PQRS administrative claims-based reporting deadline is October 15 Physicians who do not successfully participate in the Physician Quality Reporting System (PQRS) this year will be subject to PQRS payment penalties starting in 2015. PQRS is a Centers for Medicare and Medicaid Services (CMS) quality reporting program that uses a combination of incentive payments and payment adjustments to promote reporting of quality information by eligible professionals. Physicians who do not report on at least one individual measure in 2013 or elect to participate in the administrative claims reporting option will receive a 1.5 percent payment penalty in 2015. The penalty ... September 20, 2013 General Medicare, Physicians Quality Reporting System, PQRS, Centers for Medicare and Medicaid Services, Insurance/Reimbursement 0 0 Comment Read More »
Medicare transition to Noridian is just a week away! We are just one week away from the September 16 cutover date from Palmetto to the new Medicare Part B fee-for-service contractor, Noridian. Although efforts have been made to minimize the burden to practices and to ensure that physicians continue to receive their Medicare payments in a timely fashion after the transition, there are a number of things physicians should be aware of, including: Last day to submit to Palmetto: September 11, 2013 is the last day providers may submit electronic claims to Palmetto (2:00 p.m. cutoff time), and the ... September 10, 2013 Medicare Medicare, Medicare Transition, Noridian, Palmetto, Insurance/Reimbursement 0 0 Comment Read More »
Medicare transition is less than two weeks away September 16, 2013, is the cutover date for transition of the Medicare Part B fee-for-service contractor from Palmetto GBA to Noridian. Although efforts have been made to minimize the burden to practices and to ensure that physicians continue to receive their Medicare payments in a timely fashion after the transition, physician practices will have to make some changes in their processes, including but not limited to the following: •Electronic claim submitters must change the contractor ID (payor ID) on their transmissions. The new ID for the Northern California jurisdiction is ... September 3, 2013 Medicare Insurance/Reimbursement, Medicare Transition, Medicare, Noridian 0 0 Comment Read More »
Medicare transition is three weeks away September 16, 2013, is the cutover date for transition of the Medicare Part B fee-for-service contractor from Palmetto GBA to Noridian. Although every effort has been made to minimize the burden to practices and to ensure that physicians continue to receive their Medicare payments in a timely fashion after the transition, physician practices will have to make some changes in their processes. Practices are encouraged to review the resources available to you to ensure you are aware of and prepared for the transition. Physician practices that submit their claims electronically, ... August 26, 2013 Medicare Medicare, Medicare Transition, Noridian, Insurance/Reimbursement 0 0 Comment Read More »
DHCS to implement 10 percent Medi-Cal cuts in January 2014 The Department of Health Care Services (DHCS) today announced that it would begin to implement the 10 percent Medi-Cal physician payment rate reduction on October 1, 2013, for Medi-Cal managed care and on January 9, 2014, for fee for service. DHCS also announced that it would be retroactively implementing the cuts for FFS providers to June 1, 2011, when the law authorizing the cuts went into effect. DHCS said it will recoup a percentage of provider payments to recover overpaid funds during the retroactive period. These retroactive payment recoveries will ... August 15, 2013 Medi-Cal Advocacy, Insurance/Reimbursement, Medi-Cal, Access to Care 0 0 Comment Read More »
State delays duals pilot project until April 1 The California Department of Health Care Services (DHCS) announced today that it would delay by three months implementation of the state's "pilot project" to redesign care for Medicare/Medi-Cal dual eligibles. The program, called CalMediConnect, is now expected to begin no earlier than April 2014. The project was authorized by the Assembly in July 2012 in an effort to save money and better coordinate care for the state’s low-income seniors and persons with disabilities. The program begins with a three-year demonstration project that would see a large portion of the state's ... August 15, 2013 Managed Care, Medi-Cal, Medicare DHCS, Medi-Cal, Medicare, Dual Eligible, Insurance/Reimbursement 0 0 Comment Read More »
Anthem Blue Cross announces changes to reimbursement policies and claims software In late July, Anthem Blue Cross sent physicians a notice advising of upcoming changes to the insurer’s reimbursement policies and claims editing software called ClaimsXten. The changes will go into effect on November 1, 2013. Because of these changes, physicians may notice a difference in how certain codes and code pairs are adjudicated. Along with the notice, Anthem provided a comprehensive grid outlining all new, revised and existing reimbursement policies and claims editing rules as well as copies of Anthem’s reimbursement policies. Changes include: denial of 3D rendering CPT codes 76376 ... August 7, 2013 Managed Care Insurance/Reimbursement, Managed Care, Anthem Blue Cross 0 0 Comment Read More »
CMA urges CMS to postpone changes to QIO program The Centers for Medicare and Medicaid Services (CMS) recently called for public comments on how it can best organize the national cadre of Medicare Quality Improvement Organization (QIO) contractors. The mission of the QIO program is to improve the effectiveness, efficiency, economy and quality of services delivered to Medicare beneficiaries. Currently, CMS contracts with one organization in each state to serve as that state's QIO contractor. QIOs are private, mostly not-for-profit organizations, staffed by physicians and other health care professionals who are trained to review medical care, help beneficiaries with ... July 25, 2013 Medicare Centers for Medicare and Medicaid Services, Insurance/Reimbursement, Quality of Care, Medicare 0 0 Comment Read More »
House committee releases bipartisan Medicare SGR reform bill Three congressional committees have been hard at work over the past few months on legislation that would eliminate the desperately broken Medicare sustainable growth rate (SGR) formula that is used to determine physician payment rates. On Friday, the health subcommittee of the U.S. House of Representatives Energy and Commerce Committee's health subcommittee released its bill to repeal the SGR. One Tuesday the bill was approved by the subcommittee and now heads to the full committee for consideration. The House Ways and Means Committee and the Senate Finance Committee have ... July 25, 2013 Medicare Insurance/Reimbursement, Medicare, SGR, Advocacy, Sustainable Growth Rate 0 0 Comment Read More »
CMA publishes Medicare quality reporting guide The Medicare Physician Quality Reporting System (PQRS) is a reporting program that uses a combination of incentive payments and payment reductions to promote reporting of quality information by eligible professionals. Up until now, this program has been voluntary and physicians have received bonuses for participating. That's about to change. Failure to participate now means physicians could face significant penalties in 2015 and beyond. Find out more in CMA's new guide, "Getting Started with the Medicare Physician Quality Reporting System." The guide is avaialble to members only. Contact: CMA's reimbursement help line, (888) ... July 25, 2013 Medicare Insurance/Reimbursement, PQRS, Medicare, Physicians Quality Reporting System 0 0 Comment Read More »
