Sustainable Growth Rate Fix….Maybe?

After a permanent repeal of the sustainable growth rate (SGR) formula passed the House of Representatives in late March, the measure’s backers in the Senate worked to quell a potential revolt from Senate conservatives over its initial $214 billion price tag.

Senate Majority Leader Mitch McConnell (R-Ky.) says he expects the Senate will permanently repeal the SGR this week to prevent automatic cuts in Medicare payments to doctors that will take effect April 15 absent a fix. But senators on both sides of the aisle call for more scrutiny and further amendments to the bill.

Despite the successful passage of the bill in the House, healthcare experts say the measure doesn’t provide enough specifics. For example, the legislation does not establish which care quality metrics Medicare will be use to determine payments in lieu of the SGR.

Medicare Physician Fee Schedule

The negative update of 21% under current law for the Medicare Physician Fee Schedule is scheduled to take effect on April 1, 2015.  Medicare Physician Fee Schedule claims for services rendered on or before March 31, 2015, are unaffected by the payment cut and will be processed and paid under normal procedures and time frames.  The Administration urges Congress to take action to ensure these cuts do not take effect.  However, until that happens, CMS must take steps to implement the negative update.  Under current law, electronic claims are not paid sooner than 14 calendar days (29 days for paper claims) after the date of receipt.  CMS will notify you on or before April 11, 2015, with more information about the status of Congressional action to avert the negative update and next steps.

Radiology Providers: Identical Services on the Same Claim

Palmetto GBA would like to remind providers of the importance of the correct use of modifiers when filing claims to Medicare.  Research has revealed that a number of radiology claims contained incorrect usage of CPT modifiers when billing for identical services on the same claim.  In the near future, we will begin to monitor these claims through our Palmetto GBA Advanced Clinical Editing (P-ACE) system. Providers who have claims submissions that meet this criteria will receive a ‘Smart Edit’ on your claims acknowledgement transaction report (277CA) signifying the need for correction and resubmission of your claim.

Applies to:
Jurisdiction 11 Part B//General
Jurisdiction 11 Part B//Radiology

ICD-10 Implementation Not Delayed

Congress has NOT voted on a delay of ICD-10 implementation. House Chairmen Upton, Sessions Statement on ICD-10 is as follows:

WASHINGTON, DC – House Energy and Commerce Committee Chairman Fred Upton (R-MI) and House Rules Committee Chairman Pete Sessions (R-TX) issued the following statement on the implementation of ICD-10, the most recent coding system to be used by health care providers for reimbursement and other functions. The Energy and Commerce Committee has been working with CMS to ensure the October 1, 2015, implementation is achieved and is prepared to have a hearing on the issue in the New Year.

MPM Has A New Chief Operations Officer

Susan D. Jones has been named Chief Operations Officer for Medical Practice Management.  Susan started at MPM over 20 years ago as the Director of Training.  Susan’s work in training has led to her involvement in all aspects of MPM’s CARE system.  Most recently she has served as the Regional Manager for the Southeast Division.   Her extensive industry and system knowledge gives her the unique ability to work with our IT staff to continually improve our billing software and streamline our processes.   Susan has a degree in Industrial Engineering from North Carolina State University and an MBA from the University of Richmond.

HIPAA Deadline: Update Business Associate Agreements

Business associate agreements that have not already been updated as required by the HIPAA Omnibus Rule should be updated by September 22, 2014.

The Omnibus Rule changed and added mandatory language for  business associate contracts. The compliance date for the HIPAA Omnibus Rule had been September 23, 2013. Recognizing the burden on the industry in amending or entering into new business associate agreements, the Department of Health and Human Services permitted an additional year to update certain business associate agreements.

Immediate Action Needed To Avoid Automatic Medicare Payment Reductions

The deadline for groups to register to participate in the 2014 Physician Quality Reporting System (PQRS) Group Practice Reporting Option (GPRO) is September 30, 2014, 11:59 p.m. ET. Groups with 10 or more eligible professionals can avoid the automatic negative two percent (-2.0%) Value Modifier payment adjustment in CY 2016 by participating in the PQRS GPRO in CY 2014 and meeting the satisfactory reporting criteria to avoid the CY 2016 PQRS payment adjustment.

Deadline For ICD-10 Allows Health Care Industry Ample Time To Prepare For Change

On July 31, HHS issued a rule finalizing October 1, 2015 as the new compliance date for health care providers, health plans, and health care clearinghouses to transition to ICD-10. This deadline allows providers, insurance companies, and others in the health care industry time to ramp up their operations to ensure their systems and business processes are ready to go on October 1, 2015.

Meaningful Use Proposed Rule – NPRM Extends Stage 2 & Certification

The Centers for Medicare & Medicaid Services and the Office of the National Coordinator for Health Information Technology released a notice of proposed rulemaking (NPRM) that would extend electronic health record (EHR) meaningful use (MU) attestation requirements for physicians to qualify for Medicare incentive payments. The proposed rule, which must still be finalized, extends Stage 2 through 2016 and would allow EHR adopters still on 2011 certified systems to attest in 2014. The proposed rule indicates that the Agencies are aware of the burdens on physicians to meet compliance and are responding to the outcry from the medical community. The final rule is anticipated in early fall.

Payments Provided by “Credit Card” numbers from Health Plans

Some health plans providing payment via credit card numbers are requiring the practices to pay associated administrative fees.  As a reminder, health plans must provide EFT payments using the national standards whenever a provider requests it.  In addition, health plans are not permitted to delay or reject transactions that follow the standard format, incentivize a provider to use an alternate payment method (such as a credit card), or charge excessive fees for using the standards.