Archive for January, 2013

2013 Physician Quality Report System (PQRS)

Providers are reminded that Physician Quality Reporting program requirements and measure specifications for the current program year may be different from the Physician Quality Reporting program requirements and measure specifications for a prior year. Eligible professionals are responsible for ensuring that they are using the Physician Quality Reporting documents for the correct program year.

A full list of the 2013 PQRS codes is available in the Measures and Specifications Manual on the CMS PQRS ‘Measures Codes’ page under the ‘Related Links’ heading at the bottom of the page.  

Affordable Care Act Administrative Simplification Enforcement Delayed 90 Days

The Centers for Medicare & Medicaid Services (CMS) announced a discretionary enforcement delay of 90 days for the insurance eligibility request, response and claim status verification which is part of the operating rules for the HIPAA electronic standards effective January 1, 2013.

These are the first of several new administrative simplification operating rules and standards required by the Patient Protection and Affordable Care Act of 2010 (ACA). Under the new standards health plans will be required to provide, within 20 seconds of the request, patient co-pay and deductible information. Those health plans and clearinghouses that are ready to test these operating rules with their practice partners are listed on the CAQH CORE website.

Congress Passes One-Year SGR Fix

Congress passed The American Taxpayer Relief Act of 2012, to avert the “fiscal cliff.” President Obama is expected to sign the legislation shortly.

  • Prevents the Medicare physician payment SGR cut for one year. It eliminates the 27 percent Medicare physician payment cut, which took effect today and replaces it with a “zero percent update” to the Medicare physician fee schedule conversion factor for 2013.  This is not a fee schedule rate freeze. It means any conversion factor adjustments and RVU changes contained in the final fee schedule rule for 2013 may result in payment rate changes.
  • Turns off the January 2, 2013 sequester for two months. This prevents an across the board, two percent cut for all Medicare providers. It’s expected Congress will revisit issues related to the sequester in the near future.
  • Extends the Medicare 1.0 work RVU GPCI floor through December 31, 2013