Noridian sends out another wave of Medicare revalidation requests As called for under the Affordable Care Act (ACA), Medicare Administrative Contractors (MACs) have been requiring physicians to revalidate their Medicare enrollments. Between now and March 23, 2015, MACs will continue reaching out to physicians, notifying them of the need to revalidate. The most recent round of revalidations requests went out by December 30, 2013. The revalidation requirement is necessitated by new screening criteria called for under the ACA. Newly enrolling and revalidating providers will be placed in one of three screening categories representing the level of risk to the ... February 7, 2014 Medicare Affordable Care Act, Medicare, Noridian, PECOS, ACA, Provider Enrollment Chain and Ownership System 0 0 Comment Read More »
Did you know you can request reconsideration if you're getting dinged with a 2% Medicare eRx penalty? Physicians and group practices who were not successful electronic prescribers under the 2012 or 2013 Medicare eRx Incentive Program will be subject to a negative payment adjustment of 2 percent in 2014 on all Medicare Part B claims paid under the physician fee schedule. The Centers for Medicare and Medicaid Services (CMS) has notified physicians and group practices that did not meet the requirements and will be subject to the 2014 payment adjustment. Some practices have reported that their meaningful use attestation was not taken into consideration as an exemption. ... February 5, 2014 General Health Information Technology, Insurance/Reimbursement, E-Prescribing, Medicare 0 0 Comment Read More »
Making sense of Medicare payment changes With the new 2014 fee schedule, the temporary halt to the sustainable growth rate (SGR) cut and an interim .5 percent payment increase, Medicare physicians are understandably confused about what impact these changes will have on their practices. Below is a quick summary of the various Medicare payment changes facing physicians in 2014: 2014 Fee Schedule: While the 2014 Medicare fee schedule contains a 3.7 percent conversion factor increase, the overall fee schedule is budget neutral due to myriad relative value unit (RVU) changes. These changes will impact providers differently ... January 14, 2014 Medicare Medicare, Insurance/Reimbursement 0 0 Comment Read More »
Duals demonstration project delayed in three counties The California Department of Health Care Services (DHCS) has delayed passive enrollment for three of the eight counties affected by the state's "pilot project" to redesign care for Medicare/Medi-Cal dual eligibles. The project in these three counties—Alameda, Santa Clara and Los Angeles—will begin instead with a voluntary period, during which patients can choose early enrollment with a Medi-Cal managed care plan, or wait until the automatic passive enrollment period, which will begin no earlier than July 1, 2014. The project—known as Cal MediConnect—was authorized by the state in July 2012 ... December 16, 2013 Managed Care Dual Eligible, Insurance/Reimbursement, Medicare, Medi-Cal 0 0 Comment Read More »
House passes budget with three month SGR patch The U.S. House of Representatives today passed a bipartisan two-year budget deal that includes a three-month patch that will stop the 24 percent Medicare physician payment cut that would otherwise take effect January 1, 2014—and replace it with a 0.5 percent payment raise—which will give lawmakers a little more time to finalize the long-term Medicare payment reforms currently making their way through Congress. The budget now goes to the U.S. Senate, which is expected to approve the measure next week. December 13, 2013 Medicare Advocacy, SGR, Sustainable Growth Rate, Medicare 0 0 Comment Read More »
2014 Medicare fee schedule confirms 24 percent cut Demonstrating yet again how broken the Medicare sustainable growth rate (SGR) formula is, physicians will face a 24 percent Medicare payment cut next year if Congress does not seize the opportunity to put a stop to the formula's annual threat of drastic payment cuts. This figure was confirmed by the Centers for Medicare and Medicaid Services (CMS) last week, when the agency released its final physician fee schedule for 2014. The California Medical Association (CMA) is currently reviewing the final rule, which was released much later than usual because of ... December 3, 2013 Medicare Medicare, SGR, Sustainable Growth Rate, Advocacy, Insurance/Reimbursement 0 0 Comment Read More »
Both houses of Congress working together in an unprecedented collaboration to repeal SGR http:///On Thursday, the Senate Finance Committee and the House Ways and Means Committee released an unprecedented bipartisan and bicameral “discussion draft” proposal that would fully repeal the flawed Medicare Sustainable Growth Rate (SGR) formula. The draft legislation would not provide automatic payment increases for 10 years. However, starting in 2016 physicians can choose to participate in new payment models (such as medical homes) and qualify for 5 percent annual bonuses. In 2017 and beyond, physicians remaining in the fee-for-service program can participate in a new “value-based performance payment program,” which ... November 5, 2013 Medicare Insurance/Reimbursement, Medicare, SGR, Sustainable Growth Rate, Advocacy 0 0 Comment Read More »
CMA part of national effort to urge House leadership to act on Medicare SGR payment overhaul before the year ends The California Medical Association (CMA) is part of a national multi-state, multi-specialty effort headed by the American Medical Association to keep bipartisan momentum going to address Medicare fee-for-service sustainable growth rate (SGR) reform. CMA has asked the California congressional delegation to sign a letter to House Speaker John Boehner and House Minority Leader Nancy Pelosi urging them to make it a priority to reform the Medicare physician payment system before the end of the year. The joint letter is being circulated in Congress by Rep. Bill Flores (R-TX) and ... October 28, 2013 Medicare Insurance/Reimbursement, Medicare, SGR, Sustainable Growth Rate, Advocacy 0 0 Comment Read More »
Government shutdown to have minimal impact on Medicare and TRICARE programs With the October 1 shutdown of the federal government, the California Medical Association (CMA) has received calls from physicians with questions about how federally funded programs like Medicare and TRICARE will be affected. TRICARE On October 1, 2013, the Defense Health Agency issued a statement regarding TRICARE programs, indicating that there will be minimal impact to TRICARE beneficiaries utilizing private sector physicians. CMA has also confirmed with United Healthcare Military & Veterans Services, the managed care support contractor for the TRICARE West Region, that there should be no interruption in operations ... October 4, 2013 General Medicare, TRICARE, Insurance/Reimbursement 0 0 Comment Read More »
Medicare and Medi-Cal continue to operate despite government shutdown; FDA, CDC, and NIH are impacted A stalemate in Congress over a spending plan for the 2013-2014 fiscal year and a delay in the Affordable Care Act (ACA), has forced a federal shutdown at midnight last night, closing many federal agencies, including a number of departments under the U.S. Department of Health and Human Services (HHS). The new fiscal year began today, October 1. The House Republicans are proposing to continue spending at current levels with a one year delay in the implementation of the ACA. While the Senate Democrats have also agreed to continue ... October 2, 2013 General Medi-Cal, Medicare, Government, Insurance/Reimbursement 0 0 Comment Read More »
