustainable Growth Rate 0 0 Comment Read More »
House passes year-long SGR patch, includes California GPCI fix This morning the U.S. House of Representatives passed a year-long patch to stop the Medicare 24 percent sustainable growth rate (SGR) cut on an unusual 30-second voice vote. Unable to come to an agreement on how to fund a permanent repeal of the badly broken formula, despite a bill with bipartisan, bicameral support, Congress appears poised to kick the can down the road for the 17th time in just 10 years. The California Medical Association (CMA) is extremely disappointed that Congress has been unable to find bipartisan funding sources ... March 27, 2014 Medicare Advocacy, GPCI, Medicare, SGR, Federal Legislation 0 0 Comment Read More »
CMS suspends RAC audits, sets up physician safeguards Physicians and hospitals will get a short reprieve from Medicare’s recovery audit contractors (RAC) until next fall, according to the Centers for Medicare & Medicaid Services (CMS). The agency says it is temporarily halting audits as it reevaluates its contracts and implements improvements for physicians. The RAC program is responsible for identifying fraud and waste in the Medicare system by detecting improper Medicare payments. Last month, CMS announced it would pause any new additional document requests (ADR) from RACs until new contracts are settled, in order to reduce provider confusion ... March 19, 2014 Medicare Medicare, RAC, Recovery Audit Contractor, Insurance/Reimbursement 0 0 Comment Read More »
Medicare ICD-10 front-end testing week extended Due to the success of the first week of ICD-10 testing, Noridian has partnered with Centers for Medicare & Medicaid Services (CMS) to continue acceptance testing for EDI submitters and vendors for an indefinite period. The purpose of acceptance testing is to ensure that base system functionality and front end editing have been updated for ICD-10 and are functioning correctly. Acceptance testing will help ensure you are ready for the October 2014 implementation of ICD-10. The California Medical Association (CMA) encourages all direct EDI submitters and vendors to test with Noridian. ... March 19, 2014 Medicare ICD-10, Medicare, Insurance/Reimbursement, Noridian 0 0 Comment Read More »
House-passed SGR repeal with mandate penalty delay is DOA In a 238-181 vote, the U.S. House of Representatives today passed HR 4015, a bill to repeal the Medicare sustainable growth rate (SGR) and put in place a replacement payment system with an amendment offered by House Republican leaders that would pay for the repeal through a five-year delay of the Affordable Care act's individual mandate penalty. Though cheered by House Republicans, the legislation is viewed as "dead on arrival" by policy analysts and health care providers, as its defeat in the U.S. Senate is a near certainty. The move ... March 17, 2014 Medicare Insurance/Reimbursement, Advocacy, Medicare 0 0 Comment Read More »
Practices required to use new CMS 1500 claim form beginning April 1 Earlier this year, the White House Office of Management and Budget (OMB) approved the revised Centers for Medicare & Medicaid Services (CMS) 1500 claim form (version 02/12 OMB control number 0938-1197). The CMS 1500 claim form is the required format for submitting paper claims to Medicare. As of April 1, 2014, CMS will no longer accept paper claims on the old form. Until then, CMS is accepting both the old and new forms. The revised form adds the following functionality: Indicators for differentiating between ICD-9 and ICD-10 ... March 12, 2014 Medicare Billing/Coding, Medicare, Practice Management, Insurance/Reimbursement 0 0 Comment Read More »
Physicians: Call Congress Now RE Medicare SGR Repeal and Payment Reform Medicare SGR Repeal and Payment Reform: HR 4015/S 2000 DON'T PATCH IT, REPEAL IT! Physicians: Call Congress Now! (800) 833-6354 (Takes 2 minutes). Reform won't happen unless Congress hears from thousands of physicians! Click here to learn more. March 12, 2014 Medicare SGR, Sustainable Growth Rate, Medicare 0 0 Comment Read More »
Another delay for the Cal MediConnect project for dual eligibles The California Department of Health Care Services (DHCS) recently announced yet another delay for the Cal MediConnect project for dual eligibles. Implementation in Orange County has been delayed indefinitely, following a Centers for Medicare and Medicaid Services (CMS) audit of CalOptima—which is the county's only Medi-Cal managed care plan. The audit uncovered a number of serious issues that must be resolved before the duals transition can move forward in Orange County. Previously, Orange County was scheduled to begin passive enrollment on April 1, 2014. According to DHCS, implementation of Cal ... February 12, 2014 Medi-Cal, Medicare Medi-Cal, Medicare, Dual Eligible, Insurance/Reimbursement 0 0 Comment Read More »
