By Ann M Brunk CPC CMRS on February 17, 2012
Today, the U.S. House of Representatives and the U.S. Senate passed a 10-month measure that will prevent a 27.4% payment cut, due to the flawed Sustainable Growth Rate (SGR) portion of the fee schedule, to Medicare providers scheduled for March 1. The measure extends the Geographic Practice Cost Index (GPCI) at the current level, and includes a 10 month extension of the therapy cap exceptions process that will begin to create a path to a reformed therapy payment system. The exceptions process will be under the following new provisions:
- Modifier - Mandates consistent use of the KX modifier at the cap ($1880 for 2012)
- Manual Medical Review - Starting on October 1, 2012 patients who meet or exceed $3,700 in therapy expenditures will be subject to a manual medical review. The legislation designates that this medical review will be similar to the process used following Deficit Reduction Act (DRA) implementation in 2006. The $3,700 threshold will be applied to the combined PT/Speech cap and a separate $3,700 threshold will be applied to the OT cap.
- NPI – Starting October 1, 2012, each request for payment must include the national provider identifier of the physician who currently periodically reviews the plan of care.
- Temporary Application of the Therapy Cap to Outpatient Hospital Settings – The therapy cap (with exceptions) will temporarily be applied to hospital outpatient departments beginning no later than October 1, 2012. This provision will sunset at the end of 2012 unless Congress extends it into 2013.
- MedPAC – Not later than June 15, 2013, MedPAC shall submit to the House Energy and Commerce Committee, House Ways and Means Committee and the Senate Finance Committee a report on how to improve the outpatient therapy benefit. The report will include recommendations on how to reform the payment system so that the benefit is better designed to reflect individual acuity, condition and therapy needs of the patient. The report will examine private sector initiatives relating to outpatient therapy benefits.
- Data Collection – Beginning January 1, 2013, the Secretary shall implement a claims based data collection strategy that is designed to assist in reforming the Medicare payment system for outpatient therapy. The system will be designed to provide for the collection of data on patient function during the course of therapy services in order to better understand patient condition and outcomes. In proposing and implementing such a strategy, the Secretary will consult with relevant stakeholders.
GAO Report on Manual Medical Review- Not later than May 1, 2013, the Comptroller General shall issue a report to the House Committee on Energy and Commerce, the House Ways and Means Committee and the Senate Finance Committee on the implementation of the manual medical review process. The report shall include data on the number of individuals and claims subject to the process, the number of reviews conducted and the outcome of the reviews
Posted in News | Tagged CMS, Congress, Medicare, Medicare Reimbursement, Physical Therapy |
By Ann M Brunk CPC CMRS on December 21, 2011
January 1, 2012 means deductibles start over again for many health insurance policies including Medicare.
The 2012 Medicare Part B deductible will be $140.00.
Medicare Part B beneficiaries who do not have a supplemental plan may be responsible for 20% of the Medicare approved amount for services after meeting their deductible.
Posted in Did You Know, News | Tagged Medical Billing, Medicare |
By Ann M Brunk CPC CMRS on November 28, 2011
Aetna’s Behavioral Health network is now open in Colorado’s Larimer and Weld counties. To become a provider with Aetna go to Aetna’s Provider Enrollment page (click this link) and complete the Application Request.
Posted in Did You Know | Tagged Aetna, Behavioral Health, Mental Health |
By Ann M Brunk CPC CMRS on November 4, 2011
More than 1 million providers of health services to Medicare patients are paid under the Medicare Physcian Fee Schedule (MPFS). Without intervention from Congress the MPFS will experience a 27.4% reduction in 2012.
Under current law, providers will face steep across-the-board reductions in payment rates, based on a formula– the Sustainable Growth Rate (SGR) – that was adopted in the Balanced Budget Act of 1997. Without a change in the law from Congress, Medicare payment rates to providers paid under the MPFS will be reduced by 27.4 percent for services in 2012—less than the 29.5 percent reduction that CMS had estimated in March of this year because Medicare cost growth has been lower than expected. This is the eleventh time the SGR formula has resulted in a payment cut, although the cuts have been averted through legislation in all but 2002.
More information can be found at: http://www.cms.gov/apps/media/press/factsheet.asp?Counter=4155
Posted in News | Tagged CMS, Medicare, Medicare Reimbursement, MPFS, SGR |
By Ann M Brunk CPC CMRS on October 21, 2011
Providers have only ten days remaining to request a hardship exemption for the 2012 electronic prescribing (eRx) payment adjustment.
Eligible professionals (EPs) who have not met eRx Incentive Program requirements (and who are not exempt) will incur a 1 percent payment reduction to their allowable Medicare Part B charges beginning Jan. 1, 2012.
To determine if you are subject to the 2012 eRx payment adjustment, review Medicare Learning Network (MLN®) Special Edition article SE1107. If you are, the next step is to determine if you meet any of the hardship exemption categories specified by the Centers for Medicare & Medicaid Services (CMS) in the 2011 Medicare Electronic Prescribing (eRx) Incentive Program final rule. Review the regulations to be certain.
Posted in News | Tagged CMS, eRX, Health Care Reform, Medicare Reimbursement |
By Ann M Brunk CPC CMRS on October 21, 2011
- under the Affordable Care Act of 2010 all Medicare payments must be electronic by January 1, 2014.
- If you’re not currently receiving EFT payments from Medicare you’ll be required to complete and submit the CMS 588 EFT form to start receiving them.
- accepting EFT payments from health insurers can save you thousands of dollars annually and speed up payment? The AMA offers an “Electronic Funds Transfer (EFT) Toolkit” to assist you with signing up for EFT payments. For more information visit: ama-assn.org/go/eft
Posted in News | Tagged AMA, CMS, EFT |
By Ann M Brunk CPC CMRS on February 24, 2011
You’ve just learned that one of the insurance carriers overpaid a claim – what should you do? The law is specific on how these funds should be handled.
The Fraud Enforcement and Recovery Act (FERA) which passed in 2009 clearly states that any person who knowingly conceals or knowingly and improperly avoids an “obligation to pay” would be liable under the False Claims Act’s reverse false claims provisions.
Changes to the False Claims Act were also subsequently covered in the Health Care Reform bill passed in March 2010. Importantly, the Health Care Reform Act defines “overpayments” as “any funds that a person receives or retains” under Medicare or Medicaid, to which they are not entitled. But don’t be fooled – this applies to all insurance carriers, not just Medicare and Medicaid.
The Health Care Reform Act further provides that all overpayments must be reported and refunded within 60 days of being identified.
The legislation made it clear that an overpayment retained by a person after the deadline for reporting and returning the overpayment is an “obligation” for purposes of the False Claims Act.
Are you aware of overpayments? Have you and/or your billing company notified the carrier? Remember when/if an overpayment is identified it must be repaid within 60 days or the provider may be liable under the False Claims Act.
Posted in News | Tagged False Claims Act, FERA, Health Care Reform, Medicare, Medicare Reimbursement, Overpayments |
By Ann M Brunk CPC CMRS on November 29, 2010
Today, November 29, 2010, the House, by voice vote, approved the bill passed by the Senate earlier this month, postponing a 23 percent cut in Medicare reimbursements scheduled to take effect Dec. 1, 2010.
”This bill is a stopgap measure to make sure that seniors and military families can continue to see their doctors during December while we work on the solution for the next year,” said Rep. Frank Pallone, R-N.J., chairman of the Energy and Commerce health subcommittee.
Health care payment formulas for military service members and veterans are tied to Medicare. The payment cuts are the result of a 1990s budget balancing law to keep Medicare spending in line.
With medical groups estimating that as many as two-thirds of doctors would stop taking new Medicare patients if the cuts go into effect, Congress has had to periodically step in to stop the automatic cuts. Senate Finance Committee Chairman Max Baucus, D-Mont., and the panel’s top Republican, Charles Grassley of Iowa, say they are working on a 12-month postponement that would give them time to devise a new system for paying doctors.
It is estimated that repeal of the current budget formula would cost $300 billion over 10 years that would have to be made up with other spending cuts or added to the deficit.
Posted in News | Tagged Medicare, Medicare Reimbursement |
By Ann M Brunk CPC CMRS on November 21, 2010
Senate Finance Committee moved through a one month “doc fix” on Thursday, November 18, 2010. This “fix” will be paid for by cuts to payments for therapy serivces. The House still needs to act before November 30th and if they don’t we will incur a 23 percent cut in Medicare payments under the Sustainable Growth Rate (SGR) formula on December 1, 2010.
If enacted, this will be the fourth short term patch this year and should Congress choose not to act in December 2010 we will incur a 25% cut beginning on January 1, 2011.
Posted in News | Tagged Medical Billing, Medicare |
By Ann M Brunk CPC CMRS on September 9, 2010
Updated ICD-9 Codes go into effect October 1, 2010. Claims submitted after this date with invalid codes will not be processed by carriers.
This may also be the time to start reviewing the changes we’ll encounter with ICD-10 implementation in 2013. It’s never too early to start reviewing the impact of these new codes.
Need more information on 2011 ICD-9 code changes, or the upcoming ICD-10 codes? Contact HBS and let us help.
Posted in News | Tagged claims processing, icd-10 codes, icd-9 codes |
