A new fast fact is now available on the MLN Provider Compliance web page. This web page provides the latest MLN Education Products and MLN Matters® Articles designed to help Medicare FFS providers understand common billing errors and avoid improper payments. Please bookmark this page and check back often as a new fast fact is added each month.
A new fast fact is now available on the MLN Provider Compliance web page. This web page provides the latest MLN Education Products and MLN Matters® Articles designed to help Medicare FFS providers understand common billing errors and avoid improper payments. Please bookmark this page and check back often as a new fast fact is added each month.
Effective May 1, 2013, the Centers for Medicare and Medicaid Services (CMS) will turn on the Phase 2 denial edits. This means that Medicare will deny claims for services or supplies that require an ordering/referring physician to be identified in the Medicare enrollment system, PECOS. If that physician is not identified, is not in Medicare's enrollment records, or is not of a specialty type that may order/refer the service/item being billed, he/she will not be paid.
As such, you are encouraged to enroll online, not by paper. Online is much faster. Make sure and read the directions thoroughly. There is an Electronic Fund Transfer (EFT), Form 588, that has to be mailed in by paper with an original signature, but you have to establish a bank account first. If you are receiving Medicare checks in the mail, this will stop and the funds will be electronically sent to the bank. Waiting too long to begin this process could mean that your enrollment application may not be processed prior to the May 1, 2013, implementation date. If this happens, your claims will be denied.
Over the last year, CMS has listened to your feedback about Internet-based PECOS and made improvements to increase access to more information. PECOS is easier to use than ever with the following upgrades that are now available: Providers/suppliers now have an easier way to view their enrollment information. PECOS will display the following information:
o View Approved Enrollment Record – displays the provider/supplier’s finalized enrollment information in PECOS,
o View Submitted Application – displays the provider/supplier’s enrollment information pertaining to the last electronic submission, and
o View New or In-Progress Applications – displays the provider/supplier’s enrollment information as its being edited in PECOS.
The provider/supplier can access the enrollment information from the My Enrollment page. The information will display in an HTML view and can be saved and/or printed by the provider/supplier. Note: The CMS-855 PDF forms are no longer available and have been replaced with the new HTML views. The enrollment tutorial videos, located on the PECOS home page, have been updated to illustrate the most common enrollment scenarios completed by providers/suppliers. A new part B provider service has been established for Centralized Flu Billers. In addition, the Centralized Flu Biller Approval letter has been added as a type of Required/Supporting documentation for a CMS 855B enrollment. Centralized Flu Biller enrollments submitted via PECOS will be routed to Novitas Solutions, the designated Medicare Administrative Contractor (MAC) responsible for enrolling this provider service. A new “Durable Medical Equipment (DME) License Information” topic has been added to PECOS. This topic will display the DME license information currently on file for existing suppliers. The information is viewable only and cannot be edited or deleted by the supplier.
New applications will not display the DME License Information topic. The Reassignment Report can now be found under the “View” button on the My Enrollments page in PECOS. The report displays the following information:
o Provider Name,
o National Provider identifier (NPI),
o Current Enrollment Status,
o Enrollment State,
o Revalidation Notice Sent Date, and
o Revalidation Status
The report displays up to 50 records on the report screen. For reassignment reports containing more than 50 records, the authorized user will be prompted to download the report into an excel spreadsheet by clicking the Generate Report button at the bottom of the screen.
To access internet-based PECOS, go to the PECOS website.
https://pecos.cms.hhs.gov/pecos/login.do
CMS has recently added three new and three updated FAQs related to the Medicare and Medicaid Electronic Health Record (EHR) Incentive Programs. I encourage you to stay informed by taking a few minutes to review the new information. To search and access more FAQs related to the EHR Incentive Programs, please use the CMS FAQ System: https://questions.cms.gov/
New FAQs:
1. If an eligible professional (EP) practices at an outpatient location, a location other than an inpatient (place of service 21) or emergency department (place of service 23), and that location is only equipped with Certified EHR Technology to the criteria applicable to an inpatient setting, must the EP include that location in their meaningful use calculations? Read the answer here. https://questions.cms.gov/faq.php?faqId=7811
2. If an EP practices at an outpatient location that has not implemented all the functionalities necessary to meet meaningful use, is that location considered equipped with Certified EHR Technology? Must that location be included in the EP's meaningful use calculations? Does it matter if the location possesses ambulatory Certified EHR Technology covering the relevant meaningful use objectives, but does not implement them? Read the answer here. https://questions.cms.gov/faq.php?faqId=7813
3. When combining meaningful use data from multiple locations equipped with Certified EHR Technology, is it required to have a full meaningful use report from each location or is it acceptable to only collect denominator information from one or more locations? Read the answer here. https://questions.cms.gov/faq.php?faqId=7815
Updated FAQs:
1. How and when will incentive payments for the Medicare EHR Incentive Programs be made? Read the answer here. https://questions.cms.gov/faq.php?faqId=2899
2. If multiple EPs or eligible hospitals contribute information to a shared portal or to a patient's online personal health record (PHR), how is it counted for meaningful use when the patient accesses the information on the portal or PHR? Read the answer here. https://questions.cms.gov/faq.php?faqId=7735
3. If I participated in the Medicaid EHR Incentive Progra m last year, am I required to participate in the following year? Read the answer here. https://questions.cms.gov/faq.php?faqId=7737
Want more information about the EHR Incentive Programs? Make sure to visit the Medicare and Medicaid EHR Incentive Programs website for the latest news and updates on the EHR Incentive Programs https://www.cms.gov/Regulations-and-guidance/Legislation/EHRIncentivePrograms/index.html?redirect=/ehrincentiveprograms/
CMS has several updates related to the Electronic Health Record (EHR) Incentive Programs.
February 28 Deadline
Eligible professionals (EPs) who participated in the Medicare Electronic Health Record (EHR) Incentive Program in 2012 must complete attestation for the 2012 program year by February 28, 2013. CMS has several resources located on the Educational Resources web page of the EHR Incentive Programs website to help you properly meet meaningful use and attest. Register and attest today.
Medicaid EPs should check with their State for their attestation deadline.
Electronic Reporting Pilot Deadline
If you selected the electronic reporting pilot option for your submission of clinical quality measures (CQMs) for the EHR Incentive Program (for the 2012 reporting year), you must submit 12 months of CQM data using a PQRS-qualified EHR system or data submission vendor. Failure to submit your CQMs electronically by 11:59pm ET on February 28 will result in your attestation being rejected for the 2012 program year. If you are unable to continue or determine that you no longer wish to participate in the electronic reporting pilot, you may opt out by:
1. Returning to your EHR Incentive Program registration
2. Changing your selection to “No” on the “e-Reporting” screen for CQMs
3. Entering your CQM data into the portal as part of your meaningful use attestation
The Stage 2 rule for the Electronic Health Record (EHR) Incentive Programs included changes to the Stage 1 meaningful use objectives, measures, and exclusions for eligible professionals (EPs), eligible hospitals, and critical access hospitals (CAHs). Some of these Stage 1 changes took effect on October 1, 2012, for eligible hospitals and CAHs, or January 1, 2013, for EPs. Several are optional, but others are required, this according to the American Institute of Healthcare Compliance (AIHC).
Stage 1 Changes and Timing:
Computerized Physician Order Entry (CPOE)
Change: Addition of an alternative measure based on the total number of medication orders created during the EHR reporting period
Timing: 2013 and onward
Change: Revised the description of who can enter orders into the EHR and have it count as CPOE
Timing: 2013 and onward (regardless of what stage of meaningful use the provider is attesting to)
Electronic Prescribing
Change: Additional exclusion to the objective for electronic prescribing for providers who are not within a 10 mile radius of a pharmacy that accepts electronic prescriptions
Timing: 2013 and onward
Record and Chart Changes in Vital Signs
Change: Age limit increased for recording blood pressure in patients from ages 2 to ages 3; no age limit for height and weight
Timing: Optional in 2013; required starting in 2014
Change: Exclusion if the EP sees no patients 3 years or older, if all three vital signs are not relevant to their scope of practice, if height and weight are not relevant to their scope of practice, or if blood pressure is not relevant to their scope of practice
Timing: Optional in 2013; required starting in 2014
Public Health Reporting Objectives
Change: Require that providers perform at least one test of their certified EHR technology's capability to send data to public health agencies, except where prohibited
Timing: Required in 2013 and onward (for all Stage 1 public health objectives)
Electronic Exchange of Key Clinical Information
Change: Objective for electronic exchange of key clinical information no longer required for Stage 1 for EPs, eligible hospitals, and CAHs
Timing: No longer required in 2013 and onward
For more details about each of these changes review the CMS Stage 1 Changes Tipsheet.
Physicians furnishing services to Medicare beneficiaries in areas designated as of December 31, 2012 by the Health Resources and Services Administration (HRSA) as primary care geographic Health Professional Shortage Areas (HPSAs) are eligible for a ten percent bonus payment for services furnished from January 1, 2013, to December 31, 2013. If an area does not have a geographic primary care HPSA designation, but does have a geographic mental health HPSA designation, then only psychiatrists furnishing services to Medicare beneficiaries in the designated area are eligible for the ten percent bonus.
It is the responsibility of the physician to determine if a service is furnished in a geographic HPSA. Eligibility is determined annually based on the status of the designation as of December 31 of the prior year.
o A physician or provider that was eligible for the ten percent bonus in 2012 may not be eligible for the bonus in 2013.
o A physician or provider that was not eligible for the ten percent bonus in 2011 may be eligible for the bonus in 2012. Information on designated areas is available from HRSA.
The following websites may be helpful in determining if an area is a geographic primary care or mental health HPSA:
CMS publishes annually a list of ZIP codes for which the ten percent bonus is paid automatically. Only areas where the entire ZIP code falls within the designated area at the time the list is developed are listed.
o Physicians and providers furnishing services in eligible areas that are not on the CMS list of ZIP codes for automatic payment of the bonus must use the AQ modifier to receive the bonus. Only physicians furnishing services in areas designated as of December 31, 2012 as a geographic primary care HPSA whose ZIP code is not on the list should use the modifier.
o Only psychiatrists furnishing services in areas that are not designated as a primary care HPSA as of December 31, 2012 but are designated as a geographic mental health HPSA should use the modifier if the ZIP code is not on the list for automatic payment.
Information on the Medicare Physician bonus program, including the list of ZIP codes eligible for automatic payment of the bonus, can be found on the Physician Bonuses website.
Twenty-thousand physicians in four Midwest states received a glimpse into their financial future this past March. Landing in their e-mail inboxes were links to reports from Medicare showing the amount their patients cost on average as well as the quality of the care they provided. The reports also showed how Medicare spending on each doctor’s patients compared with their peers in Kansas, Iowa, Missouri and Nebraska.
The “Quality and Resource Use” reports, which Medicare plans to eventually provide to doctors nationwide, are one of the most visible phases of the government’s effort to figure out how to enact a complex, delicate and little-noticed provision of the 2010 health-care law: paying more to doctors who provide quality care at lower cost to Medicare, and reducing payments to physicians who run up Medicare’s costs without better results.
According to CMS, making providers routinely pay attention to cost and quality is widely viewed as crucial if the country is going to rein in its health-care spending, which amounts to more than $2.5 trillion a year. It’s also key to keeping Medicare solvent. Efforts have begun to change the way Medicare pays hospitals, doctors and other providers who agree to work together in new alliances known as “accountable care organizations.” This fall, the federal health program for 47 million seniors and disabled people also is adjusting hospital payments based on quality of care, and it plans to take cost into account as early as next year.
But applying these same precepts to physicians is much more difficult - physicians see far fewer patients than do hospitals, so making statistically accurate assessments of doctors’ care is much harder. Comparing specialists is tricky, since some focus on particular kinds of patients that tend to be more costly.
“It may be the most difficult measurement challenge in the whole world of value-based purchasing,” said Dr. Donald Berwick, former administrator of the federal Centers for Medicare and Medicaid Services, or CMS. “We do have to be cautious in this case. It could lead to levels of gaming and misunderstanding and incorrect signals to physicians that might not be best for everyone.”
