MLN Matters® Article #MM6786 – titled “Screening for the Human Immunodeficiency Virus (HIV) Infection” – has been revised to change the three HIV screening G-code descriptors to align with the respective descriptors in the official code files. This article is based on Change Request #6786, which provides the clinical and billing requirements for HIV screening tests for both male and female Medicare beneficiaries. For more information, please read the article at http://www.CMS.gov/MLNMattersArticles/downloads/MM6786.pdf
Dallas L Alford IV, CPA is a licensed Certified Public Accountant in the state of North Carolina and owner of Atlantic Financial Consulting, a consulting firm that provides comprehensive medical billing services, practice management consulting, coding audits, Medicare compliance, Medicare RAC support and other general medical practice consulting services.
To learn more about Atlantic Financial Consulting you may visit their website at http://atlanticfinancial.us or contact Dallas L Alford IV, CPA directly at 1 888-428-2555, Ext. 200.
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Sunday, February 27, 2011
From the MLN: “2011 Electronic Prescribing Incentive Program Update: Future Payment Adjustments”
MLN Matters® Special Edition Article #SE1107 – titled “2011 Electronic Prescribing (eRx) Incentive Program Update: Future Payment Adjustments” – which reminds eligible professionals who are not successful electronic prescribers that they may be subject to a payment adjustment, is now available at http://www.CMS.gov/MLNMattersArticles/downloads/SE1107.pdf. This article is based on recent updates to the Electronic Prescribing Incentive Program.
Dallas L Alford IV, CPA is a licensed Certified Public Accountant in the state of North Carolina and owner of Atlantic Financial Consulting, a consulting firm that provides comprehensive medical billing services, practice management consulting, coding audits, Medicare compliance, Medicare RAC support and other general medical practice consulting services.
To learn more about Atlantic Financial Consulting you may visit their website at http://atlanticfinancial.us or contact Dallas L Alford IV, CPA directly at 1 888-428-2555, Ext. 200.
Dallas L Alford IV, CPA is a licensed Certified Public Accountant in the state of North Carolina and owner of Atlantic Financial Consulting, a consulting firm that provides comprehensive medical billing services, practice management consulting, coding audits, Medicare compliance, Medicare RAC support and other general medical practice consulting services.
To learn more about Atlantic Financial Consulting you may visit their website at http://atlanticfinancial.us or contact Dallas L Alford IV, CPA directly at 1 888-428-2555, Ext. 200.
From the MLN: February 2011 “Quarterly Provider Compliance Newsletter” Released
JUST RELEASED! The Medicare Learning Network® (MLN) has released the February 2011 issue of the “Medicare Quarterly Provider Compliance Newsletter,” which is designed to provide education on how to avoid common billing errors and other erroneous activities when dealing with the Medicare Program. In this issue, a number of Recovery Audit findings that affect inpatient hospitals, physicians, and Durable Medical Equipment (DME) suppliers are presented. This publication is issued on a quarterly basis and highlights the top issues of that particular quarter, as identified through a variety of sources. The current issue may be downloaded at http://www.CMS.gov/MLNProducts/downloads/MedQtrlyComp_Newsletter_ICN905712.pdf. An archive and searchable index of previously-issued newsletters are also now available at http://www.CMS.gov/MLNProducts/downloads/MedQtrlyCompNL_Archive.pdf.
Dallas L Alford IV, CPA is a licensed Certified Public Accountant in the state of North Carolina and owner of Atlantic Financial Consulting, a consulting firm that provides comprehensive medical billing services, practice management consulting, coding audits, Medicare compliance, Medicare RAC support and other general medical practice consulting services.
To learn more about Atlantic Financial Consulting you may visit their website at http://atlanticfinancial.us or contact Dallas L Alford IV, CPA directly at 1 888-428-2555, Ext. 200.
Dallas L Alford IV, CPA is a licensed Certified Public Accountant in the state of North Carolina and owner of Atlantic Financial Consulting, a consulting firm that provides comprehensive medical billing services, practice management consulting, coding audits, Medicare compliance, Medicare RAC support and other general medical practice consulting services.
To learn more about Atlantic Financial Consulting you may visit their website at http://atlanticfinancial.us or contact Dallas L Alford IV, CPA directly at 1 888-428-2555, Ext. 200.
Clarification of National Standards Permitting Qualified RDs, RNs, or Pharmacists to Individually Furnish Diabetes Self-Management Training Services
The Centers for Medicare and Medicaid Services recently clarified payment policy regarding the quality standards applicable to Diabetes Self-Management Training (DSMT) providers. In particular, CMS instructed contractors about the differences between the quality standards for entities following the CMS quality standards and those following the National Standards for Diabetes Self-Management Training Program (National Standards).
CMS Quality Standards – DSMT providers following CMS quality standards generally require a multidisciplinary team approach to the provision of DSMT services (although there is an exception to this requirement which permits an Registered Dietitian who is also a Certified Diabetes Educator to individually furnish DSMT services in a rural area). In addition, CMS has noted that a dietitian may not be the sole provider of the DSMT service. CMS has instructed contractors that this exception and special note are applicable only to those entities following the CMS quality standards.
National Standards – National Standards no longer require a multidisciplinary team approach, although these quality standards note that DSMT services are most effective when delivered by multidisciplinary teams consisting of a Registered Dietitian (RD), Registered Nurse (RN), and pharmacist as the key primary instructors for diabetes educators assisting in the delivery of services. Current National Standards require that at least one member of the team (or, if no team, the individual furnishing the training) must be an RD, an RN, or a pharmacist. The National Standards continue to call for all of the instructor(s) on the diabetes team to be certified as diabetes educator(s) or have recent educational and experiential preparation in education and diabetes management. However, the review and approval of credentials of DSMT program instructors is solely the role of the accrediting organization (listed below).
Until the Medicare Benefit Policy Manual is revised, contractors have been instructed to recognize that DSMT services may be furnished by an individual RD, RN, or pharmacist when those services are billed by, or on behalf of, a DSMT entity accredited as meeting the National Standards by the American Diabetes Association, Indian Health Service, or the American Association of Diabetes Educators, which are all CMS-approved accrediting organizations that use the National Standards for DSMT programs. This clarification does not affect who can qualify as “certified providers” to bill for DSMT services and, as such, payment for DSMT services may only be made to a physician, individual, or other provider that bills Medicare for other services for which direct Medicare payment may be made by CMS.
When following the National Standards, RDs may submit claims and be paid directly for DSMT services, as appropriate, because RDs are permitted to bill and receive payment for other Medicare services. However, since pharmacists and RNs cannot bill and receive payment directly from CMS for these types of services, the DSMT services they furnish to Medicare beneficiaries are billed by other certified providers, as appropriate, on their behalf.
Dallas L Alford IV, CPA is a licensed Certified Public Accountant in the state of North Carolina and owner of Atlantic Financial Consulting, a consulting firm that provides comprehensive medical billing services, practice management consulting, coding audits, Medicare compliance, Medicare RAC support and other general medical practice consulting services.
To learn more about Atlantic Financial Consulting you may visit their website at http://atlanticfinancial.us or contact Dallas L Alford IV, CPA directly at 1 888-428-2555, Ext. 200.
CMS Quality Standards – DSMT providers following CMS quality standards generally require a multidisciplinary team approach to the provision of DSMT services (although there is an exception to this requirement which permits an Registered Dietitian who is also a Certified Diabetes Educator to individually furnish DSMT services in a rural area). In addition, CMS has noted that a dietitian may not be the sole provider of the DSMT service. CMS has instructed contractors that this exception and special note are applicable only to those entities following the CMS quality standards.
National Standards – National Standards no longer require a multidisciplinary team approach, although these quality standards note that DSMT services are most effective when delivered by multidisciplinary teams consisting of a Registered Dietitian (RD), Registered Nurse (RN), and pharmacist as the key primary instructors for diabetes educators assisting in the delivery of services. Current National Standards require that at least one member of the team (or, if no team, the individual furnishing the training) must be an RD, an RN, or a pharmacist. The National Standards continue to call for all of the instructor(s) on the diabetes team to be certified as diabetes educator(s) or have recent educational and experiential preparation in education and diabetes management. However, the review and approval of credentials of DSMT program instructors is solely the role of the accrediting organization (listed below).
Until the Medicare Benefit Policy Manual is revised, contractors have been instructed to recognize that DSMT services may be furnished by an individual RD, RN, or pharmacist when those services are billed by, or on behalf of, a DSMT entity accredited as meeting the National Standards by the American Diabetes Association, Indian Health Service, or the American Association of Diabetes Educators, which are all CMS-approved accrediting organizations that use the National Standards for DSMT programs. This clarification does not affect who can qualify as “certified providers” to bill for DSMT services and, as such, payment for DSMT services may only be made to a physician, individual, or other provider that bills Medicare for other services for which direct Medicare payment may be made by CMS.
When following the National Standards, RDs may submit claims and be paid directly for DSMT services, as appropriate, because RDs are permitted to bill and receive payment for other Medicare services. However, since pharmacists and RNs cannot bill and receive payment directly from CMS for these types of services, the DSMT services they furnish to Medicare beneficiaries are billed by other certified providers, as appropriate, on their behalf.
Dallas L Alford IV, CPA is a licensed Certified Public Accountant in the state of North Carolina and owner of Atlantic Financial Consulting, a consulting firm that provides comprehensive medical billing services, practice management consulting, coding audits, Medicare compliance, Medicare RAC support and other general medical practice consulting services.
To learn more about Atlantic Financial Consulting you may visit their website at http://atlanticfinancial.us or contact Dallas L Alford IV, CPA directly at 1 888-428-2555, Ext. 200.
Strong Interest in Medicare and Medicaid EHR Incentive Programs
In a press release earlier this week, CMS announced that there has been strong interest in early registration for the Medicare and Medicaid EHR (Electronic Health Record) Incentive Programs.
In January, more than 21,000 providers initiated registration for the programs, and four states began issuing Medicaid incentive payments, totaling $20,425,550. In particular, the press release highlighted the following successes:
The Office of the National Coordinator for Health Information Technology announced that as of Fri Feb 11, more than 45,000 providers requested information or registration help from 62 Regional Extension Centers.
On Wed Jan 5, Kentucky made an initial payment of $2.86-million to a teaching hospital, University of Kentucky Healthcare. On the same day, Kentucky disbursed an incentive payment of $1.3-million to Central Baptist Hospital, and Oklahoma issued incentive payments to two physicians at the Gastorf Family Clinic of Durant, Oklahoma, totaling $42,500 ($21,250 each), for having adopted certified EHRs.
On Wed Jan 12, Louisiana announced a payment of $63,750 to Winn Community Health Center, the first federally-qualified health center in the nation to receive an incentive payment. The incentive payment consisted of $21,250 for each of three eligible professionals at the clinic.
During the week of Mon Jan 17, Iowa issued its first Medicaid EHR incentive payments in the amount of $21,250 each for two eligible professionals.
CMS Administrator Donald Berwick, MD, said “This strong early interest in the Medicare and Medicaid EHR Incentive Programs among providers and state Medicaid programs is most welcome and very encouraging. We encourage early adoption, and we’re seeing the registration numbers continue on an upward trajectory. The valuable feedback we’ve seen in these early weeks of the program helps us to fine-tune our list of frequently-asked-questions and other resources to increase providers’ understanding of the incentive programs and help them in getting signed up.”
Want more information about the EHR Incentive Programs? Visit the EHR Incentive Programs website for the latest news and updates on the EHR Incentive Programs, and join the CMS EHR listserv to stay up-to-date.
Dallas L Alford IV, CPA is a licensed Certified Public Accountant in the state of North Carolina and owner of Atlantic Financial Consulting, a consulting firm that provides comprehensive medical billing services, practice management consulting, coding audits, Medicare compliance, Medicare RAC support and other general medical practice consulting services.
To learn more about Atlantic Financial Consulting you may visit their website at http://atlanticfinancial.us or contact Dallas L Alford IV, CPA directly at 1 888-428-2555, Ext. 200.
In January, more than 21,000 providers initiated registration for the programs, and four states began issuing Medicaid incentive payments, totaling $20,425,550. In particular, the press release highlighted the following successes:
The Office of the National Coordinator for Health Information Technology announced that as of Fri Feb 11, more than 45,000 providers requested information or registration help from 62 Regional Extension Centers.
On Wed Jan 5, Kentucky made an initial payment of $2.86-million to a teaching hospital, University of Kentucky Healthcare. On the same day, Kentucky disbursed an incentive payment of $1.3-million to Central Baptist Hospital, and Oklahoma issued incentive payments to two physicians at the Gastorf Family Clinic of Durant, Oklahoma, totaling $42,500 ($21,250 each), for having adopted certified EHRs.
On Wed Jan 12, Louisiana announced a payment of $63,750 to Winn Community Health Center, the first federally-qualified health center in the nation to receive an incentive payment. The incentive payment consisted of $21,250 for each of three eligible professionals at the clinic.
During the week of Mon Jan 17, Iowa issued its first Medicaid EHR incentive payments in the amount of $21,250 each for two eligible professionals.
CMS Administrator Donald Berwick, MD, said “This strong early interest in the Medicare and Medicaid EHR Incentive Programs among providers and state Medicaid programs is most welcome and very encouraging. We encourage early adoption, and we’re seeing the registration numbers continue on an upward trajectory. The valuable feedback we’ve seen in these early weeks of the program helps us to fine-tune our list of frequently-asked-questions and other resources to increase providers’ understanding of the incentive programs and help them in getting signed up.”
Want more information about the EHR Incentive Programs? Visit the EHR Incentive Programs website for the latest news and updates on the EHR Incentive Programs, and join the CMS EHR listserv to stay up-to-date.
Dallas L Alford IV, CPA is a licensed Certified Public Accountant in the state of North Carolina and owner of Atlantic Financial Consulting, a consulting firm that provides comprehensive medical billing services, practice management consulting, coding audits, Medicare compliance, Medicare RAC support and other general medical practice consulting services.
To learn more about Atlantic Financial Consulting you may visit their website at http://atlanticfinancial.us or contact Dallas L Alford IV, CPA directly at 1 888-428-2555, Ext. 200.
New Update on Health Information Technology: ONC Explains How 2011 Marks Age of Meaningful Use
The latest public letter from Dr David Blumenthal, National Coordinator for Health Information Technology, marks 2011 as the year when medical care entered a new era – the age of meaningful use of health information. The letter highlights the programs ONC has implemented in order to build an infrastructure to support meaningful use, and also examines the role of meaningful use as a vision of how information can be used in innovative ways to revolutionize the work of health professionals and healthcare institutions.
Visit the ONC website (at http://HealthIT.HHS.gov/portal/server.pt?open=512&mode=2&objID=3541) to read the letter and learn more about the age of meaningful use.
Dallas L Alford IV, CPA is a licensed Certified Public Accountant in the state of North Carolina and owner of Atlantic Financial Consulting, a consulting firm that provides comprehensive medical billing services, practice management consulting, coding audits, Medicare compliance, Medicare RAC support and other general medical practice consulting services.
To learn more about Atlantic Financial Consulting you may visit their website at http://atlanticfinancial.us or contact Dallas L Alford IV, CPA directly at 1 888-428-2555, Ext. 200.
Visit the ONC website (at http://HealthIT.HHS.gov/portal/server.pt?open=512&mode=2&objID=3541) to read the letter and learn more about the age of meaningful use.
Dallas L Alford IV, CPA is a licensed Certified Public Accountant in the state of North Carolina and owner of Atlantic Financial Consulting, a consulting firm that provides comprehensive medical billing services, practice management consulting, coding audits, Medicare compliance, Medicare RAC support and other general medical practice consulting services.
To learn more about Atlantic Financial Consulting you may visit their website at http://atlanticfinancial.us or contact Dallas L Alford IV, CPA directly at 1 888-428-2555, Ext. 200.
Updated Educational Resources on the Home Health Agency Web Page
The Centers for Medicare and Medicaid Services (CMS) is pleased to announce the posting of updated educational resources on Section 6407 of the Affordable Care Act (ACA) of 2010 to the Home Health Agency webpage at http://www.cms.gov/center/hha.asp on CMS website.
Section 6407 of the Affordable Care Act (ACA) of 2010 established a physician face-to-face encounter requirement for certification of eligibility for home health services. Before a physician can certify a patient’s eligibility for Medicare home health services, the law mandates that the physician must document that he or she, or a non-physician practitioner working with the certifying physician, has had a face-to-face encounter with the patient. This provision is a requirement for home health payment.
The educational resources added to the webpage include a PowerPoint slide presentation, a Special Edition MLN Matters article and questions and answers related to this provision.
We hope you find this information helpful.
Dallas L Alford IV, CPA is a licensed Certified Public Accountant in the state of North Carolina and owner of Atlantic Financial Consulting, a consulting firm that provides comprehensive medical billing services, practice management consulting, coding audits, Medicare compliance, Medicare RAC support and other general medical practice consulting services.
To learn more about Atlantic Financial Consulting you may visit their website at http://atlanticfinancial.us or contact Dallas L Alford IV, CPA directly at 1 888-428-2555, Ext. 200.
Section 6407 of the Affordable Care Act (ACA) of 2010 established a physician face-to-face encounter requirement for certification of eligibility for home health services. Before a physician can certify a patient’s eligibility for Medicare home health services, the law mandates that the physician must document that he or she, or a non-physician practitioner working with the certifying physician, has had a face-to-face encounter with the patient. This provision is a requirement for home health payment.
The educational resources added to the webpage include a PowerPoint slide presentation, a Special Edition MLN Matters article and questions and answers related to this provision.
We hope you find this information helpful.
Dallas L Alford IV, CPA is a licensed Certified Public Accountant in the state of North Carolina and owner of Atlantic Financial Consulting, a consulting firm that provides comprehensive medical billing services, practice management consulting, coding audits, Medicare compliance, Medicare RAC support and other general medical practice consulting services.
To learn more about Atlantic Financial Consulting you may visit their website at http://atlanticfinancial.us or contact Dallas L Alford IV, CPA directly at 1 888-428-2555, Ext. 200.
National Correct Coding Initiative Seminars and Webinars - March 2011
In October 2010, DMA began notifying providers through bulletin articles of DMA’s plan to implement the National Correct Coding Initiative (NCCI) on March 31, 2011.
The Patient Protection and Affordable Care Act [(H.R. 3590) Section 65607 (Mandatory State Use of NCCI] requires state Medicaid programs to incorporate NCCI methodologies into their claims processing systems by April 1, 2011. The purpose of the NCCI edits is to prevent improper payments when incorrect code combinations are reported.
The two components of NCCI are procedure-to-procedure edits (CCI) and medically unlikely edits (MUE).
CCI procedure-to-procedure edits are for practitioners, ambulatory surgical centers, and outpatient hospital service (only for drugs, high-tech images, ultrasounds, and labs as they are billed at a CPT/HCPCS code level) that define pairs of HCPCS/CPT codes that should not be reported together.
MUE are units of service edits for practitioners, ambulatory surgical centers, outpatient hospital service (only for drugs, high-tech images, ultrasounds, and labs as they are billed at a CPT/HCPCS code level), and durable medical equipment. This component defines for each HCPCS/CPT code the number of units of service that is unlikely to be correct (e.g., claims for excision of more than one appendix or more than one hysterectomy). For more information on NCCI, refer to DMA’s website at http://www.ncdhhs.gov/dma/provider/ncci.htm.
DMA has scheduled training during the month of March 2011 to educate providers on the National Correct Coding Initiative.
Seminars
Wilmington - March 2
Greensboro - March 8
Greenville - March 15
Raleigh - March 22
Asheville - March 29
Charlotte - March 30
Webinars
Two webinar sessions are offered on each of the following dates. The morning sessions begin at 9:00 a.m. and end at 10:30 a.m. The afternoon sessions begin at 1:30 p.m. and end at 3:00 p.m.
March 03, 2011
March 10, 2011
March 17, 2011
March 24, 2011
March 31, 2011
For detailed information on the training sessions, refer to DMA’s website at http://www.ncdhhs.gov/dma/provider/seminars.htm or contact HP Enterprise Provider Services at 1-800-688-6696, menu option 3.
Dallas L Alford IV, CPA is a licensed Certified Public Accountant in the state of North Carolina and owner of Atlantic Financial Consulting, a consulting firm that provides comprehensive medical billing services, practice management consulting, coding audits, Medicare compliance, Medicare RAC support and other general medical practice consulting services.
To learn more about Atlantic Financial Consulting you may visit their website at http://atlanticfinancial.us or contact Dallas L Alford IV, CPA directly at 1 888-428-2555, Ext. 200.
The Patient Protection and Affordable Care Act [(H.R. 3590) Section 65607 (Mandatory State Use of NCCI] requires state Medicaid programs to incorporate NCCI methodologies into their claims processing systems by April 1, 2011. The purpose of the NCCI edits is to prevent improper payments when incorrect code combinations are reported.
The two components of NCCI are procedure-to-procedure edits (CCI) and medically unlikely edits (MUE).
CCI procedure-to-procedure edits are for practitioners, ambulatory surgical centers, and outpatient hospital service (only for drugs, high-tech images, ultrasounds, and labs as they are billed at a CPT/HCPCS code level) that define pairs of HCPCS/CPT codes that should not be reported together.
MUE are units of service edits for practitioners, ambulatory surgical centers, outpatient hospital service (only for drugs, high-tech images, ultrasounds, and labs as they are billed at a CPT/HCPCS code level), and durable medical equipment. This component defines for each HCPCS/CPT code the number of units of service that is unlikely to be correct (e.g., claims for excision of more than one appendix or more than one hysterectomy). For more information on NCCI, refer to DMA’s website at http://www.ncdhhs.gov/dma/provider/ncci.htm.
DMA has scheduled training during the month of March 2011 to educate providers on the National Correct Coding Initiative.
Seminars
Wilmington - March 2
Greensboro - March 8
Greenville - March 15
Raleigh - March 22
Asheville - March 29
Charlotte - March 30
Webinars
Two webinar sessions are offered on each of the following dates. The morning sessions begin at 9:00 a.m. and end at 10:30 a.m. The afternoon sessions begin at 1:30 p.m. and end at 3:00 p.m.
March 03, 2011
March 10, 2011
March 17, 2011
March 24, 2011
March 31, 2011
For detailed information on the training sessions, refer to DMA’s website at http://www.ncdhhs.gov/dma/provider/seminars.htm or contact HP Enterprise Provider Services at 1-800-688-6696, menu option 3.
Dallas L Alford IV, CPA is a licensed Certified Public Accountant in the state of North Carolina and owner of Atlantic Financial Consulting, a consulting firm that provides comprehensive medical billing services, practice management consulting, coding audits, Medicare compliance, Medicare RAC support and other general medical practice consulting services.
To learn more about Atlantic Financial Consulting you may visit their website at http://atlanticfinancial.us or contact Dallas L Alford IV, CPA directly at 1 888-428-2555, Ext. 200.
Friday, February 25, 2011
2011 Electronic Prescribing (eRx) Incentive Program Reminder-Avoiding the Adjustment
In November, the Centers for Medicare & Medicaid Services announced that, beginning in calendar year 2012, eligible professionals who are not successful electronic prescribers based on claims submitted between January 1, 2011 – June 30, 2011, may be subject to a payment adjustment on their Medicare Part B Physician Fee Schedule (PFS) covered professional services. Section 132 of the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA) authorizes CMS to apply this payment adjustment whether or not the eligible professional is planning to participate in the eRx Incentive Program.
From 2012 through 2014, the payment adjustment will increase each calendar year. In 2012, the payment adjustment for not being a successful electronic prescriber will result in an eligible professional or group practice receiving 99% of their Medicare Part B PFS amount that would otherwise apply to such services. In 2013, an eligible professional or group practice will receive 98.5% of their Medicare Part B PFS covered professional services for not being a successful electronic prescriber in 2011 or as defined in a future regulation. In 2014, the payment adjustment for not being a successful electronic prescriber is 2%, resulting in an eligible professional or group practice receiving 98% of their Medicare Part B PFS covered professional services.
The payment adjustment does not apply if <10% of an eligible professional’s (or group practice’s) allowed charges for the January 1, 2011 through June 30, 2011 reporting period are comprised of codes in the denominator of the 2011 eRx measure. Please note that earning an eRx incentive for 2011 will NOT necessarily exempt an eligible professional or group practice from the payment adjustment in 2012. How to Avoid the 2012 eRx Payment Adjustment · Eligible professionals – An eligible professional can avoid the 2012 eRx Payment Adjustment if (s)he: Is not a physician (MD, DO, or podiatrist), nurse practitioner, or physician assistant as of Jun 30, 2011 based on primary taxonomy code in NPPES; Does not have prescribing privileges. Note: (S)he must report (G8644) at least one time on an eligible claim prior to June 30, 2011; Does not have at least 100 cases containing an encounter code in the measure denominator; Becomes a successful e-prescriber; and Reports the eRx measure for at least 10 unique eRx events for patients in the denominator of the measure. · Group Practices - For group practices that are participating in eRx GPRO I or GPRO II during 2011, the group practice MUST become a successful e-prescriber. Depending on the group’s size, the group practice must report the eRx measure for 75-2,500 unique eRx events for patients in the denominator of the measure. For additional information, please visit the “Getting Started” webpage at http://www.cms.gov/erxincentive on the CMS website for more information; or download the Medicare’s Practical Guide to the Electronic Prescribing (eRx) Incentive Program under Educational Resources. Dallas L Alford IV, CPA is a licensed Certified Public Accountant in the state of North Carolina and owner of Atlantic Financial Consulting, a consulting firm that provides comprehensive medical billing services, practice management consulting, coding audits, Medicare compliance, Medicare RAC support and other general medical practice consulting services. To learn more about Atlantic Financial Consulting you may visit their website at http://atlanticfinancial.us or contact Dallas L Alford IV, CPA directly at 1 888-428-2555, Ext. 200.
From 2012 through 2014, the payment adjustment will increase each calendar year. In 2012, the payment adjustment for not being a successful electronic prescriber will result in an eligible professional or group practice receiving 99% of their Medicare Part B PFS amount that would otherwise apply to such services. In 2013, an eligible professional or group practice will receive 98.5% of their Medicare Part B PFS covered professional services for not being a successful electronic prescriber in 2011 or as defined in a future regulation. In 2014, the payment adjustment for not being a successful electronic prescriber is 2%, resulting in an eligible professional or group practice receiving 98% of their Medicare Part B PFS covered professional services.
The payment adjustment does not apply if <10% of an eligible professional’s (or group practice’s) allowed charges for the January 1, 2011 through June 30, 2011 reporting period are comprised of codes in the denominator of the 2011 eRx measure. Please note that earning an eRx incentive for 2011 will NOT necessarily exempt an eligible professional or group practice from the payment adjustment in 2012. How to Avoid the 2012 eRx Payment Adjustment · Eligible professionals – An eligible professional can avoid the 2012 eRx Payment Adjustment if (s)he: Is not a physician (MD, DO, or podiatrist), nurse practitioner, or physician assistant as of Jun 30, 2011 based on primary taxonomy code in NPPES; Does not have prescribing privileges. Note: (S)he must report (G8644) at least one time on an eligible claim prior to June 30, 2011; Does not have at least 100 cases containing an encounter code in the measure denominator; Becomes a successful e-prescriber; and Reports the eRx measure for at least 10 unique eRx events for patients in the denominator of the measure. · Group Practices - For group practices that are participating in eRx GPRO I or GPRO II during 2011, the group practice MUST become a successful e-prescriber. Depending on the group’s size, the group practice must report the eRx measure for 75-2,500 unique eRx events for patients in the denominator of the measure. For additional information, please visit the “Getting Started” webpage at http://www.cms.gov/erxincentive on the CMS website for more information; or download the Medicare’s Practical Guide to the Electronic Prescribing (eRx) Incentive Program under Educational Resources. Dallas L Alford IV, CPA is a licensed Certified Public Accountant in the state of North Carolina and owner of Atlantic Financial Consulting, a consulting firm that provides comprehensive medical billing services, practice management consulting, coding audits, Medicare compliance, Medicare RAC support and other general medical practice consulting services. To learn more about Atlantic Financial Consulting you may visit their website at http://atlanticfinancial.us or contact Dallas L Alford IV, CPA directly at 1 888-428-2555, Ext. 200.
Important Information on the Timely Claims Filing Requirement
The Centers for Medicare & Medicaid Services (CMS) would like to remind Medicare Fee-For-Service physicians, providers and suppliers submitting claims to Medicare for payment, as a result of the Patient Protection and Affordable Care Act (PPACA), effective immediately, all claims for services furnished on or after Jan 1, 2010, must be filed with your Medicare contractor no later than one calendar year (12 months) from the date of service – or Medicare will deny them.
In general, the start date for determining the 1-year timely filing period is the date of service or “From” date on the claim. For institutional claims that include span dates of service (i.e., a “From” and “Through” date on the claim), the “Through” date on the claim is used for determining the date of service for claims filing timeliness. For claims submitted by physicians and other suppliers that include span dates of service, the line item “From” date is used for determining the date of service for claims filing timeliness.
For additional information about the new maximum period for claims submission filing dates, contact your Medicare contractor, or review the MLN Matters articles listed below related to this subject:
§ MM6960 – “Systems Changes Necessary to Implement the Patient Protection and Affordable Care Act (PPACA) Section 6404 - Maximum Period for Submission of Medicare Claims Reduced to Not More Than 12 Months” – http://www.cms.gov/MLNMattersArticles/downloads/MM6960.pdf on the CMS website.
§ MM7080 – “Timely Claims Filing: Additional Instructions” – http://www.cms.gov/MLNMattersArticles/downloads/MM7080.pdf on the CMS website.
§ MM7270 – “Changes to the Time Limits for Filing Medicare Fee-for-Service Claims – http://www.cms.gov/MLNMattersArticles/downloads/MM7270.pdf on the CMS website.
You can also listen to a podcast on this subject by visiting http://www.cms.gov/CMSFeeds/02_listofpodcasts.asp on the CMS website.
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February Flu Shot Reminder
It’s Not too Late to Give and Get the Flu Vaccine. Take advantage of each office visit and continue to protect your patients against the seasonal flu. Medicare will continue to pay for the seasonal flu vaccine and its administration for all Medicare beneficiaries through the entire flu season. The Centers for Disease Control and Prevention (CDC) recommends that patients, health care workers and caregivers be vaccinated against the seasonal flu. Protect your patients. Protect your family. Protect yourself. Get Your Flu Vaccine - Not the Flu.
Remember – Influenza vaccine plus its administration are covered Part B benefits. Note that influenza vaccine is NOT a Part D covered drug. For information about Medicare’s coverage of the influenza vaccine and its administration, as well as related educational resources for health care professionals and their staff, please visit the following CMS websites: http://www.cms.gov/MLNProducts/Downloads/Flu_Products.pdf and http://www.cms.gov/AdultImmunizations.
Dallas L Alford IV, CPA is a licensed Certified Public Accountant in the state of North Carolina and owner of Atlantic Financial Consulting, a consulting firm that provides comprehensive medical billing services, practice management consulting, coding audits, Medicare compliance, Medicare RAC support and other general medical practice consulting services.
To learn more about Atlantic Financial Consulting you may visit their website at http://atlanticfinancial.us or contact Dallas L Alford IV, CPA directly at 1 888-428-2555, Ext. 200.
In general, the start date for determining the 1-year timely filing period is the date of service or “From” date on the claim. For institutional claims that include span dates of service (i.e., a “From” and “Through” date on the claim), the “Through” date on the claim is used for determining the date of service for claims filing timeliness. For claims submitted by physicians and other suppliers that include span dates of service, the line item “From” date is used for determining the date of service for claims filing timeliness.
For additional information about the new maximum period for claims submission filing dates, contact your Medicare contractor, or review the MLN Matters articles listed below related to this subject:
§ MM6960 – “Systems Changes Necessary to Implement the Patient Protection and Affordable Care Act (PPACA) Section 6404 - Maximum Period for Submission of Medicare Claims Reduced to Not More Than 12 Months” – http://www.cms.gov/MLNMattersArticles/downloads/MM6960.pdf on the CMS website.
§ MM7080 – “Timely Claims Filing: Additional Instructions” – http://www.cms.gov/MLNMattersArticles/downloads/MM7080.pdf on the CMS website.
§ MM7270 – “Changes to the Time Limits for Filing Medicare Fee-for-Service Claims – http://www.cms.gov/MLNMattersArticles/downloads/MM7270.pdf on the CMS website.
You can also listen to a podcast on this subject by visiting http://www.cms.gov/CMSFeeds/02_listofpodcasts.asp on the CMS website.
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February Flu Shot Reminder
It’s Not too Late to Give and Get the Flu Vaccine. Take advantage of each office visit and continue to protect your patients against the seasonal flu. Medicare will continue to pay for the seasonal flu vaccine and its administration for all Medicare beneficiaries through the entire flu season. The Centers for Disease Control and Prevention (CDC) recommends that patients, health care workers and caregivers be vaccinated against the seasonal flu. Protect your patients. Protect your family. Protect yourself. Get Your Flu Vaccine - Not the Flu.
Remember – Influenza vaccine plus its administration are covered Part B benefits. Note that influenza vaccine is NOT a Part D covered drug. For information about Medicare’s coverage of the influenza vaccine and its administration, as well as related educational resources for health care professionals and their staff, please visit the following CMS websites: http://www.cms.gov/MLNProducts/Downloads/Flu_Products.pdf and http://www.cms.gov/AdultImmunizations.
Dallas L Alford IV, CPA is a licensed Certified Public Accountant in the state of North Carolina and owner of Atlantic Financial Consulting, a consulting firm that provides comprehensive medical billing services, practice management consulting, coding audits, Medicare compliance, Medicare RAC support and other general medical practice consulting services.
To learn more about Atlantic Financial Consulting you may visit their website at http://atlanticfinancial.us or contact Dallas L Alford IV, CPA directly at 1 888-428-2555, Ext. 200.
CMS delays implementation of the Medicaid RAC program
The Centers for Medicare and Medicare Services (CMS) has delayed the deadline for states to implement their Medicaid recovery audit contractor (RAC) programs until an unspecified time later this year. The CMS bulletin said that the agency was doing so “out of consideration for state operational issues and to ensure states comply with the provisions of the final rule,” which has yet to be published. The original implementation date was April 1. CMS says when the final rule is published, it will include a new implementation deadline.
Dallas L Alford IV, CPA is a licensed Certified Public Accountant in the state of North Carolina and owner of Atlantic Financial Consulting, a consulting firm that provides comprehensive medical billing services, practice management consulting, coding audits, Medicare compliance, Medicare RAC support and other general medical practice consulting services.
To learn more about Atlantic Financial Consulting you may visit their website at http://atlanticfinancial.us or contact Dallas L Alford IV, CPA directly at 1 888-428-2555, Ext. 200.
Dallas L Alford IV, CPA is a licensed Certified Public Accountant in the state of North Carolina and owner of Atlantic Financial Consulting, a consulting firm that provides comprehensive medical billing services, practice management consulting, coding audits, Medicare compliance, Medicare RAC support and other general medical practice consulting services.
To learn more about Atlantic Financial Consulting you may visit their website at http://atlanticfinancial.us or contact Dallas L Alford IV, CPA directly at 1 888-428-2555, Ext. 200.
Thursday, February 24, 2011
HHS imposes $4.3 million fine for HIPAA violations
The Office for Civil Rights (OCR) of the Department of Health and Human Services this week imposed its first ever civil money penalty against a HIPAA covered entity for violations of the privacy rule. The $4.3 million fine was levied against Cignet Health of Prince George’s County, Md. for failing to provide its patients access to their medical records.
HIPAA requires a covered entity to provide its patients with copies of medical records within 30 days of a records request but allows an extension up to 60 days. Forty-one patients who had requested their medical records over a 13-month period and did not receive them filed complaints against the practice with OCR. Notably, the practice failed to respond to OCR’s request for the records and otherwise failed to cooperate with the government. The government’s fine included $1.3 million for failure to provide the patients their medical records and $3 million for the practice’s failure to cooperate, which constituted “willful neglect” to comply with the HIPAA privacy rule.
In imposing such a large fine, OCR relied on its enhanced enforcement authority granted as part of the Health Information Technology for Economic and Clinical Health (HITECH) Act.
Dallas L Alford IV, CPA is a licensed Certified Public Accountant in the state of North Carolina and owner of Atlantic Financial Consulting, a consulting firm that provides comprehensive medical billing services, practice management consulting, coding audits, Medicare compliance, Medicare RAC support and other general medical practice consulting services.
To learn more about Atlantic Financial Consulting you may visit their website at http://atlanticfinancial.us or contact Dallas L Alford IV, CPA directly at 1 888-428-2555, Ext. 200.
HIPAA requires a covered entity to provide its patients with copies of medical records within 30 days of a records request but allows an extension up to 60 days. Forty-one patients who had requested their medical records over a 13-month period and did not receive them filed complaints against the practice with OCR. Notably, the practice failed to respond to OCR’s request for the records and otherwise failed to cooperate with the government. The government’s fine included $1.3 million for failure to provide the patients their medical records and $3 million for the practice’s failure to cooperate, which constituted “willful neglect” to comply with the HIPAA privacy rule.
In imposing such a large fine, OCR relied on its enhanced enforcement authority granted as part of the Health Information Technology for Economic and Clinical Health (HITECH) Act.
Dallas L Alford IV, CPA is a licensed Certified Public Accountant in the state of North Carolina and owner of Atlantic Financial Consulting, a consulting firm that provides comprehensive medical billing services, practice management consulting, coding audits, Medicare compliance, Medicare RAC support and other general medical practice consulting services.
To learn more about Atlantic Financial Consulting you may visit their website at http://atlanticfinancial.us or contact Dallas L Alford IV, CPA directly at 1 888-428-2555, Ext. 200.
Medicare fraud investigation nets more than 100 providers
Feb 23, 2011
By: Medical Economics Staff
MIAMI – The feds are getting serious about cracking down on Medicare fraud. A February 17 nationwide bust netted 111 physicians, nurses, and therapists, the largest such roundup in Medicare history.
The providers are charged with everything from altering patients’ diagnoses and medications to make it look like they qualified for additional treatment to billing for procedures that were never performed.
More than 700 law enforcement agents arrested suspects in Miami, Los Angeles, Dallas, Houston, Detroit, Chicago, New York, Tampa, and Baton Rouge. The suspects are accused of illegally billing Medicare more than $225 million.
The FBI agent in charge of the case said that law enforcement will never stop Medicare fraud until the system institutes reforms such as screening and fingerprinting providers, and using unique numbers for patients instead of Social Security numbers. Officials estimate that the program is cheated out of $60 billion to $90 billion each year.
Dallas L Alford IV, CPA is a licensed Certified Public Accountant in the state of North Carolina and owner of Atlantic Financial Consulting, a consulting firm that provides comprehensive medical billing services, practice management consulting, coding audits, Medicare compliance, Medicare RAC support and other general medical practice consulting services.
To learn more about Atlantic Financial Consulting you may visit their website at http://atlanticfinancial.us or contact Dallas L Alford IV, CPA directly at 1 888-428-2555, Ext. 200.
By: Medical Economics Staff
MIAMI – The feds are getting serious about cracking down on Medicare fraud. A February 17 nationwide bust netted 111 physicians, nurses, and therapists, the largest such roundup in Medicare history.
The providers are charged with everything from altering patients’ diagnoses and medications to make it look like they qualified for additional treatment to billing for procedures that were never performed.
More than 700 law enforcement agents arrested suspects in Miami, Los Angeles, Dallas, Houston, Detroit, Chicago, New York, Tampa, and Baton Rouge. The suspects are accused of illegally billing Medicare more than $225 million.
The FBI agent in charge of the case said that law enforcement will never stop Medicare fraud until the system institutes reforms such as screening and fingerprinting providers, and using unique numbers for patients instead of Social Security numbers. Officials estimate that the program is cheated out of $60 billion to $90 billion each year.
Dallas L Alford IV, CPA is a licensed Certified Public Accountant in the state of North Carolina and owner of Atlantic Financial Consulting, a consulting firm that provides comprehensive medical billing services, practice management consulting, coding audits, Medicare compliance, Medicare RAC support and other general medical practice consulting services.
To learn more about Atlantic Financial Consulting you may visit their website at http://atlanticfinancial.us or contact Dallas L Alford IV, CPA directly at 1 888-428-2555, Ext. 200.
Tuesday, February 22, 2011
CMS limits RAC record request
On Feb. 11, the Centers for Medicare & Medicaid Services (CMS) announced new limits on the number of medical records that Recovery Audit Contractors (RACs) may request when reviewing Medicare claims from physicians and other practitioners. RACs use the records to validate billing practices and medical necessity for services provided to Medicare patients. The new limits became effective Feb. 14, 2011. CMS reduced the number of records RACs can request in response to feedback from the physician community. For details, see the CMS notice.
Dallas L Alford IV, CPA is a licensed Certified Public Accountant in the state of North Carolina and owner of Atlantic Financial Consulting, a consulting firm that provides comprehensive medical billing services, practice management consulting, coding audits, Medicare compliance, Medicare RAC support and other general medical practice consulting services.
To learn more about Atlantic Financial Consulting you may visit their website at http://atlanticfinancial.us or contact Dallas L Alford IV, CPA directly at 1 888-428-2555, Ext. 200.
Dallas L Alford IV, CPA is a licensed Certified Public Accountant in the state of North Carolina and owner of Atlantic Financial Consulting, a consulting firm that provides comprehensive medical billing services, practice management consulting, coding audits, Medicare compliance, Medicare RAC support and other general medical practice consulting services.
To learn more about Atlantic Financial Consulting you may visit their website at http://atlanticfinancial.us or contact Dallas L Alford IV, CPA directly at 1 888-428-2555, Ext. 200.
President introduces the 2012 proposed budget; Congress continues to work on this year’s funding
On Feb. 14, President Obama submitted his fiscal 2012 budget request to Congress. The proposal consists of various Medicare and Medicaid cuts including:
A reduction in the Medicaid provider tax threshold
Anti-fraud legislative initiatives
A change to biosimilars policy
Limits on so-called “pay-for-delay” patent settlements between brand-name and generic drug companies.
These measures would raise $62.2 billion, which would offset the $54.4 billion cost of the 2-year doc fix
The White House budget request calls for two sets of adjustments to the sustainable growth rate (SGR) formula used by Medicare to reimburse physicians — a two-year patch budgeted at $54 billion, and “relief from 2014-2021” that the administration says would cost $315 billion. The current SGR funding expires on Dec. 31, 2011.
The House of Representatives is currently debating a continuing resolution (CR) which will set spending limits for government agencies and federal programs for the rest of this fiscal year. Both the House and Senate must agree to identical legislation before March 4 to allow the government to continue operating.
Dallas L Alford IV, CPA is a licensed Certified Public Accountant in the state of North Carolina and owner of Atlantic Financial Consulting, a consulting firm that provides comprehensive medical billing services, practice management consulting, coding audits, Medicare compliance, Medicare RAC support and other general medical practice consulting services.
To learn more about Atlantic Financial Consulting you may visit their website at http://atlanticfinancial.us or contact Dallas L Alford IV, CPA directly at 1 888-428-2555, Ext. 200.
A reduction in the Medicaid provider tax threshold
Anti-fraud legislative initiatives
A change to biosimilars policy
Limits on so-called “pay-for-delay” patent settlements between brand-name and generic drug companies.
These measures would raise $62.2 billion, which would offset the $54.4 billion cost of the 2-year doc fix
The White House budget request calls for two sets of adjustments to the sustainable growth rate (SGR) formula used by Medicare to reimburse physicians — a two-year patch budgeted at $54 billion, and “relief from 2014-2021” that the administration says would cost $315 billion. The current SGR funding expires on Dec. 31, 2011.
The House of Representatives is currently debating a continuing resolution (CR) which will set spending limits for government agencies and federal programs for the rest of this fiscal year. Both the House and Senate must agree to identical legislation before March 4 to allow the government to continue operating.
Dallas L Alford IV, CPA is a licensed Certified Public Accountant in the state of North Carolina and owner of Atlantic Financial Consulting, a consulting firm that provides comprehensive medical billing services, practice management consulting, coding audits, Medicare compliance, Medicare RAC support and other general medical practice consulting services.
To learn more about Atlantic Financial Consulting you may visit their website at http://atlanticfinancial.us or contact Dallas L Alford IV, CPA directly at 1 888-428-2555, Ext. 200.
Saturday, February 19, 2011
CMS Staff to Conduct Follow-up Calls for CERT Program
The Centers for Medicare and Medicaid Services (CMS) will be conducting follow-up calls to providers for the Comprehensive Error Rate Testing (CERT) program. Our staff may contact you to obtain all necessary medical record documentation for claims reviewed under the CERT program. Although you may have already received letters and telephone calls from the CERT contractor, these additional efforts by CMS to obtain adequate documentation may change your claim’s status from “improper payment” to “proper payment.” This will allow us to calculate a more accurate Medicare FFS error rate, while also reducing the amount of improper payments.
Dallas L Alford IV, CPA is a licensed Certified Public Accountant in the state of North Carolina and owner of Atlantic Financial Consulting, a consulting firm that provides comprehensive medical billing services, practice management consulting, coding audits, Medicare compliance, Medicare RAC support and other general medical practice consulting services.
To learn more about Atlantic Financial Consulting you may visit their website at http://atlanticfinancial.us or contact Dallas L Alford IV, CPA directly at 1 888-428-2555, Ext. 200.
Dallas L Alford IV, CPA is a licensed Certified Public Accountant in the state of North Carolina and owner of Atlantic Financial Consulting, a consulting firm that provides comprehensive medical billing services, practice management consulting, coding audits, Medicare compliance, Medicare RAC support and other general medical practice consulting services.
To learn more about Atlantic Financial Consulting you may visit their website at http://atlanticfinancial.us or contact Dallas L Alford IV, CPA directly at 1 888-428-2555, Ext. 200.
From the MLN: “Medicare Appeals Process: Five Levels to Protect Providers, Physicians, and Other Suppliers” Revised
The revised brochure titled “The Medicare Appeals Process: Five Levels to Protect Providers, Physicians, and Other Suppliers” (revised January 2011) is now available in downloadable format from the Medicare Learning Network® at http://www.CMS.gov/MLNProducts/downloads/MedicareAppealsProcess.pdf. This brochure is designed to provide an overview of the Medicare Part-A and Part-B administrative appeals process available to providers, physicians, and other suppliers who provide services and supplies to Medicare beneficiaries, as well as details on where to obtain more information about this appeals process.
Dallas L Alford IV, CPA is a licensed Certified Public Accountant in the state of North Carolina and owner of Atlantic Financial Consulting, a consulting firm that provides comprehensive medical billing services, practice management consulting, coding audits, Medicare compliance, Medicare RAC support and other general medical practice consulting services.
To learn more about Atlantic Financial Consulting you may visit their website at http://atlanticfinancial.us or contact Dallas L Alford IV, CPA directly at 1 888-428-2555, Ext. 200.
Dallas L Alford IV, CPA is a licensed Certified Public Accountant in the state of North Carolina and owner of Atlantic Financial Consulting, a consulting firm that provides comprehensive medical billing services, practice management consulting, coding audits, Medicare compliance, Medicare RAC support and other general medical practice consulting services.
To learn more about Atlantic Financial Consulting you may visit their website at http://atlanticfinancial.us or contact Dallas L Alford IV, CPA directly at 1 888-428-2555, Ext. 200.
Agendas for the March 2011 ICD-9-CM Coordination & Maintenance Committee Meeting Now Available
Wed Mar 9 and Thu Mar 10
This will be the last meeting to address ICD-9-CM and ICD-10 code updates before the partial code freeze is implemented. The following agendas have been posted:
Procedures topics, Wed Mar 9 – Agenda is posted in the “Downloads” section at http://www.CMS.gov/ICD9ProviderDiagnosticCodes/03_meetings.asp. Handouts will also be available on this website a few days before the meeting.
Diagnosis topics, Thu Mar 10 – The link to this agenda is under “Upcoming Meeting, March 9-10, 2011” at http://www.CDC.gov/nchs/icd/icd9cm_maintenance.htm. Handouts will also be available at this website a few days before the meeting.
Dallas L Alford IV, CPA is a licensed Certified Public Accountant in the state of North Carolina and owner of Atlantic Financial Consulting, a consulting firm that provides comprehensive medical billing services, practice management consulting, coding audits, Medicare compliance, Medicare RAC support and other general medical practice consulting services.
To learn more about Atlantic Financial Consulting you may visit their website at http://atlanticfinancial.us or contact Dallas L Alford IV, CPA directly at 1 888-428-2555, Ext. 200.
This will be the last meeting to address ICD-9-CM and ICD-10 code updates before the partial code freeze is implemented. The following agendas have been posted:
Procedures topics, Wed Mar 9 – Agenda is posted in the “Downloads” section at http://www.CMS.gov/ICD9ProviderDiagnosticCodes/03_meetings.asp. Handouts will also be available on this website a few days before the meeting.
Diagnosis topics, Thu Mar 10 – The link to this agenda is under “Upcoming Meeting, March 9-10, 2011” at http://www.CDC.gov/nchs/icd/icd9cm_maintenance.htm. Handouts will also be available at this website a few days before the meeting.
Dallas L Alford IV, CPA is a licensed Certified Public Accountant in the state of North Carolina and owner of Atlantic Financial Consulting, a consulting firm that provides comprehensive medical billing services, practice management consulting, coding audits, Medicare compliance, Medicare RAC support and other general medical practice consulting services.
To learn more about Atlantic Financial Consulting you may visit their website at http://atlanticfinancial.us or contact Dallas L Alford IV, CPA directly at 1 888-428-2555, Ext. 200.
2011 Physician Quality Reporting System & Electronic Prescribing Incentive Program National Provider Call and Webinar with Question & Answer Session
The Centers for Medicare & Medicaid Services’ (CMS) Provider Communications Group will host a national provider conference call and webinar on the 2011 Physician Quality Reporting System and Electronic Prescribing (eRx) Incentive Program. This toll-free call will take place from 1:30 p.m. – 3:00 p.m., EST, on Tuesday, March 8, 2011.
The Physician Quality Reporting System is voluntary quality reporting program that provides an incentive payment to identified individual eligible professionals (EPs) and group practices who satisfactorily report data on quality measures for covered Physician Fee Schedule (PFS) services furnished to Medicare Part B Fee-For-Service (FFS) beneficiaries.
The Physician Quality Reporting System was first implemented in 2007 as a result of section 101 of the Tax Relief and Health Care Act of 2006 (TRHCA), and further expanded as a result of the Medicare, Medicaid, and SCHIP Extension Act of 2007 (MMSEA), and the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA).
The eRx Incentive Program is an incentive program for eligible professionals initially implemented in 2009 as a result of section 132(b) of the MIPPA. The eRx Incentive Program promotes the adoption and use of eRx systems by individual eligible professionals and group practices.
Following the formal presentation that will cover the following:
Measure Reporting; and
How to Get Started --Participating in the 2011 Physician Quality Reporting System and 2011 Electronic Prescribing Incentive Program (eRx).
The lines will be opened to allow participants to ask questions of CMS Physician Quality Reporting System and eRx subject matter experts.
A PowerPoint slide presentation will be posted to the Physician Quality Reporting System webpage at, http://www.cms.gov/PQRI/04_CMSSponsoredCalls.asp on the CMS website for you to download prior to the call so that you can follow along with the presenter.
Educational products are available on the Physician Quality Reporting System dedicated web page located at, http://www.cms.hhs.gov/PQRI , on the CMS website, in the Educational Resources section, as well as educational products are available on the eRx Incentive Program dedicated web page located at http://www.cms.hhs.gov/ERxIncentive on the CMS website. Feel free to download the resources prior to the call so that you may ask questions of the CMS presenters.
Conference call details:
Date: March 8, 2011
Conference Title: Physician Quality Reporting System (PQRS) & Electronic Prescribing Incentive Program National Provider Call
Time: 1:30 p.m. EST
In order to receive the call-in information, you must register for the call. It is important to note that if you are planning to sit in with a group, only one person needs to register to receive the call-in data. This registration is solely to reserve a phone line, NOT to allow participation.
Registration will close at 1:30 p.m. EST on March 7, 2011, or when available space has been filled. No exceptions will be made, so please be sure to register prior to this time.
To register for the call participants need to go to: http://www.eventsvc.com/palmettogba/030811
Fill in all required data.
Verify that your time zone is displayed correctly in the drop down box.
Click "Register".
You will be taken to the “Thank you for registering” page and will receive a confirmation email shortly thereafter. Note: Please print and save this page, in the event that your server blocks the confirmation emails. If you do not receive the confirmation email, please check your spam/junk mail filter as it may have been directed there.
CMS added a webinar as part of this national conference call. This feature will allow participants who are on the Internet the ability to follow the presentation online as it is given. This will not have any effect on those participants who are only dialing in to the audio portion of the call.
Please note participants who are not signed into the webinar should download the presentation from the CMS website. CMS would like to thank those of you who will participate in this feature.
To access Adobe Connect Pro Webinar: please use the following URL: https://webinar.CMS.hhs.gov/PQRSandERX– Instructions: Sign in as a “Guest” when prompted – please enter your first and last name.
Please dial in for the call first and then go to Adobe Connect Pro.
If assistance for hearing impaired services is needed the request must be sent to medicare.ttt@palmettogba.com no later than 3 business day before the event.
For those of who will be unable to attend, a transcript and MP3 file of the call will be available at least one week after the call at http://www.cms.hhs.gov/pqri on the CMS website.
Dallas L Alford IV, CPA is a licensed Certified Public Accountant in the state of North Carolina and owner of Atlantic Financial Consulting, a consulting firm that provides comprehensive medical billing services, practice management consulting, coding audits, Medicare compliance, Medicare RAC support and other general medical practice consulting services.
To learn more about Atlantic Financial Consulting you may visit their website at http://atlanticfinancial.us or contact Dallas L Alford IV, CPA directly at 1 888-428-2555, Ext. 200.
The Physician Quality Reporting System is voluntary quality reporting program that provides an incentive payment to identified individual eligible professionals (EPs) and group practices who satisfactorily report data on quality measures for covered Physician Fee Schedule (PFS) services furnished to Medicare Part B Fee-For-Service (FFS) beneficiaries.
The Physician Quality Reporting System was first implemented in 2007 as a result of section 101 of the Tax Relief and Health Care Act of 2006 (TRHCA), and further expanded as a result of the Medicare, Medicaid, and SCHIP Extension Act of 2007 (MMSEA), and the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA).
The eRx Incentive Program is an incentive program for eligible professionals initially implemented in 2009 as a result of section 132(b) of the MIPPA. The eRx Incentive Program promotes the adoption and use of eRx systems by individual eligible professionals and group practices.
Following the formal presentation that will cover the following:
Measure Reporting; and
How to Get Started --Participating in the 2011 Physician Quality Reporting System and 2011 Electronic Prescribing Incentive Program (eRx).
The lines will be opened to allow participants to ask questions of CMS Physician Quality Reporting System and eRx subject matter experts.
A PowerPoint slide presentation will be posted to the Physician Quality Reporting System webpage at, http://www.cms.gov/PQRI/04_CMSSponsoredCalls.asp on the CMS website for you to download prior to the call so that you can follow along with the presenter.
Educational products are available on the Physician Quality Reporting System dedicated web page located at, http://www.cms.hhs.gov/PQRI , on the CMS website, in the Educational Resources section, as well as educational products are available on the eRx Incentive Program dedicated web page located at http://www.cms.hhs.gov/ERxIncentive on the CMS website. Feel free to download the resources prior to the call so that you may ask questions of the CMS presenters.
Conference call details:
Date: March 8, 2011
Conference Title: Physician Quality Reporting System (PQRS) & Electronic Prescribing Incentive Program National Provider Call
Time: 1:30 p.m. EST
In order to receive the call-in information, you must register for the call. It is important to note that if you are planning to sit in with a group, only one person needs to register to receive the call-in data. This registration is solely to reserve a phone line, NOT to allow participation.
Registration will close at 1:30 p.m. EST on March 7, 2011, or when available space has been filled. No exceptions will be made, so please be sure to register prior to this time.
To register for the call participants need to go to: http://www.eventsvc.com/palmettogba/030811
Fill in all required data.
Verify that your time zone is displayed correctly in the drop down box.
Click "Register".
You will be taken to the “Thank you for registering” page and will receive a confirmation email shortly thereafter. Note: Please print and save this page, in the event that your server blocks the confirmation emails. If you do not receive the confirmation email, please check your spam/junk mail filter as it may have been directed there.
CMS added a webinar as part of this national conference call. This feature will allow participants who are on the Internet the ability to follow the presentation online as it is given. This will not have any effect on those participants who are only dialing in to the audio portion of the call.
Please note participants who are not signed into the webinar should download the presentation from the CMS website. CMS would like to thank those of you who will participate in this feature.
To access Adobe Connect Pro Webinar: please use the following URL: https://webinar.CMS.hhs.gov/PQRSandERX– Instructions: Sign in as a “Guest” when prompted – please enter your first and last name.
Please dial in for the call first and then go to Adobe Connect Pro.
If assistance for hearing impaired services is needed the request must be sent to medicare.ttt@palmettogba.com no later than 3 business day before the event.
For those of who will be unable to attend, a transcript and MP3 file of the call will be available at least one week after the call at http://www.cms.hhs.gov/pqri on the CMS website.
Dallas L Alford IV, CPA is a licensed Certified Public Accountant in the state of North Carolina and owner of Atlantic Financial Consulting, a consulting firm that provides comprehensive medical billing services, practice management consulting, coding audits, Medicare compliance, Medicare RAC support and other general medical practice consulting services.
To learn more about Atlantic Financial Consulting you may visit their website at http://atlanticfinancial.us or contact Dallas L Alford IV, CPA directly at 1 888-428-2555, Ext. 200.
EHR Incentive Programs: Stay Informed
Have you registered for the CMS EHR Incentive Programs yet? Registration for the Medicare and Medicaid EHR Incentive Programs has already begun, and providers and hospitals began receiving their Medicaid EHR incentive payments in January. The University of Kentucky Healthcare, the University of Kentucky's teaching hospital, and Central Baptist Hospital became the first hospitals to receive payments, and physicians at the Gastorf Family Clinic in Durant, OK, became the first eligible professionals to collect their initial Medicaid EHR Incentive Program payments.
Not sure if you are eligible to participate in the EHR Incentive Programs? Need help with registration? The Medicare and Medicaid EHR Incentive Programs website features several resources to assist you, including:
The Eligibility Widget – In order to register, you must first find out if you qualify as an eligible professional or eligible hospital. The eligibility widget will walk you step-by-step through the eligibility requirements, letting you know if you qualify for the Medicare or Medicaid EHR Incentive Programs. You can find this resource on the CMS website at http://www.CMS.gov/EHRIncentivePrograms/15_Eligibility.asp.
Information About Registration – To help you prepare, a list of all the information you will need during your registration process is provided for both eligible professionals and eligible hospitals. You can find this resource on the CMS website at http://www.CMS.gov/EHRIncentivePrograms/20_RegistrationandAttestation.asp#BOOKMARK2.
The Eligible Professional Registration Webinar – Are you ready to register? Check out the registration webinar for eligible professionals, which provides video guidance to help you through the registration process. View at http://www.YouTube.com/user/CMSHHSgov#p/u/0/sKngNjd8Iuc.
Hospital Tip Sheets – Located on the EHR Incentive Programs website are helpful tip sheets providing information on payment and eligibility guidelines for Medicare, Medicaid, and Critical Access Hospitals. You can find these resources at http://www.CMS.gov/EHRIncentivePrograms/55_EducationalMaterials.asp.
EHR Listserv – CMS has created a new listserv specifically about the EHR Incentive Programs. The listserv will provide timely, authoritative information about the programs, including registration and attestation updates and details about the payment process. By subscribing to the listserv, you’ll be kept informed of upcoming deadlines and answers to the questions and concerns that we have gathered from eligible professionals and hospitals in the field. New updates will be emailed through the listserv to keep you informed of any developments, and subscribers will be notified of any new FAQs that are published on the CMS EHR Incentive Programs’ website. Sign up at and learn more http://www.CMS.gov/EHRIncentivePrograms/65_CMS_EHR_Listserv.asp.
Learn more about the EHR Incentive Programs and keep up to date at http://www.CMS.gov/EHRIncentivePrograms.
EHR Incentive Programs: Not Sure Where to Start?
Everyone’s talking about the Medicare & Medicare Electronic Health Record Incentive Programs. Not sure what it’s all about? CMS has developed the following tip sheets to get you started. You can view them electronically or order free printed copies.
Payment and Eligibility For Professionals
§ Eligibility Flow Chart
§ Tip Sheet for Eligible Professionals
§ Tip Sheet for Eligible Professionals
§ Medicare EHR Incentive Program, Physician Quality Reporting System, and e-Prescribing Comparison
Payment and Eligibility For Hospitals
Tip Sheet for Medicare Hospitals
Tip Sheet for Critical Access Hospitals
Tip Sheet for Medicaid Hospitals
And for more information, visit the http://www.CMS.gov/EHRIncentivePrograms for the latest news and updates on the EHR Incentive Programs.
Dallas L Alford IV, CPA is a licensed Certified Public Accountant in the state of North Carolina and owner of Atlantic Financial Consulting, a consulting firm that provides comprehensive medical billing services, practice management consulting, coding audits, Medicare compliance, Medicare RAC support and other general medical practice consulting services.
To learn more about Atlantic Financial Consulting you may visit their website at http://atlanticfinancial.us or contact Dallas L Alford IV, CPA directly at 1 888-428-2555, Ext. 200.
Not sure if you are eligible to participate in the EHR Incentive Programs? Need help with registration? The Medicare and Medicaid EHR Incentive Programs website features several resources to assist you, including:
The Eligibility Widget – In order to register, you must first find out if you qualify as an eligible professional or eligible hospital. The eligibility widget will walk you step-by-step through the eligibility requirements, letting you know if you qualify for the Medicare or Medicaid EHR Incentive Programs. You can find this resource on the CMS website at http://www.CMS.gov/EHRIncentivePrograms/15_Eligibility.asp.
Information About Registration – To help you prepare, a list of all the information you will need during your registration process is provided for both eligible professionals and eligible hospitals. You can find this resource on the CMS website at http://www.CMS.gov/EHRIncentivePrograms/20_RegistrationandAttestation.asp#BOOKMARK2.
The Eligible Professional Registration Webinar – Are you ready to register? Check out the registration webinar for eligible professionals, which provides video guidance to help you through the registration process. View at http://www.YouTube.com/user/CMSHHSgov#p/u/0/sKngNjd8Iuc.
Hospital Tip Sheets – Located on the EHR Incentive Programs website are helpful tip sheets providing information on payment and eligibility guidelines for Medicare, Medicaid, and Critical Access Hospitals. You can find these resources at http://www.CMS.gov/EHRIncentivePrograms/55_EducationalMaterials.asp.
EHR Listserv – CMS has created a new listserv specifically about the EHR Incentive Programs. The listserv will provide timely, authoritative information about the programs, including registration and attestation updates and details about the payment process. By subscribing to the listserv, you’ll be kept informed of upcoming deadlines and answers to the questions and concerns that we have gathered from eligible professionals and hospitals in the field. New updates will be emailed through the listserv to keep you informed of any developments, and subscribers will be notified of any new FAQs that are published on the CMS EHR Incentive Programs’ website. Sign up at and learn more http://www.CMS.gov/EHRIncentivePrograms/65_CMS_EHR_Listserv.asp.
Learn more about the EHR Incentive Programs and keep up to date at http://www.CMS.gov/EHRIncentivePrograms.
EHR Incentive Programs: Not Sure Where to Start?
Everyone’s talking about the Medicare & Medicare Electronic Health Record Incentive Programs. Not sure what it’s all about? CMS has developed the following tip sheets to get you started. You can view them electronically or order free printed copies.
Payment and Eligibility For Professionals
§ Eligibility Flow Chart
§ Tip Sheet for Eligible Professionals
§ Tip Sheet for Eligible Professionals
§ Medicare EHR Incentive Program, Physician Quality Reporting System, and e-Prescribing Comparison
Payment and Eligibility For Hospitals
Tip Sheet for Medicare Hospitals
Tip Sheet for Critical Access Hospitals
Tip Sheet for Medicaid Hospitals
And for more information, visit the http://www.CMS.gov/EHRIncentivePrograms for the latest news and updates on the EHR Incentive Programs.
Dallas L Alford IV, CPA is a licensed Certified Public Accountant in the state of North Carolina and owner of Atlantic Financial Consulting, a consulting firm that provides comprehensive medical billing services, practice management consulting, coding audits, Medicare compliance, Medicare RAC support and other general medical practice consulting services.
To learn more about Atlantic Financial Consulting you may visit their website at http://atlanticfinancial.us or contact Dallas L Alford IV, CPA directly at 1 888-428-2555, Ext. 200.
Important Information on the Timely Claims Filing Requirement
The Centers for Medicare & Medicaid Services (CMS) would like to remind Medicare Fee-For-Service physicians, providers and suppliers submitting claims to Medicare for payment, as a result of the Patient Protection and Affordable Care Act (PPACA), effective immediately, all claims for services furnished on or after Jan 1, 2010, must be filed with your Medicare contractor no later than one calendar year (12 months) from the date of service – or Medicare will deny them.
In general, the start date for determining the 1-year timely filing period is the date of service or “From” date on the claim. For institutional claims that include span dates of service (i.e., a “From” and “Through” date on the claim), the “Through” date on the claim is used for determining the date of service for claims filing timeliness. For claims submitted by physicians and other suppliers that include span dates of service, the line item “From” date is used for determining the date of service for claims filing timeliness.
For additional information about the new maximum period for claims submission filing dates, contact your Medicare contractor, or review the MLN Matters articles listed below related to this subject:
§ MM6960 – “Systems Changes Necessary to Implement the Patient Protection and Affordable Care Act (PPACA) Section 6404 - Maximum Period for Submission of Medicare Claims Reduced to Not More Than 12 Months” – http://www.cms.gov/MLNMattersArticles/downloads/MM6960.pdf on the CMS website.
§ MM7080 – “Timely Claims Filing: Additional Instructions” – http://www.cms.gov/MLNMattersArticles/downloads/MM7080.pdf on the CMS website.
§ MM7270 – “Changes to the Time Limits for Filing Medicare Fee-for-Service Claims – http://www.cms.gov/MLNMattersArticles/downloads/MM7270.pdf on the CMS website.
You can also listen to a podcast on this subject by visiting http://www.cms.gov/CMSFeeds/02_listofpodcasts.asp on the CMS website.
Dallas L Alford IV, CPA is a licensed Certified Public Accountant in the state of North Carolina and owner of Atlantic Financial Consulting, a consulting firm that provides comprehensive medical billing services, practice management consulting, coding audits, Medicare compliance, Medicare RAC support and other general medical practice consulting services.
To learn more about Atlantic Financial Consulting you may visit their website at http://atlanticfinancial.us or contact Dallas L Alford IV, CPA directly at 1 888-428-2555, Ext. 200.
In general, the start date for determining the 1-year timely filing period is the date of service or “From” date on the claim. For institutional claims that include span dates of service (i.e., a “From” and “Through” date on the claim), the “Through” date on the claim is used for determining the date of service for claims filing timeliness. For claims submitted by physicians and other suppliers that include span dates of service, the line item “From” date is used for determining the date of service for claims filing timeliness.
For additional information about the new maximum period for claims submission filing dates, contact your Medicare contractor, or review the MLN Matters articles listed below related to this subject:
§ MM6960 – “Systems Changes Necessary to Implement the Patient Protection and Affordable Care Act (PPACA) Section 6404 - Maximum Period for Submission of Medicare Claims Reduced to Not More Than 12 Months” – http://www.cms.gov/MLNMattersArticles/downloads/MM6960.pdf on the CMS website.
§ MM7080 – “Timely Claims Filing: Additional Instructions” – http://www.cms.gov/MLNMattersArticles/downloads/MM7080.pdf on the CMS website.
§ MM7270 – “Changes to the Time Limits for Filing Medicare Fee-for-Service Claims – http://www.cms.gov/MLNMattersArticles/downloads/MM7270.pdf on the CMS website.
You can also listen to a podcast on this subject by visiting http://www.cms.gov/CMSFeeds/02_listofpodcasts.asp on the CMS website.
Dallas L Alford IV, CPA is a licensed Certified Public Accountant in the state of North Carolina and owner of Atlantic Financial Consulting, a consulting firm that provides comprehensive medical billing services, practice management consulting, coding audits, Medicare compliance, Medicare RAC support and other general medical practice consulting services.
To learn more about Atlantic Financial Consulting you may visit their website at http://atlanticfinancial.us or contact Dallas L Alford IV, CPA directly at 1 888-428-2555, Ext. 200.
2011 Electronic Prescribing (eRx) Incentive Program Reminder-Avoiding the Adjustment
In November, the Centers for Medicare & Medicaid Services announced that, beginning in calendar year 2012, eligible professionals who are not successful electronic prescribers based on claims submitted between January 1, 2011 – June 30, 2011, may be subject to a payment adjustment on their Medicare Part B Physician Fee Schedule (PFS) covered professional services. Section 132 of the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA) authorizes CMS to apply this payment adjustment whether or not the eligible professional is planning to participate in the eRx Incentive Program.
From 2012 through 2014, the payment adjustment will increase each calendar year. In 2012, the payment adjustment for not being a successful electronic prescriber will result in an eligible professional or group practice receiving 99% of their Medicare Part B PFS amount that would otherwise apply to such services. In 2013, an eligible professional or group practice will receive 98.5% of their Medicare Part B PFS covered professional services for not being a successful electronic prescriber in 2011 or as defined in a future regulation. In 2014, the payment adjustment for not being a successful electronic prescriber is 2%, resulting in an eligible professional or group practice receiving 98% of their Medicare Part B PFS covered professional services.
The payment adjustment does not apply if <10% of an eligible professional’s (or group practice’s) allowed charges for the January 1, 2011 through June 30, 2011 reporting period are comprised of codes in the denominator of the 2011 eRx measure. Please note that earning an eRx incentive for 2011 will NOT necessarily exempt an eligible professional or group practice from the payment adjustment in 2012. How to Avoid the 2012 eRx Payment Adjustment · Eligible professionals – An eligible professional can avoid the 2012 eRx Payment Adjustment if (s)he: Is not a physician (MD, DO, or podiatrist), nurse practitioner, or physician assistant as of Jun 30, 2011 based on primary taxonomy code in NPPES; Does not have prescribing privileges. Note: (S)he must report (G8644) at least one time on an eligible claim prior to June 30, 2011; Does not have at least 100 cases containing an encounter code in the measure denominator; Becomes a successful e-prescriber; and Reports the eRx measure for at least 10 unique eRx events for patients in the denominator of the measure. · Group Practices - For group practices that are participating in eRx GPRO I or GPRO II during 2011, the group practice MUST become a successful e-prescriber. Depending on the group’s size, the group practice must report the eRx measure for 75-2,500 unique eRx events for patients in the denominator of the measure. For additional information, please visit the “Getting Started” webpage at http://www.cms.gov/erxincentive on the CMS website for more information; or download the Medicare’s Practical Guide to the Electronic Prescribing (eRx) Incentive Program under Educational Resources. Dallas L Alford IV, CPA is a licensed Certified Public Accountant in the state of North Carolina and owner of Atlantic Financial Consulting, a consulting firm that provides comprehensive medical billing services, practice management consulting, coding audits, Medicare compliance, Medicare RAC support and other general medical practice consulting services. To learn more about Atlantic Financial Consulting you may visit their website at http://atlanticfinancial.us or contact Dallas L Alford IV, CPA directly at 1 888-428-2555, Ext. 200.
From 2012 through 2014, the payment adjustment will increase each calendar year. In 2012, the payment adjustment for not being a successful electronic prescriber will result in an eligible professional or group practice receiving 99% of their Medicare Part B PFS amount that would otherwise apply to such services. In 2013, an eligible professional or group practice will receive 98.5% of their Medicare Part B PFS covered professional services for not being a successful electronic prescriber in 2011 or as defined in a future regulation. In 2014, the payment adjustment for not being a successful electronic prescriber is 2%, resulting in an eligible professional or group practice receiving 98% of their Medicare Part B PFS covered professional services.
The payment adjustment does not apply if <10% of an eligible professional’s (or group practice’s) allowed charges for the January 1, 2011 through June 30, 2011 reporting period are comprised of codes in the denominator of the 2011 eRx measure. Please note that earning an eRx incentive for 2011 will NOT necessarily exempt an eligible professional or group practice from the payment adjustment in 2012. How to Avoid the 2012 eRx Payment Adjustment · Eligible professionals – An eligible professional can avoid the 2012 eRx Payment Adjustment if (s)he: Is not a physician (MD, DO, or podiatrist), nurse practitioner, or physician assistant as of Jun 30, 2011 based on primary taxonomy code in NPPES; Does not have prescribing privileges. Note: (S)he must report (G8644) at least one time on an eligible claim prior to June 30, 2011; Does not have at least 100 cases containing an encounter code in the measure denominator; Becomes a successful e-prescriber; and Reports the eRx measure for at least 10 unique eRx events for patients in the denominator of the measure. · Group Practices - For group practices that are participating in eRx GPRO I or GPRO II during 2011, the group practice MUST become a successful e-prescriber. Depending on the group’s size, the group practice must report the eRx measure for 75-2,500 unique eRx events for patients in the denominator of the measure. For additional information, please visit the “Getting Started” webpage at http://www.cms.gov/erxincentive on the CMS website for more information; or download the Medicare’s Practical Guide to the Electronic Prescribing (eRx) Incentive Program under Educational Resources. Dallas L Alford IV, CPA is a licensed Certified Public Accountant in the state of North Carolina and owner of Atlantic Financial Consulting, a consulting firm that provides comprehensive medical billing services, practice management consulting, coding audits, Medicare compliance, Medicare RAC support and other general medical practice consulting services. To learn more about Atlantic Financial Consulting you may visit their website at http://atlanticfinancial.us or contact Dallas L Alford IV, CPA directly at 1 888-428-2555, Ext. 200.
Friday, February 18, 2011
Sessions on ICD-10 at the 2011 Healthcare Information Management and Systems Society (HIMSS) National Conference
Attending the 2011 HIMSS Annual Conference and Exhibition, February 20-24, 2011? If so, be sure to check out the sessions on ICD-10, including a day-long symposium on ICD-10 and Version 5010 on Sunday, February 20, 2011. The ICD-10 symposium and subsequent sessions at the conference will feature presentations by the Centers for Medicare & Medicaid Services (CMS) and healthcare industry stakeholder groups.
Below is a preview of the CMS sessions on ICD-10 at HIMSS:
SUNDAY, FEBRUARY 20, 2011
5010 & ICD-10 SYMPOSIUM: KEEPING AHEAD OF THE CURVE
CMS – State of the 5010 World
8:30am – 9:30am
Christine Stahlecker, MBA, Director, CMS, will present an overview of the state of HIPAA 5010, including review of program positives, program challenges, developing risks and remediation approaches. Comments concerning training and regulatory challenges that CMS sees emerging in the industry will also be discussed.
CMS – State of the ICD-10 World
4:30pm to 5:30pm
Robert Anthony, Health Insurance Specialist, CMS, will present an overview of the state of ICD-10, including review of program positives, program challenges, developing risks and remediation approaches.
TUESDAY, FEBRUARY 22, 2011
ICD-10: A CMS Update
1:00pm to 2:00pm; Room 308 A, Event 110
Karen Trudel, Acting Director, Office of E-Health Standards and Services, CMS will discuss the latest information about the U.S. health care industry's change from ICD-9 to ICD-10 for medical diagnosis and inpatient procedure coding.
Check out the HIMSS agenda today for more information on ICD-10 sessions:
http://www.himssconference.org/docs/HIMSS11FULLbrochure.pdf
Be sure to visit us at booth# 706 for additional information on ICD-10!
Keep Up to Date on Version 5010 and ICD-10.
Please visit www.cms.gov/icd10 for the latest news and resources to help you prepare!
Version 5010 and ICD-10 are coming. Will you be ready?
Dallas L Alford IV, CPA is a licensed Certified Public Accountant in the state of North Carolina and owner of Atlantic Financial Consulting, a consulting firm that provides comprehensive medical billing services, practice management consulting, coding audits, Medicare compliance, Medicare RAC support and other general medical practice consulting services.
To learn more about Atlantic Financial Consulting you may visit their website at http://atlanticfinancial.us or contact Dallas L Alford IV, CPA directly at 1 888-428-2555, Ext. 200.
Below is a preview of the CMS sessions on ICD-10 at HIMSS:
SUNDAY, FEBRUARY 20, 2011
5010 & ICD-10 SYMPOSIUM: KEEPING AHEAD OF THE CURVE
CMS – State of the 5010 World
8:30am – 9:30am
Christine Stahlecker, MBA, Director, CMS, will present an overview of the state of HIPAA 5010, including review of program positives, program challenges, developing risks and remediation approaches. Comments concerning training and regulatory challenges that CMS sees emerging in the industry will also be discussed.
CMS – State of the ICD-10 World
4:30pm to 5:30pm
Robert Anthony, Health Insurance Specialist, CMS, will present an overview of the state of ICD-10, including review of program positives, program challenges, developing risks and remediation approaches.
TUESDAY, FEBRUARY 22, 2011
ICD-10: A CMS Update
1:00pm to 2:00pm; Room 308 A, Event 110
Karen Trudel, Acting Director, Office of E-Health Standards and Services, CMS will discuss the latest information about the U.S. health care industry's change from ICD-9 to ICD-10 for medical diagnosis and inpatient procedure coding.
Check out the HIMSS agenda today for more information on ICD-10 sessions:
http://www.himssconference.org/docs/HIMSS11FULLbrochure.pdf
Be sure to visit us at booth# 706 for additional information on ICD-10!
Keep Up to Date on Version 5010 and ICD-10.
Please visit www.cms.gov/icd10 for the latest news and resources to help you prepare!
Version 5010 and ICD-10 are coming. Will you be ready?
Dallas L Alford IV, CPA is a licensed Certified Public Accountant in the state of North Carolina and owner of Atlantic Financial Consulting, a consulting firm that provides comprehensive medical billing services, practice management consulting, coding audits, Medicare compliance, Medicare RAC support and other general medical practice consulting services.
To learn more about Atlantic Financial Consulting you may visit their website at http://atlanticfinancial.us or contact Dallas L Alford IV, CPA directly at 1 888-428-2555, Ext. 200.
Important Information on the Timely Claims Filing Requirement
The Centers for Medicare & Medicaid Services (CMS) would like to remind Medicare Fee-For-Service physicians, providers and suppliers submitting claims to Medicare for payment, as a result of the Patient Protection and Affordable Care Act (PPACA), effective immediately, all claims for services furnished on or after January 1, 2010, must be filed with your Medicare contractor no later than one calendar year (12 months) from the date of service – or Medicare will deny them.
In general, the start date for determining the 1-year timely filing period is the date of service or “From” date on the claim. For institutional claims that include span dates of service (i.e., a “From” and “Through” date on the claim), the “Through” date on the claim is used for determining the date of service for claims filing timeliness. For claims submitted by physicians and other suppliers that include span dates of service, the line item “From” date is used for determining the date of service for claims filing timeliness.
For additional information about the new maximum period for claims submission filing dates, contact your Medicare contractor, or review the MLN Matters articles listed below related to this subject:
§ MM6960 – “Systems Changes Necessary to Implement the Patient Protection and Affordable Care Act (PPACA) Section 6404 - Maximum Period for Submission of Medicare Claims Reduced to Not More Than 12 Months” – http://www.cms.gov/MLNMattersArticles/downloads/MM6960.pdf on the CMS website.
§ MM7080 – “Timely Claims Filing: Additional Instructions” – http://www.cms.gov/MLNMattersArticles/downloads/MM7080.pdf on the CMS website.
§ MM7270 – “Changes to the Time Limits for Filing Medicare Fee-for-Service Claims – http://www.cms.gov/MLNMattersArticles/downloads/MM7270.pdf on the CMS website.
You can also listen to a podcast on this subject by visiting http://www.cms.gov/CMSFeeds/02_listofpodcasts.asp on the CMS website.
Dallas L Alford IV, CPA is a licensed Certified Public Accountant in the state of North Carolina and owner of Atlantic Financial Consulting, a consulting firm that provides comprehensive medical billing services, practice management consulting, coding audits, Medicare compliance, Medicare RAC support and other general medical practice consulting services.
To learn more about Atlantic Financial Consulting you may visit their website at http://atlanticfinancial.us or contact Dallas L Alford IV, CPA directly at 1 888-428-2555, Ext. 200.
In general, the start date for determining the 1-year timely filing period is the date of service or “From” date on the claim. For institutional claims that include span dates of service (i.e., a “From” and “Through” date on the claim), the “Through” date on the claim is used for determining the date of service for claims filing timeliness. For claims submitted by physicians and other suppliers that include span dates of service, the line item “From” date is used for determining the date of service for claims filing timeliness.
For additional information about the new maximum period for claims submission filing dates, contact your Medicare contractor, or review the MLN Matters articles listed below related to this subject:
§ MM6960 – “Systems Changes Necessary to Implement the Patient Protection and Affordable Care Act (PPACA) Section 6404 - Maximum Period for Submission of Medicare Claims Reduced to Not More Than 12 Months” – http://www.cms.gov/MLNMattersArticles/downloads/MM6960.pdf on the CMS website.
§ MM7080 – “Timely Claims Filing: Additional Instructions” – http://www.cms.gov/MLNMattersArticles/downloads/MM7080.pdf on the CMS website.
§ MM7270 – “Changes to the Time Limits for Filing Medicare Fee-for-Service Claims – http://www.cms.gov/MLNMattersArticles/downloads/MM7270.pdf on the CMS website.
You can also listen to a podcast on this subject by visiting http://www.cms.gov/CMSFeeds/02_listofpodcasts.asp on the CMS website.
Dallas L Alford IV, CPA is a licensed Certified Public Accountant in the state of North Carolina and owner of Atlantic Financial Consulting, a consulting firm that provides comprehensive medical billing services, practice management consulting, coding audits, Medicare compliance, Medicare RAC support and other general medical practice consulting services.
To learn more about Atlantic Financial Consulting you may visit their website at http://atlanticfinancial.us or contact Dallas L Alford IV, CPA directly at 1 888-428-2555, Ext. 200.
Thursday, February 17, 2011
2011 Electronic Prescribing (eRx) Incentive Program Reminder-Avoiding the Adjustment
In November, the Centers for Medicare & Medicaid Services announced that, beginning in calendar year 2012, eligible professionals who are not successful electronic prescribers based on claims submitted between January 1, 2011 – June 30, 2011, may be subject to a payment adjustment on their Medicare Part B Physician Fee Schedule (PFS) covered professional services. Section 132 of the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA) authorizes CMS to apply this payment adjustment whether or not the eligible professional is planning to participate in the eRx Incentive Program.
From 2012 through 2014, the payment adjustment will increase each calendar year. In 2012, the payment adjustment for not being a successful electronic prescriber will result in an eligible professional or group practice receiving 99% of their Medicare Part B PFS amount that would otherwise apply to such services. In 2013, an eligible professional or group practice will receive 98.5% of their Medicare Part B PFS covered professional services for not being a successful electronic prescriber in 2011 or as defined in a future regulation. In 2014, the payment adjustment for not being a successful electronic prescriber is 2%, resulting in an eligible professional or group practice receiving 98% of their Medicare Part B PFS covered professional services.
The payment adjustment does not apply if <10% of an eligible professional’s (or group practice’s) allowed charges for the January 1, 2011 through June 30, 2011 reporting period are comprised of codes in the denominator of the 2011 eRx measure. Please note that earning an eRx incentive for 2011 will NOT necessarily exempt an eligible professional or group practice from the payment adjustment in 2012. How to Avoid the 2012 eRx Payment Adjustment · Eligible professionals – An eligible professional can avoid the 2012 eRx Payment Adjustment if (s)he: Is not a physician (MD, DO, or podiatrist), nurse practitioner, or physician assistant as of Jun 30, 2011 based on primary taxonomy code in NPPES; Does not have prescribing privileges. Note: (S)he must report (G8644) at least one time on an eligible claim prior to June 30, 2011; Does not have at least 100 cases containing an encounter code in the measure denominator; Becomes a successful e-prescriber; and Reports the eRx measure for at least 10 unique eRx events for patients in the denominator of the measure. · Group Practices - For group practices that are participating in eRx GPRO I or GPRO II during 2011, the group practice MUST become a successful e-prescriber. Depending on the group’s size, the group practice must report the eRx measure for 75-2,500 unique eRx events for patients in the denominator of the measure. For additional information, please visit the “Getting Started” webpage at http://www.cms.gov/erxincentive on the CMS website for more information; or download the Medicare’s Practical Guide to the Electronic Prescribing (eRx) Incentive Program under Educational Resources. Dallas L Alford IV, CPA is a licensed Certified Public Accountant in the state of North Carolina and owner of Atlantic Financial Consulting, a consulting firm that provides comprehensive medical billing services, practice management consulting, coding audits, Medicare compliance, Medicare RAC support and other general medical practice consulting services. To learn more about Atlantic Financial Consulting you may visit their website at http://atlanticfinancial.us or contact Dallas L Alford IV, CPA directly at 1 888-428-2555, Ext. 200.
From 2012 through 2014, the payment adjustment will increase each calendar year. In 2012, the payment adjustment for not being a successful electronic prescriber will result in an eligible professional or group practice receiving 99% of their Medicare Part B PFS amount that would otherwise apply to such services. In 2013, an eligible professional or group practice will receive 98.5% of their Medicare Part B PFS covered professional services for not being a successful electronic prescriber in 2011 or as defined in a future regulation. In 2014, the payment adjustment for not being a successful electronic prescriber is 2%, resulting in an eligible professional or group practice receiving 98% of their Medicare Part B PFS covered professional services.
The payment adjustment does not apply if <10% of an eligible professional’s (or group practice’s) allowed charges for the January 1, 2011 through June 30, 2011 reporting period are comprised of codes in the denominator of the 2011 eRx measure. Please note that earning an eRx incentive for 2011 will NOT necessarily exempt an eligible professional or group practice from the payment adjustment in 2012. How to Avoid the 2012 eRx Payment Adjustment · Eligible professionals – An eligible professional can avoid the 2012 eRx Payment Adjustment if (s)he: Is not a physician (MD, DO, or podiatrist), nurse practitioner, or physician assistant as of Jun 30, 2011 based on primary taxonomy code in NPPES; Does not have prescribing privileges. Note: (S)he must report (G8644) at least one time on an eligible claim prior to June 30, 2011; Does not have at least 100 cases containing an encounter code in the measure denominator; Becomes a successful e-prescriber; and Reports the eRx measure for at least 10 unique eRx events for patients in the denominator of the measure. · Group Practices - For group practices that are participating in eRx GPRO I or GPRO II during 2011, the group practice MUST become a successful e-prescriber. Depending on the group’s size, the group practice must report the eRx measure for 75-2,500 unique eRx events for patients in the denominator of the measure. For additional information, please visit the “Getting Started” webpage at http://www.cms.gov/erxincentive on the CMS website for more information; or download the Medicare’s Practical Guide to the Electronic Prescribing (eRx) Incentive Program under Educational Resources. Dallas L Alford IV, CPA is a licensed Certified Public Accountant in the state of North Carolina and owner of Atlantic Financial Consulting, a consulting firm that provides comprehensive medical billing services, practice management consulting, coding audits, Medicare compliance, Medicare RAC support and other general medical practice consulting services. To learn more about Atlantic Financial Consulting you may visit their website at http://atlanticfinancial.us or contact Dallas L Alford IV, CPA directly at 1 888-428-2555, Ext. 200.
Wednesday, February 16, 2011
2011 Physician Quality Reporting System & Electronic Prescribing Incentive Program National Provider Call with Question & Answer Session
The Centers for Medicare & Medicaid Services’ (CMS) Provider Communications Group will host a national provider conference call on the 2011 Physician Quality Reporting System and Electronic Prescribing (eRx) Incentive Program. This toll-free call will take place from 2:30 p.m. – 4:00 p.m. EST on Tuesday, February 15, 2011.
The Physician Quality Reporting System is voluntary quality reporting program that provides an incentive payment to identified individual eligible professionals (EPs) and group practices who satisfactorily report data on quality measures for covered Physician Fee Schedule (PFS) services furnished to Medicare Part B Fee-For-Service (FFS) beneficiaries.
The Physician Quality Reporting System was first implemented in 2007 as a result of section 101 of the Tax Relief and Health Care Act of 2006 (TRHCA), and further expanded as a result of the Medicare, Medicaid, and SCHIP Extension Act of 2007 (MMSEA), and the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA).
The eRx Incentive Program is an incentive program initially implemented in 2009 as a result of section 132(b) of the MIPPA. The eRx Incentive Program promotes the adoption and use of eRx systems by individual eligible professionals and group practices.
Following the formal presentation that will cover the following:
Electronic Health Record (EHR) Reporting Made Simple; and
eRx Future Payment Adjustment.
The lines will be opened to allow participants to ask questions of CMS Physician Quality Reporting System and eRx subject matter experts.
A PowerPoint slide presentation is posted to the Physician Quality Reporting System webpage at,http://www.cms.gov/PQRI/04_CMSSponsoredCalls.asp on the CMS website for you to download prior to the call so that you can follow along with the presenter.
Educational products are available on the Physician Quality Reporting System dedicated web page located at,http://www.cms.gov/PQRI , on the CMS website, in the Educational Resources section, as well as educational products are available on the eRx Incentive Program dedicated web page located at http://www.cms.gov/ERxIncentive on the CMS website. Feel free to download the resources prior to the call so that you may ask questions of the CMS presenters.
Conference call details:
Date: February 15, 2011
Conference Title: Physician Quality Reporting System (PQRS) & Electronic Prescribing Incentive Program National Provider Call
Time: 2:30 p.m. EST
In order to receive the call-in information, you must register for the call. It is important to note that if you are planning to sit in with a group, only one person needs to register to receive the call-in data. This registration is solely to reserve a phone line, NOT to allow participation. Registration will close at 2:30 p.m. EST on February 14, 2011, or when available space has been filled. No exceptions will be made, so please be sure to register prior to this time.
To register for the call participants need to go to:
http://www.eventsvc.com/palmettogba/021511
Fill in all required data.
Verify that your time zone is displayed correctly in the drop down box.
Click "Register".
You will be taken to the “Thank you for registering” page and will receive a confirmation email shortly thereafter. Note: Please print and save this page, in the event that your server blocks the confirmation emails. If you do not receive the confirmation email, please check your spam/junk mail filter as it may have been directed there.
If assistance for hearing impaired services is needed the request must be sent to medicare.ttt@palmettogba.com no later than 3 business day before the event
Dallas L Alford IV, CPA is a licensed Certified Public Accountant in the state of North Carolina and owner of Atlantic Financial Consulting, a consulting firm that provides comprehensive medical billing services, practice management consulting, coding audits, Medicare compliance, Medicare RAC support and other general medical practice consulting services.
To learn more about Atlantic Financial Consulting you may visit their website at http://atlanticfinancial.us or contact Dallas L Alford IV, CPA directly at 1 888-428-2555, Ext. 200.
The Physician Quality Reporting System is voluntary quality reporting program that provides an incentive payment to identified individual eligible professionals (EPs) and group practices who satisfactorily report data on quality measures for covered Physician Fee Schedule (PFS) services furnished to Medicare Part B Fee-For-Service (FFS) beneficiaries.
The Physician Quality Reporting System was first implemented in 2007 as a result of section 101 of the Tax Relief and Health Care Act of 2006 (TRHCA), and further expanded as a result of the Medicare, Medicaid, and SCHIP Extension Act of 2007 (MMSEA), and the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA).
The eRx Incentive Program is an incentive program initially implemented in 2009 as a result of section 132(b) of the MIPPA. The eRx Incentive Program promotes the adoption and use of eRx systems by individual eligible professionals and group practices.
Following the formal presentation that will cover the following:
Electronic Health Record (EHR) Reporting Made Simple; and
eRx Future Payment Adjustment.
The lines will be opened to allow participants to ask questions of CMS Physician Quality Reporting System and eRx subject matter experts.
A PowerPoint slide presentation is posted to the Physician Quality Reporting System webpage at,http://www.cms.gov/PQRI/04_CMSSponsoredCalls.asp on the CMS website for you to download prior to the call so that you can follow along with the presenter.
Educational products are available on the Physician Quality Reporting System dedicated web page located at,http://www.cms.gov/PQRI , on the CMS website, in the Educational Resources section, as well as educational products are available on the eRx Incentive Program dedicated web page located at http://www.cms.gov/ERxIncentive on the CMS website. Feel free to download the resources prior to the call so that you may ask questions of the CMS presenters.
Conference call details:
Date: February 15, 2011
Conference Title: Physician Quality Reporting System (PQRS) & Electronic Prescribing Incentive Program National Provider Call
Time: 2:30 p.m. EST
In order to receive the call-in information, you must register for the call. It is important to note that if you are planning to sit in with a group, only one person needs to register to receive the call-in data. This registration is solely to reserve a phone line, NOT to allow participation. Registration will close at 2:30 p.m. EST on February 14, 2011, or when available space has been filled. No exceptions will be made, so please be sure to register prior to this time.
To register for the call participants need to go to:
http://www.eventsvc.com/palmettogba/021511
Fill in all required data.
Verify that your time zone is displayed correctly in the drop down box.
Click "Register".
You will be taken to the “Thank you for registering” page and will receive a confirmation email shortly thereafter. Note: Please print and save this page, in the event that your server blocks the confirmation emails. If you do not receive the confirmation email, please check your spam/junk mail filter as it may have been directed there.
If assistance for hearing impaired services is needed the request must be sent to medicare.ttt@palmettogba.com no later than 3 business day before the event
Dallas L Alford IV, CPA is a licensed Certified Public Accountant in the state of North Carolina and owner of Atlantic Financial Consulting, a consulting firm that provides comprehensive medical billing services, practice management consulting, coding audits, Medicare compliance, Medicare RAC support and other general medical practice consulting services.
To learn more about Atlantic Financial Consulting you may visit their website at http://atlanticfinancial.us or contact Dallas L Alford IV, CPA directly at 1 888-428-2555, Ext. 200.
Sunday, February 13, 2011
“CMS Email Subscription Service” Publication Available in Print
The educational tool titled “CMS Email Subscription Service” (revised October 2010), which provides education on the various CMS Fee-For-Service (FFS) electronic mailing lists, is now available in print format from the Medicare Learning Network® (MLN). To place your order, visit http://www.CMS.gov/MLNGenInfo, scroll down to “Related Links Inside CMS,” and select “MLN Product Ordering Page.”
Dallas L Alford IV, CPA is a licensed Certified Public Accountant in the state of North Carolina and owner of Atlantic Financial Consulting, a consulting firm that provides comprehensive medical billing services, practice management consulting, coding audits, Medicare compliance, Medicare RAC support and other general medical practice consulting services.
To learn more about Atlantic Financial Consulting you may visit their website at http://atlanticfinancial.us or contact Dallas L Alford IV, CPA directly at 1 888-428-2555, Ext. 200.
Dallas L Alford IV, CPA is a licensed Certified Public Accountant in the state of North Carolina and owner of Atlantic Financial Consulting, a consulting firm that provides comprehensive medical billing services, practice management consulting, coding audits, Medicare compliance, Medicare RAC support and other general medical practice consulting services.
To learn more about Atlantic Financial Consulting you may visit their website at http://atlanticfinancial.us or contact Dallas L Alford IV, CPA directly at 1 888-428-2555, Ext. 200.
“The 2007 Physician Quality Reporting Initiative” Publication
A new Medicare Learning Network® publication titled “The 2007 Physician Quality Reporting Initiative (PQRI)” (November 2010) is now available in downloadable format at http://www.CMS.gov/MLNProducts/downloads/PQRIbooklet012811-ICN905743.pdf. This booklet is a compilation of CMS’s various educational resources relevant to the 2007 Physician Quality Reporting Initiative.
Dallas L Alford IV, CPA is a licensed Certified Public Accountant in the state of North Carolina and owner of Atlantic Financial Consulting, a consulting firm that provides comprehensive medical billing services, practice management consulting, coding audits, Medicare compliance, Medicare RAC support and other general medical practice consulting services.
To learn more about Atlantic Financial Consulting you may visit their website at http://atlanticfinancial.us or contact Dallas L Alford IV, CPA directly at 1 888-428-2555, Ext. 200.
Dallas L Alford IV, CPA is a licensed Certified Public Accountant in the state of North Carolina and owner of Atlantic Financial Consulting, a consulting firm that provides comprehensive medical billing services, practice management consulting, coding audits, Medicare compliance, Medicare RAC support and other general medical practice consulting services.
To learn more about Atlantic Financial Consulting you may visit their website at http://atlanticfinancial.us or contact Dallas L Alford IV, CPA directly at 1 888-428-2555, Ext. 200.
“Evaluation and Management Services Guide” Publication Revised
The publication titled “Evaluation and Management Services Guide” (revised December 2010) is now available in downloadable format from the Medicare Learning Network® at http://www.CMS.gov/MLNProducts/downloads/eval_mgmt_serv_guide-ICN006764.pdf. This guide is designed to provide education on medical record documentation and evaluation and management billing and coding considerations. The “1995 Documentation Guidelines for Evaluation and Management Services” and the “1997 Documentation Guidelines for Evaluation and Management Services” are included in this publication.
Dallas L Alford IV, CPA is a licensed Certified Public Accountant in the state of North Carolina and owner of Atlantic Financial Consulting, a consulting firm that provides comprehensive medical billing services, practice management consulting, coding audits, Medicare compliance, Medicare RAC support and other general medical practice consulting services.
To learn more about Atlantic Financial Consulting you may visit their website at http://atlanticfinancial.us or contact Dallas L Alford IV, CPA directly at 1 888-428-2555, Ext. 200.
Dallas L Alford IV, CPA is a licensed Certified Public Accountant in the state of North Carolina and owner of Atlantic Financial Consulting, a consulting firm that provides comprehensive medical billing services, practice management consulting, coding audits, Medicare compliance, Medicare RAC support and other general medical practice consulting services.
To learn more about Atlantic Financial Consulting you may visit their website at http://atlanticfinancial.us or contact Dallas L Alford IV, CPA directly at 1 888-428-2555, Ext. 200.
“Understanding the Remittance Advice: A Guide for Medicare Providers, Physicians, Suppliers and Billers” Publication Revised
The publication titled “Understanding the Remittance Advice: A Guide for Medicare Providers, Physicians, Suppliers and Billers” (revised October 2010) is designed to educate institutional and professional providers who bill Medicare with general remittance advice (RA) information. It includes instructions to help you interpret the RA received from Medicare and reconcile it against submitted claims and provides guidance on how to read Electronic Remittance Advices (ERAs) and Standard Paper Remittance Advices (SPRs), as well as information on balancing an RA. This publication may be downloaded from http://www.CMS.gov/MLNProducts/downloads/RA_Guide_Full_03-22-06.pdf.
Dallas L Alford IV, CPA is a licensed Certified Public Accountant in the state of North Carolina and owner of Atlantic Financial Consulting, a consulting firm that provides comprehensive medical billing services, practice management consulting, coding audits, Medicare compliance, Medicare RAC support and other general medical practice consulting services.
To learn more about Atlantic Financial Consulting you may visit their website at http://atlanticfinancial.us or contact Dallas L Alford IV, CPA directly at 1 888-428-2555, Ext. 200.
Dallas L Alford IV, CPA is a licensed Certified Public Accountant in the state of North Carolina and owner of Atlantic Financial Consulting, a consulting firm that provides comprehensive medical billing services, practice management consulting, coding audits, Medicare compliance, Medicare RAC support and other general medical practice consulting services.
To learn more about Atlantic Financial Consulting you may visit their website at http://atlanticfinancial.us or contact Dallas L Alford IV, CPA directly at 1 888-428-2555, Ext. 200.
“HIPAA EDI Standards” Web-Based Training Revised
The Medicare Learning Network® is now offering the revised “HIPAA EDI Standards” web-based training (revised January 2011) for CE credit. The goal of this activity is to provide information to physicians, suppliers, and healthcare professionals regarding electronic billing and other healthcare electronic transactions such as the Administrative Simplification provisions of HIPAA, electronic transaction standards and code sets required by HIPAA, and an overview of the steps involved in the Medicare electronic data interchange process. To take this training, visit http://www.CMS.gov/MLNProducts
and click on “Web-Based Training Modules” under “Related Links Inside CMS.”
Dallas L Alford IV, CPA is a licensed Certified Public Accountant in the state of North Carolina and owner of Atlantic Financial Consulting, a consulting firm that provides comprehensive medical billing services, practice management consulting, coding audits, Medicare compliance, Medicare RAC support and other general medical practice consulting services.
To learn more about Atlantic Financial Consulting you may visit their website at http://atlanticfinancial.us or contact Dallas L Alford IV, CPA directly at 1 888-428-2555, Ext. 200.
and click on “Web-Based Training Modules” under “Related Links Inside CMS.”
Dallas L Alford IV, CPA is a licensed Certified Public Accountant in the state of North Carolina and owner of Atlantic Financial Consulting, a consulting firm that provides comprehensive medical billing services, practice management consulting, coding audits, Medicare compliance, Medicare RAC support and other general medical practice consulting services.
To learn more about Atlantic Financial Consulting you may visit their website at http://atlanticfinancial.us or contact Dallas L Alford IV, CPA directly at 1 888-428-2555, Ext. 200.
“Publications For Your Medicare Beneficiaries” Factsheet
New! The Medicare Learning Network® (MLN) has released a new product titled “Publications For Your Medicare Beneficiaries.” This factsheet lists a variety of beneficiary-related publications available to assist providers in responding to patients’ questions related to Medicare, all of which can be printed and provided to patients. This product is available in downloadable format at http://www.CMS.gov/MLNProducts/downloads/BenePubFS-ICN905183.pdf and is suggested for all providers.
Dallas L Alford IV, CPA is a licensed Certified Public Accountant in the state of North Carolina and owner of Atlantic Financial Consulting, a consulting firm that provides comprehensive medical billing services, practice management consulting, coding audits, Medicare compliance, Medicare RAC support and other general medical practice consulting services.
To learn more about Atlantic Financial Consulting you may visit their website at http://atlanticfinancial.us or contact Dallas L Alford IV, CPA directly at 1 888-428-2555, Ext. 200.
Dallas L Alford IV, CPA is a licensed Certified Public Accountant in the state of North Carolina and owner of Atlantic Financial Consulting, a consulting firm that provides comprehensive medical billing services, practice management consulting, coding audits, Medicare compliance, Medicare RAC support and other general medical practice consulting services.
To learn more about Atlantic Financial Consulting you may visit their website at http://atlanticfinancial.us or contact Dallas L Alford IV, CPA directly at 1 888-428-2555, Ext. 200.
Friday, February 11, 2011
Uninsured Americans with Pre-existing Conditions Continue to Gain Coverage through Affordable Care Act
New resources available to increase awareness of new program for the uninsured
The U.S. Department of Health and Human Services (HHS) today made new resources available to the media, consumer groups, states, health care providers, and others to increase awareness of the Pre-existing Condition Insurance Plan (PCIP), a health plan for uninsured Americans with pre-existing conditions created by the Affordable Care Act.
Americans continue to enroll in the plan, which was created in 2010 to provide comprehensive health coverage – at the same price that otherwise healthy people pay – for uninsured Americans living with such conditions as cancer, diabetes, or heart disease who have been unable to obtain affordable health insurance coverage.
This temporary program covers a broad range of health benefits and is designed as a bridge for people with pre-existing conditions who cannot obtain health insurance coverage in today’s private insurance market. In 2014, all Americans – regardless of their health status – will have access to affordable coverage either through their employer or through a new competitive marketplace, and insurers will be prohibited from denying coverage to anyone based on their health status.
The Department is actively working with states, consumer groups, chronic disease organizations, health care providers, social workers, other federal agencies, and the insurance industry to promote the plan, including holding meetings with state officials, consumer groups, and others. New resources that are available to communities to help inform eligible Americans of the plan include a new web badge that links to PCIP.gov, as well as a new newsletter and website drop-in language that partners can use in their outreach efforts.
HHS’ Center for Consumer Information and Insurance Oversight is also working with the U.S. Social Security Administration (SSA) on a comprehensive outreach campaign, putting information about the plan in the approximately 3.2 million social security disability insurance application receipts distributed each year. SSA is also promoting the Pre-existing Condition Insurance Plan in its advocate newsletter, its website, and on TVs in the waiting rooms of SSA’s more than 600 field offices.
Resources available to consumer groups, media, states and others include:
• PCIP.gov – This website offers information about eligibility, benefits and more. Consumers can find online and print applications for the plan in their state. FAQs are also available to help both organizations and consumers better understand the program.
• Web Badge – A new website button was released today that groups can post on their website to link to PCIP.gov. To add the button to your website, visit www.HealthCare.gov/stay_connected.html and embed the code listed.
• Newsletter and Website Drop-in Language – Also released today, this language is ready for consumer groups, state or local governments or other organizations to simply drop into their newsletters or post on their websites to help educate consumers about their health insurance options. To find this language, visit www.HealthCare.gov/center/brochures.
• Posters and Brochures – Organizations can download or print English and Spanish language brochures and posters about PCIP to share with consumers. Find the brochures and posters here, www.HealthCare.gov/center/brochures.
The entire HHS press release can be found (2/10/11) at http://www.hhs.gov/news/press/2011pres/02/20110210a.html
Visit PCIP.gov for more information on how the plan works in each state, including eligibility and how to
apply. To find recent enrollment numbers, visit http://www.healthcare.gov/news/factsheets/pcip02102011a.html.
Dallas L Alford IV, CPA is a licensed Certified Public Accountant in the state of North Carolina and owner of Atlantic Financial Consulting, a consulting firm that provides comprehensive medical billing services, practice management consulting, coding audits, Medicare compliance, Medicare RAC support and other general medical practice consulting services.
To learn more about Atlantic Financial Consulting you may visit their website at http://atlanticfinancial.us or contact Dallas L Alford IV, CPA directly at 1 888-428-2555, Ext. 200.
The U.S. Department of Health and Human Services (HHS) today made new resources available to the media, consumer groups, states, health care providers, and others to increase awareness of the Pre-existing Condition Insurance Plan (PCIP), a health plan for uninsured Americans with pre-existing conditions created by the Affordable Care Act.
Americans continue to enroll in the plan, which was created in 2010 to provide comprehensive health coverage – at the same price that otherwise healthy people pay – for uninsured Americans living with such conditions as cancer, diabetes, or heart disease who have been unable to obtain affordable health insurance coverage.
This temporary program covers a broad range of health benefits and is designed as a bridge for people with pre-existing conditions who cannot obtain health insurance coverage in today’s private insurance market. In 2014, all Americans – regardless of their health status – will have access to affordable coverage either through their employer or through a new competitive marketplace, and insurers will be prohibited from denying coverage to anyone based on their health status.
The Department is actively working with states, consumer groups, chronic disease organizations, health care providers, social workers, other federal agencies, and the insurance industry to promote the plan, including holding meetings with state officials, consumer groups, and others. New resources that are available to communities to help inform eligible Americans of the plan include a new web badge that links to PCIP.gov, as well as a new newsletter and website drop-in language that partners can use in their outreach efforts.
HHS’ Center for Consumer Information and Insurance Oversight is also working with the U.S. Social Security Administration (SSA) on a comprehensive outreach campaign, putting information about the plan in the approximately 3.2 million social security disability insurance application receipts distributed each year. SSA is also promoting the Pre-existing Condition Insurance Plan in its advocate newsletter, its website, and on TVs in the waiting rooms of SSA’s more than 600 field offices.
Resources available to consumer groups, media, states and others include:
• PCIP.gov – This website offers information about eligibility, benefits and more. Consumers can find online and print applications for the plan in their state. FAQs are also available to help both organizations and consumers better understand the program.
• Web Badge – A new website button was released today that groups can post on their website to link to PCIP.gov. To add the button to your website, visit www.HealthCare.gov/stay_connected.html and embed the code listed.
• Newsletter and Website Drop-in Language – Also released today, this language is ready for consumer groups, state or local governments or other organizations to simply drop into their newsletters or post on their websites to help educate consumers about their health insurance options. To find this language, visit www.HealthCare.gov/center/brochures.
• Posters and Brochures – Organizations can download or print English and Spanish language brochures and posters about PCIP to share with consumers. Find the brochures and posters here, www.HealthCare.gov/center/brochures.
The entire HHS press release can be found (2/10/11) at http://www.hhs.gov/news/press/2011pres/02/20110210a.html
Visit PCIP.gov for more information on how the plan works in each state, including eligibility and how to
apply. To find recent enrollment numbers, visit http://www.healthcare.gov/news/factsheets/pcip02102011a.html.
Dallas L Alford IV, CPA is a licensed Certified Public Accountant in the state of North Carolina and owner of Atlantic Financial Consulting, a consulting firm that provides comprehensive medical billing services, practice management consulting, coding audits, Medicare compliance, Medicare RAC support and other general medical practice consulting services.
To learn more about Atlantic Financial Consulting you may visit their website at http://atlanticfinancial.us or contact Dallas L Alford IV, CPA directly at 1 888-428-2555, Ext. 200.
Agendas for the ICD-9-CM Coordination & Maintenance Committee Meeting on March 9-10, 2011 are now available
Procedures topics, March 9, 2011
The agenda is posted in the “Downloads” section at http://www.cms.gov/ICD9ProviderDiagnosticCodes/03_meetings.asp. Handouts will be available on this website a few days before the meeting.
Diagnosis topics, March 10, 2011
The link to the agenda is under “Upcoming Meeting, March 9-10, 2011” at http://www.cdc.gov/nchs/icd/icd9cm_maintenance.htm . Handouts will be available at this website a few days before the meeting.
This will be the last meeting to address ICD-9-CM and ICD-10 code updates before the partial code freeze is implemented.
--------------------------------------------
The ICD-10 MS-DRGs v28 Definitions Manual is now available from CMS
The ICD-10 MS-DRGs v28 Definitions Manual (based on FY2011 MS-DRGs) is now posted on the Centers for Medicare & Medicaid Services (CMS) website at http://www.cms.gov/ICD10/17_ICD10_MS_DRG_Conversion_Project.asp in the “Related Links Inside CMS” section. This update is part of the ICD-10 MS-DRG Conversion Project. In the Conversion Project, CMS is using the General Equivalence Mappings (GEMs) to convert CMS payment systems. CMS is sharing information learned from this project with other organizations facing similar conversion projects. Please note that the ICD-10 MS-DRGs will be subject to formal rulemaking. CMS also plans to post the ICD-10 FY 2011 Medicare Code Editor when it is completed in March, 2011.
The ICD-10 abbreviated titles for both ICD-10-CM and ICD-10-PCS have been posted on the CMS website at http://www.cms.gov/ICD10/11b1_2011_ICD10CM_and_GEMs.asp and http://www.cms.gov/ICD10/11b_2011_ICD10PCS.asp.
Dallas L Alford IV, CPA is a licensed Certified Public Accountant in the state of North Carolina and owner of Atlantic Financial Consulting, a consulting firm that provides comprehensive medical billing services, practice management consulting, coding audits, Medicare compliance, Medicare RAC support and other general medical practice consulting services.
To learn more about Atlantic Financial Consulting you may visit their website at http://atlanticfinancial.us or contact Dallas L Alford IV, CPA directly at 1 888-428-2555, Ext. 200.
The agenda is posted in the “Downloads” section at http://www.cms.gov/ICD9ProviderDiagnosticCodes/03_meetings.asp. Handouts will be available on this website a few days before the meeting.
Diagnosis topics, March 10, 2011
The link to the agenda is under “Upcoming Meeting, March 9-10, 2011” at http://www.cdc.gov/nchs/icd/icd9cm_maintenance.htm . Handouts will be available at this website a few days before the meeting.
This will be the last meeting to address ICD-9-CM and ICD-10 code updates before the partial code freeze is implemented.
--------------------------------------------
The ICD-10 MS-DRGs v28 Definitions Manual is now available from CMS
The ICD-10 MS-DRGs v28 Definitions Manual (based on FY2011 MS-DRGs) is now posted on the Centers for Medicare & Medicaid Services (CMS) website at http://www.cms.gov/ICD10/17_ICD10_MS_DRG_Conversion_Project.asp in the “Related Links Inside CMS” section. This update is part of the ICD-10 MS-DRG Conversion Project. In the Conversion Project, CMS is using the General Equivalence Mappings (GEMs) to convert CMS payment systems. CMS is sharing information learned from this project with other organizations facing similar conversion projects. Please note that the ICD-10 MS-DRGs will be subject to formal rulemaking. CMS also plans to post the ICD-10 FY 2011 Medicare Code Editor when it is completed in March, 2011.
The ICD-10 abbreviated titles for both ICD-10-CM and ICD-10-PCS have been posted on the CMS website at http://www.cms.gov/ICD10/11b1_2011_ICD10CM_and_GEMs.asp and http://www.cms.gov/ICD10/11b_2011_ICD10PCS.asp.
Dallas L Alford IV, CPA is a licensed Certified Public Accountant in the state of North Carolina and owner of Atlantic Financial Consulting, a consulting firm that provides comprehensive medical billing services, practice management consulting, coding audits, Medicare compliance, Medicare RAC support and other general medical practice consulting services.
To learn more about Atlantic Financial Consulting you may visit their website at http://atlanticfinancial.us or contact Dallas L Alford IV, CPA directly at 1 888-428-2555, Ext. 200.
The Centers for Medicare & Medicaid Services (CMS) has a new listserv about the Medicare and Medicaid Electronic Health Record (EHR) Incentive Programs. The listserv will provide timely, authoritative information about the programs, including registration and attestation updates, and details about the payment process.
By subscribing to the listserv, CMS will keep you informed of upcoming deadlines and give you answers to the questions and concerns that we have gathered from eligible professionals and hospitals in the field. New updates will be emailed through the listserv to keep you informed of any developments, and subscribers will be notified of any new Frequently Asked Questions that are published on the CMS EHR Incentive Programs’ website. These e-mail messages are another CMS resource, in addition to those listed below, that will help you navigate the EHR Incentive Programs.
We encourage you to let others know about the CMS EHR listserv, and to share its messages. Click here to join the listserv and learn more.
The CMS EHR Incentive Programs website features the following resources:
• Path to Payment—Learn the necessary steps to receiving payments for the meaningful use of electronic health records.
• Registration Guides—Review a user guide of how to register and watch a video webinar that will help you navigate the registration website.
• Meaningful Use—Read more about the details of meaningful use, including clinical quality measures, and how to meet the requirements.
• Calendar of Important Dates – Read more about key milestone dates for the EHR Incentive Program
Want more information about the EHR Incentive Programs?
Make sure to visit the EHR Incentive Programs website at http://www.cms.gov/EHRIncentivePrograms for the latest news and updates on the EHR Incentive Programs.
Dallas L Alford IV, CPA is a licensed Certified Public Accountant in the state of North Carolina and owner of Atlantic Financial Consulting, a consulting firm that provides comprehensive medical billing services, practice management consulting, coding audits, Medicare compliance, Medicare RAC support and other general medical practice consulting services.
To learn more about Atlantic Financial Consulting you may visit their website at http://atlanticfinancial.us or contact Dallas L Alford IV, CPA directly at 1 888-428-2555, Ext. 200.
We encourage you to let others know about the CMS EHR listserv, and to share its messages. Click here to join the listserv and learn more.
The CMS EHR Incentive Programs website features the following resources:
• Path to Payment—Learn the necessary steps to receiving payments for the meaningful use of electronic health records.
• Registration Guides—Review a user guide of how to register and watch a video webinar that will help you navigate the registration website.
• Meaningful Use—Read more about the details of meaningful use, including clinical quality measures, and how to meet the requirements.
• Calendar of Important Dates – Read more about key milestone dates for the EHR Incentive Program
Want more information about the EHR Incentive Programs?
Make sure to visit the EHR Incentive Programs website at http://www.cms.gov/EHRIncentivePrograms for the latest news and updates on the EHR Incentive Programs.
Dallas L Alford IV, CPA is a licensed Certified Public Accountant in the state of North Carolina and owner of Atlantic Financial Consulting, a consulting firm that provides comprehensive medical billing services, practice management consulting, coding audits, Medicare compliance, Medicare RAC support and other general medical practice consulting services.
To learn more about Atlantic Financial Consulting you may visit their website at http://atlanticfinancial.us or contact Dallas L Alford IV, CPA directly at 1 888-428-2555, Ext. 200.
National Provider Call on Registration for the Medicaid EHR Incentive Program for Eligible Professionals Fri Feb 18, 1-2:30pm EST
The Centers for Medicare & Medicaid Services invites you to join us for a national provider call addressing how Eligible Professionals can register for the Medicaid EHR Incentive Program. Learn if you are eligible for the Medicaid EHR Incentive Program, how to register, and what other steps you must take to receive an incentive payment. We will also discuss switching between the Medicare and Medicaid programs, reassigning incentive payments, and how to get help. The presentation will be followed by a question and answer session.
The target audience for this call is eligible professionals under the Medicaid EHR Incentive Program, including:
Physicians (primarily doctors of medicine and doctors of osteopathy);
Nurse practitioners;
Certified nurse-midwives;
Dentists; and
Physician assistants who furnish services in a Federally-Qualified Health Center or Rural Health Clinic that is led by a physician assistant.
To qualify for an incentive payment under the Medicaid EHR Incentive Program, an eligible professional must meet Medicaid patient volume criteria.
In order to receive the call-in information, you must register for the call. (Note that if you are planning to sit in with a group, only one person needs to register to receive the call-in information.) Registration will close at 1pm EST on Thu Feb 17, or when available space has been filled; no exceptions will be made, so please register prior to this time. To register for the call:
Visit http://www.eventsvc.com/palmettogba/021811.
Fill in all required information and click “Register.”
You will be taken to the “Thank you for registering” page and will receive a confirmation email shortly thereafter. Please save this page, in the event that your server blocks the confirmation emails. (If you do not receive the confirmation email, please check your spam/junk mail filter as it may have been directed there.)
If assistance for hearing impaired services is needed, the request must be sent to medicare.ttt@palmettogba.com no later than 3 business days before the event.
Additional Details:
Materials will be made available prior to the training at http://www.CMS.gov/EHRIncentivePrograms/50_Spotlight.asp.
Can’t attend? A transcript and audio recording of the call will be available approximately 3 weeks afterwards at http://www.CMS.gov/EHRIncentivePrograms/50_Spotlight.asp.
Visit the Medicare & Medicaid EHR Incentive Programs website at http://www.CMS.gov/EHRIncentivePrograms to keep up to date with the latest information.
Dallas L Alford IV, CPA is a licensed Certified Public Accountant in the state of North Carolina and owner of Atlantic Financial Consulting, a consulting firm that provides comprehensive medical billing services, practice management consulting, coding audits, Medicare compliance, Medicare RAC support and other general medical practice consulting services.
To learn more about Atlantic Financial Consulting you may visit their website at http://atlanticfinancial.us or contact Dallas L Alford IV, CPA directly at 1 888-428-2555, Ext. 200.
The target audience for this call is eligible professionals under the Medicaid EHR Incentive Program, including:
Physicians (primarily doctors of medicine and doctors of osteopathy);
Nurse practitioners;
Certified nurse-midwives;
Dentists; and
Physician assistants who furnish services in a Federally-Qualified Health Center or Rural Health Clinic that is led by a physician assistant.
To qualify for an incentive payment under the Medicaid EHR Incentive Program, an eligible professional must meet Medicaid patient volume criteria.
In order to receive the call-in information, you must register for the call. (Note that if you are planning to sit in with a group, only one person needs to register to receive the call-in information.) Registration will close at 1pm EST on Thu Feb 17, or when available space has been filled; no exceptions will be made, so please register prior to this time. To register for the call:
Visit http://www.eventsvc.com/palmettogba/021811.
Fill in all required information and click “Register.”
You will be taken to the “Thank you for registering” page and will receive a confirmation email shortly thereafter. Please save this page, in the event that your server blocks the confirmation emails. (If you do not receive the confirmation email, please check your spam/junk mail filter as it may have been directed there.)
If assistance for hearing impaired services is needed, the request must be sent to medicare.ttt@palmettogba.com no later than 3 business days before the event.
Additional Details:
Materials will be made available prior to the training at http://www.CMS.gov/EHRIncentivePrograms/50_Spotlight.asp.
Can’t attend? A transcript and audio recording of the call will be available approximately 3 weeks afterwards at http://www.CMS.gov/EHRIncentivePrograms/50_Spotlight.asp.
Visit the Medicare & Medicaid EHR Incentive Programs website at http://www.CMS.gov/EHRIncentivePrograms to keep up to date with the latest information.
Dallas L Alford IV, CPA is a licensed Certified Public Accountant in the state of North Carolina and owner of Atlantic Financial Consulting, a consulting firm that provides comprehensive medical billing services, practice management consulting, coding audits, Medicare compliance, Medicare RAC support and other general medical practice consulting services.
To learn more about Atlantic Financial Consulting you may visit their website at http://atlanticfinancial.us or contact Dallas L Alford IV, CPA directly at 1 888-428-2555, Ext. 200.
CMS announces process to address inaccurate payments for some 2010 claims
Retroactive provisions in the Patient Protection and Affordable Care Act, coupled with technical corrections to the 2010 Medicare physician fee schedule, resulted in overpayments and underpayments on millions of Medicare fee-for-service claims during the first five months of 2010. To address the inaccurate claims, the Centers for Medicare & Medicaid Services (CMS) announced yesterday that it would begin reprocessing some of them over the next few weeks – a process CMS says will take "some time."
According to CMS's instructions, claims that were underpaid will not be automatically reprocessed at higher rates. However, providers should not resubmit these claims. Instead, they should request a manual reopening and adjustment of the claims from the Medicare contractor. Additionally, contractors will send requests for repayment of overpayments to providers. CMS will waive beneficiary cost-sharing and claim adjustment time limits for claims affected by these changes.
Dallas L Alford IV, CPA is a licensed Certified Public Accountant in the state of North Carolina and owner of Atlantic Financial Consulting, a consulting firm that provides comprehensive medical billing services, practice management consulting, coding audits, Medicare compliance, Medicare RAC support and other general medical practice consulting services.
To learn more about Atlantic Financial Consulting you may visit their website at http://atlanticfinancial.us or contact Dallas L Alford IV, CPA directly at 1 888-428-2555, Ext. 200.
According to CMS's instructions, claims that were underpaid will not be automatically reprocessed at higher rates. However, providers should not resubmit these claims. Instead, they should request a manual reopening and adjustment of the claims from the Medicare contractor. Additionally, contractors will send requests for repayment of overpayments to providers. CMS will waive beneficiary cost-sharing and claim adjustment time limits for claims affected by these changes.
Dallas L Alford IV, CPA is a licensed Certified Public Accountant in the state of North Carolina and owner of Atlantic Financial Consulting, a consulting firm that provides comprehensive medical billing services, practice management consulting, coding audits, Medicare compliance, Medicare RAC support and other general medical practice consulting services.
To learn more about Atlantic Financial Consulting you may visit their website at http://atlanticfinancial.us or contact Dallas L Alford IV, CPA directly at 1 888-428-2555, Ext. 200.
FTC releases guidance on medical identity theft
The Federal Trade Commission (FTC) released an educational document and press release on medical identity theft directed at healthcare providers and health plans. The document addresses:
• How someone would discover he or she is a victim of medical identity theft
• What a healthcare provider or plan should do upon learning that a patient has been a victim of medical identity theft
• What a provider or plan should tell a patient about his or her rights if victimized by medical identity theft
• How to help patients deter, detect and defend against medical identity theft
In the process of answering these questions, the FTC references federal statutes that could affect how a provider responds to a report of medical identity theft, including the Fair Credit Reporting Act and HIPAA. The FTC will provide copies of the brochure free to practices or allow practices to adapt it for their Web sites or newsletters.
Though the document addresses medical identity theft, it does not address the Red Flags Rule, a regulation that requires creditors of covered accounts to maintain identity theft prevention programs. The question of whether physicians and their practices should be included in the definition of a creditor subject to that rule remains an issue.
Dallas L Alford IV, CPA is a licensed Certified Public Accountant in the state of North Carolina and owner of Atlantic Financial Consulting, a consulting firm that provides comprehensive medical billing services, practice management consulting, coding audits, Medicare compliance, Medicare RAC support and other general medical practice consulting services.
To learn more about Atlantic Financial Consulting you may visit their website at http://atlanticfinancial.us or contact Dallas L Alford IV, CPA directly at 1 888-428-2555, Ext. 200.
• How someone would discover he or she is a victim of medical identity theft
• What a healthcare provider or plan should do upon learning that a patient has been a victim of medical identity theft
• What a provider or plan should tell a patient about his or her rights if victimized by medical identity theft
• How to help patients deter, detect and defend against medical identity theft
In the process of answering these questions, the FTC references federal statutes that could affect how a provider responds to a report of medical identity theft, including the Fair Credit Reporting Act and HIPAA. The FTC will provide copies of the brochure free to practices or allow practices to adapt it for their Web sites or newsletters.
Though the document addresses medical identity theft, it does not address the Red Flags Rule, a regulation that requires creditors of covered accounts to maintain identity theft prevention programs. The question of whether physicians and their practices should be included in the definition of a creditor subject to that rule remains an issue.
Dallas L Alford IV, CPA is a licensed Certified Public Accountant in the state of North Carolina and owner of Atlantic Financial Consulting, a consulting firm that provides comprehensive medical billing services, practice management consulting, coding audits, Medicare compliance, Medicare RAC support and other general medical practice consulting services.
To learn more about Atlantic Financial Consulting you may visit their website at http://atlanticfinancial.us or contact Dallas L Alford IV, CPA directly at 1 888-428-2555, Ext. 200.
CMS to modify meaningful use group practice registration process
The Centers for Medicare & Medicaid Services (CMS) announced that it will implement protocols in May that allow eligible professionals (EPs) to designate a third-party, such as a practice administrator, to register and attest for them as part of the EHR meaningful use incentive program . EPs are not currently allowed to designate a practice manager or any other person to register in their place. However, until CMS implements this new group practice "functionality," each EP should register himself or herself separately for the Medicare and Medicaid EHR Incentive Programs.
EPs may qualify for either $44,000 under the Medicare EHR program or up to $63,750 under the Medicaid EHR incentive program. CMS has posted information about when your state will launch its program. You may also contact your state Medicaid agency for more information about the program and or visit your state EHR Incentive Program and HIT Web site.
Dallas L Alford IV, CPA is a licensed Certified Public Accountant in the state of North Carolina and owner of Atlantic Financial Consulting, a consulting firm that provides comprehensive medical billing services, practice management consulting, coding audits, Medicare compliance, Medicare RAC support and other general medical practice consulting services.
To learn more about Atlantic Financial Consulting you may visit their website at http://atlanticfinancial.us or contact Dallas L Alford IV, CPA directly at 1 888-428-2555, Ext. 200.
EPs may qualify for either $44,000 under the Medicare EHR program or up to $63,750 under the Medicaid EHR incentive program. CMS has posted information about when your state will launch its program. You may also contact your state Medicaid agency for more information about the program and or visit your state EHR Incentive Program and HIT Web site.
Dallas L Alford IV, CPA is a licensed Certified Public Accountant in the state of North Carolina and owner of Atlantic Financial Consulting, a consulting firm that provides comprehensive medical billing services, practice management consulting, coding audits, Medicare compliance, Medicare RAC support and other general medical practice consulting services.
To learn more about Atlantic Financial Consulting you may visit their website at http://atlanticfinancial.us or contact Dallas L Alford IV, CPA directly at 1 888-428-2555, Ext. 200.
Thursday, February 10, 2011
Information for Eligible Professionals about Registration for the Electronic Health Record Incentive Programs
Designation of a third-party to register – At this time, there is no method available for a third-party to register multiple eligible professionals (EPs) for the Medicare and Medicaid EHR Incentive Programs. Beginning in May, CMS plans to implement functionality that will allow an EP to designate a third-party to register and attest on his or her behalf. We will release detailed information about that process when it is available.
Please be aware that, currently, EPs are NOT permitted to allow a practice manager or any other person to register in their place. Sharing your National Plan and Provider Enumeration System (NPPES) user ID and password with third-parties can place your information at risk. Until CMS implements new functionality in May, each EP should register himself or herself separately for the Medicare and Medicaid EHR Incentive Programs.
Registration for the Medicaid program – Eligible professionals must select between the Medicare and Medicaid EHR Incentive Programs. If you register for the Medicaid EHR Incentive Program, when you select “Medicaid” on the registration screen, you will be asked to select a state from the drop-down menu. Only states with launched programs (ie. states that are prepared to confirm your eligibility and make payments) are listed in that drop-down menu. Each month, CMS will add new states as they launch programs. If you have questions about when your state will launch, visit Medicaid State Information. You may also contact your State Medicaid Agency for more information about the program; visit State EHR Incentive Program Launch Dates and HIT Websites for the Medicaid EHR Incentive Program links for each State Medicaid Agency.
For more information about the Medicare & Medicaid EHR Incentive Programs and to register, visit http://www.CMS.gov/EHRIncentivePrograms.
Dallas L Alford IV, CPA is a licensed Certified Public Accountant in the state of North Carolina and owner of Atlantic Financial Consulting, a consulting firm that provides comprehensive medical billing services, practice management consulting, coding audits, Medicare compliance, Medicare RAC support and other general medical practice consulting services.
To learn more about Atlantic Financial Consulting you may visit their website at http://atlanticfinancial.us or contact Dallas L Alford IV, CPA directly at 1 888-428-2555, Ext. 200.
Please be aware that, currently, EPs are NOT permitted to allow a practice manager or any other person to register in their place. Sharing your National Plan and Provider Enumeration System (NPPES) user ID and password with third-parties can place your information at risk. Until CMS implements new functionality in May, each EP should register himself or herself separately for the Medicare and Medicaid EHR Incentive Programs.
Registration for the Medicaid program – Eligible professionals must select between the Medicare and Medicaid EHR Incentive Programs. If you register for the Medicaid EHR Incentive Program, when you select “Medicaid” on the registration screen, you will be asked to select a state from the drop-down menu. Only states with launched programs (ie. states that are prepared to confirm your eligibility and make payments) are listed in that drop-down menu. Each month, CMS will add new states as they launch programs. If you have questions about when your state will launch, visit Medicaid State Information. You may also contact your State Medicaid Agency for more information about the program; visit State EHR Incentive Program Launch Dates and HIT Websites for the Medicaid EHR Incentive Program links for each State Medicaid Agency.
For more information about the Medicare & Medicaid EHR Incentive Programs and to register, visit http://www.CMS.gov/EHRIncentivePrograms.
Dallas L Alford IV, CPA is a licensed Certified Public Accountant in the state of North Carolina and owner of Atlantic Financial Consulting, a consulting firm that provides comprehensive medical billing services, practice management consulting, coding audits, Medicare compliance, Medicare RAC support and other general medical practice consulting services.
To learn more about Atlantic Financial Consulting you may visit their website at http://atlanticfinancial.us or contact Dallas L Alford IV, CPA directly at 1 888-428-2555, Ext. 200.
Reprocessing Claims Affected by the Affordable Care Act and 2010 Medicare Physician Fee Schedule Changes
This message is for physicians, other practitioners, ambulance suppliers, inpatient/outpatient hospitals, long term care hospitals, inpatient rehabilitation facilities, home health agencies, and any other provider type affected by the post-effective date implementation of select provisions of the Affordable Care Act and the 2010 Medicare physician fee schedule.
On March 23, 2010, President Obama signed into law the Affordable Care Act. Various provisions of the new law were effective April 1, 2010, or earlier and, therefore, were implemented some time after their effective date. In addition, corrections to the 2010 Medicare Physician Fee Schedule (MPFS) were implemented at the same time as the Affordable Care Act revisions to the MPFS, with an effective date retroactive to January 1, 2010.
Due to the retroactive effective dates of these provisions and the MPFS corrections, a large volume of Medicare fee-for-service claims will be reprocessed. Given this large workload, the Centers for Medicare & Medicaid Services (CMS) is taking steps to ensure that new claims coming into the Medicare program are processed timely and accurately, even as the retroactive adjustments are being made. CMS will begin to reprocess these claims over the next several weeks. We expect that this reprocessing effort will take some time and will vary depending upon the claim-type, the volume, and each individual Medicare claims administration contractor.
In the majority of cases, you will not have to request adjustments because your Medicare claims administration contractor will automatically reprocess your claims. Please do not resubmit claims because they will be denied as duplicate claims and slow the retroactive adjustment process. However, any claim that contains services with submitted charges lower than the revised 2010 fee schedule amount (MPFS and ambulance fee schedule) cannot be automatically reprocessed at the higher rates. In such cases, you will need to request a manual reopening/adjustment from your Medicare contractor. While there is normally a one-year time limit for physicians and other providers and suppliers to request the reopening of claims, we believe that these circumstances fall under the “good cause” criteria described in the Claims Processing Manual, Publication 100-04, Chapter 34, Section 10.11 (http://www.cms.gov/manuals/downloads/clm104c34.pdf ). CMS is, therefore, extending the time period to request adjustment of these claims, as necessary.
Medicare claims administration contactors will follow the normal process for handling any applicable underpayments or overpayments that occur while reprocessing your claims. Underpayments will be included in your next regularly scheduled remittance after the adjustment. Overpayments resulting from institutional provider (e.g., hospitals, inpatient rehabilitation facilities, etc.) claim adjustments will be offset immediately, regardless of the amount, unless there are insufficient funds to make the offset. When these overpayments cannot be offset, the amounts will accumulate until a $25 threshold is reached. At that time, a demand letter will be sent to the institutional provider. When a claim adjustment for a non-institutional provider (e.g., physician, other practitioner, supplier, etc.) results in an overpayment, the Medicare contractor will send a request for repayment. If this overpayment is less than $10, your contractor will not request repayment until the total amount owed accrues to at least $10. See the Financial Management Manual, Publication 100-06, Chapter 4, Section 70.16 or Section 90.2 (http://www.cms.gov/manuals/downloads/fin106c04.pdf ) for more information.
The CMS wants to remind physicians, practitioners, suppliers, and other providers, impacted by the retroactive increases in payment rates for claims affected by the Affordable Care Act and 2010 MPFS changes, of the Office of Inspector General policy related to waiving beneficiary cost-sharing amounts attributable to retroactive increases in payment rates resulting from the operation of new Federal statutes or regulations. The policy may be found at the following link:
http://oig.hhs.gov/fraud/docs/alertsandbulletins/Retroactive_Beneficiary_Cost-Sharing_Liability.pdf
Please contact your Medicare claims administration contractor with any questions about this information.
Dallas L Alford IV, CPA is a licensed Certified Public Accountant in the state of North Carolina and owner of Atlantic Financial Consulting, a consulting firm that provides comprehensive medical billing services, practice management consulting, coding audits, Medicare compliance, Medicare RAC support and other general medical practice consulting services.
To learn more about Atlantic Financial Consulting you may visit their website at http://atlanticfinancial.us or contact Dallas L Alford IV, CPA directly at 1 888-428-2555, Ext. 200.
On March 23, 2010, President Obama signed into law the Affordable Care Act. Various provisions of the new law were effective April 1, 2010, or earlier and, therefore, were implemented some time after their effective date. In addition, corrections to the 2010 Medicare Physician Fee Schedule (MPFS) were implemented at the same time as the Affordable Care Act revisions to the MPFS, with an effective date retroactive to January 1, 2010.
Due to the retroactive effective dates of these provisions and the MPFS corrections, a large volume of Medicare fee-for-service claims will be reprocessed. Given this large workload, the Centers for Medicare & Medicaid Services (CMS) is taking steps to ensure that new claims coming into the Medicare program are processed timely and accurately, even as the retroactive adjustments are being made. CMS will begin to reprocess these claims over the next several weeks. We expect that this reprocessing effort will take some time and will vary depending upon the claim-type, the volume, and each individual Medicare claims administration contractor.
In the majority of cases, you will not have to request adjustments because your Medicare claims administration contractor will automatically reprocess your claims. Please do not resubmit claims because they will be denied as duplicate claims and slow the retroactive adjustment process. However, any claim that contains services with submitted charges lower than the revised 2010 fee schedule amount (MPFS and ambulance fee schedule) cannot be automatically reprocessed at the higher rates. In such cases, you will need to request a manual reopening/adjustment from your Medicare contractor. While there is normally a one-year time limit for physicians and other providers and suppliers to request the reopening of claims, we believe that these circumstances fall under the “good cause” criteria described in the Claims Processing Manual, Publication 100-04, Chapter 34, Section 10.11 (http://www.cms.gov/manuals/downloads/clm104c34.pdf ). CMS is, therefore, extending the time period to request adjustment of these claims, as necessary.
Medicare claims administration contactors will follow the normal process for handling any applicable underpayments or overpayments that occur while reprocessing your claims. Underpayments will be included in your next regularly scheduled remittance after the adjustment. Overpayments resulting from institutional provider (e.g., hospitals, inpatient rehabilitation facilities, etc.) claim adjustments will be offset immediately, regardless of the amount, unless there are insufficient funds to make the offset. When these overpayments cannot be offset, the amounts will accumulate until a $25 threshold is reached. At that time, a demand letter will be sent to the institutional provider. When a claim adjustment for a non-institutional provider (e.g., physician, other practitioner, supplier, etc.) results in an overpayment, the Medicare contractor will send a request for repayment. If this overpayment is less than $10, your contractor will not request repayment until the total amount owed accrues to at least $10. See the Financial Management Manual, Publication 100-06, Chapter 4, Section 70.16 or Section 90.2 (http://www.cms.gov/manuals/downloads/fin106c04.pdf ) for more information.
The CMS wants to remind physicians, practitioners, suppliers, and other providers, impacted by the retroactive increases in payment rates for claims affected by the Affordable Care Act and 2010 MPFS changes, of the Office of Inspector General policy related to waiving beneficiary cost-sharing amounts attributable to retroactive increases in payment rates resulting from the operation of new Federal statutes or regulations. The policy may be found at the following link:
http://oig.hhs.gov/fraud/docs/alertsandbulletins/Retroactive_Beneficiary_Cost-Sharing_Liability.pdf
Please contact your Medicare claims administration contractor with any questions about this information.
Dallas L Alford IV, CPA is a licensed Certified Public Accountant in the state of North Carolina and owner of Atlantic Financial Consulting, a consulting firm that provides comprehensive medical billing services, practice management consulting, coding audits, Medicare compliance, Medicare RAC support and other general medical practice consulting services.
To learn more about Atlantic Financial Consulting you may visit their website at http://atlanticfinancial.us or contact Dallas L Alford IV, CPA directly at 1 888-428-2555, Ext. 200.
Tuesday, February 8, 2011
Reprocessing Claims Affected by the Affordable Care Act and 2010 Medicare Physician Fee Schedule Changes
This message is for physicians, other practitioners, ambulance suppliers, inpatient/outpatient hospitals, long term care hospitals, inpatient rehabilitation facilities, home health agencies, and any other provider type affected by the post-effective date implementation of select provisions of the Affordable Care Act and the 2010 Medicare physician fee schedule.
On March 23, 2010, President Obama signed into law the Affordable Care Act. Various provisions of the new law were effective April 1, 2010, or earlier and, therefore, were implemented some time after their effective date. In addition, corrections to the 2010 Medicare Physician Fee Schedule (MPFS) were implemented at the same time as the Affordable Care Act revisions to the MPFS, with an effective date retroactive to January 1, 2010.
Due to the retroactive effective dates of these provisions and the MPFS corrections, a large volume of Medicare fee-for-service claims will be reprocessed. Given this large workload, the Centers for Medicare & Medicaid Services (CMS) is taking steps to ensure that new claims coming into the Medicare program are processed timely and accurately, even as the retroactive adjustments are being made. CMS will begin to reprocess these claims over the next several weeks. We expect that this reprocessing effort will take some time and will vary depending upon the claim-type, the volume, and each individual Medicare claims administration contractor.
In the majority of cases, you will not have to request adjustments because your Medicare claims administration contractor will automatically reprocess your claims. Please do not resubmit claims because they will be denied as duplicate claims and slow the retroactive adjustment process. However, any claim that contains services with submitted charges lower than the revised 2010 fee schedule amount (MPFS and ambulance fee schedule) cannot be automatically reprocessed at the higher rates. In such cases, you will need to request a manual reopening/adjustment from your Medicare contractor. While there is normally a one-year time limit for physicians and other providers and suppliers to request the reopening of claims, we believe that these circumstances fall under the “good cause” criteria described in the Claims Processing Manual, Publication 100-04, Chapter 34, Section 10.11 (http://www.cms.gov/manuals/downloads/clm104c34.pdf ). CMS is, therefore, extending the time period to request adjustment of these claims, as necessary.
Medicare claims administration contactors will follow the normal process for handling any applicable underpayments or overpayments that occur while reprocessing your claims. Underpayments will be included in your next regularly scheduled remittance after the adjustment. Overpayments resulting from institutional provider (e.g., hospitals, inpatient rehabilitation facilities, etc.) claim adjustments will be offset immediately, regardless of the amount, unless there are insufficient funds to make the offset. When these overpayments cannot be offset, the amounts will accumulate until a $25 threshold is reached. At that time, a demand letter will be sent to the institutional provider. When a claim adjustment for a non-institutional provider (e.g., physician, other practitioner, supplier, etc.) results in an overpayment, the Medicare contractor will send a request for repayment. If this overpayment is less than $10, your contractor will not request repayment until the total amount owed accrues to at least $10. See the Financial Management Manual, Publication 100-06, Chapter 4, Section 70.16 or Section 90.2 (http://www.cms.gov/manuals/downloads/fin106c04.pdf ) for more information.
The CMS wants to remind physicians, practitioners, suppliers, and other providers, impacted by the retroactive increases in payment rates for claims affected by the Affordable Care Act and 2010 MPFS changes, of the Office of Inspector General policy related to waiving beneficiary cost-sharing amounts attributable to retroactive increases in payment rates resulting from the operation of new Federal statutes or regulations. The policy may be found at the following link:
http://oig.hhs.gov/fraud/docs/alertsandbulletins/Retroactive_Beneficiary_Cost-Sharing_Liability.pdf
Please contact your Medicare claims administration contractor with any questions about this information.
Dallas L Alford IV, CPA is a licensed Certified Public Accountant in the state of North Carolina and owner of Atlantic Financial Consulting, a consulting firm that provides comprehensive medical billing services, practice management consulting, coding audits, Medicare compliance, Medicare RAC support and other general medical practice consulting services.
To learn more about Atlantic Financial Consulting you may visit their website at http://atlanticfinancial.us or contact Dallas L Alford IV, CPA directly at 1 888-428-2555, Ext. 200.
On March 23, 2010, President Obama signed into law the Affordable Care Act. Various provisions of the new law were effective April 1, 2010, or earlier and, therefore, were implemented some time after their effective date. In addition, corrections to the 2010 Medicare Physician Fee Schedule (MPFS) were implemented at the same time as the Affordable Care Act revisions to the MPFS, with an effective date retroactive to January 1, 2010.
Due to the retroactive effective dates of these provisions and the MPFS corrections, a large volume of Medicare fee-for-service claims will be reprocessed. Given this large workload, the Centers for Medicare & Medicaid Services (CMS) is taking steps to ensure that new claims coming into the Medicare program are processed timely and accurately, even as the retroactive adjustments are being made. CMS will begin to reprocess these claims over the next several weeks. We expect that this reprocessing effort will take some time and will vary depending upon the claim-type, the volume, and each individual Medicare claims administration contractor.
In the majority of cases, you will not have to request adjustments because your Medicare claims administration contractor will automatically reprocess your claims. Please do not resubmit claims because they will be denied as duplicate claims and slow the retroactive adjustment process. However, any claim that contains services with submitted charges lower than the revised 2010 fee schedule amount (MPFS and ambulance fee schedule) cannot be automatically reprocessed at the higher rates. In such cases, you will need to request a manual reopening/adjustment from your Medicare contractor. While there is normally a one-year time limit for physicians and other providers and suppliers to request the reopening of claims, we believe that these circumstances fall under the “good cause” criteria described in the Claims Processing Manual, Publication 100-04, Chapter 34, Section 10.11 (http://www.cms.gov/manuals/downloads/clm104c34.pdf ). CMS is, therefore, extending the time period to request adjustment of these claims, as necessary.
Medicare claims administration contactors will follow the normal process for handling any applicable underpayments or overpayments that occur while reprocessing your claims. Underpayments will be included in your next regularly scheduled remittance after the adjustment. Overpayments resulting from institutional provider (e.g., hospitals, inpatient rehabilitation facilities, etc.) claim adjustments will be offset immediately, regardless of the amount, unless there are insufficient funds to make the offset. When these overpayments cannot be offset, the amounts will accumulate until a $25 threshold is reached. At that time, a demand letter will be sent to the institutional provider. When a claim adjustment for a non-institutional provider (e.g., physician, other practitioner, supplier, etc.) results in an overpayment, the Medicare contractor will send a request for repayment. If this overpayment is less than $10, your contractor will not request repayment until the total amount owed accrues to at least $10. See the Financial Management Manual, Publication 100-06, Chapter 4, Section 70.16 or Section 90.2 (http://www.cms.gov/manuals/downloads/fin106c04.pdf ) for more information.
The CMS wants to remind physicians, practitioners, suppliers, and other providers, impacted by the retroactive increases in payment rates for claims affected by the Affordable Care Act and 2010 MPFS changes, of the Office of Inspector General policy related to waiving beneficiary cost-sharing amounts attributable to retroactive increases in payment rates resulting from the operation of new Federal statutes or regulations. The policy may be found at the following link:
http://oig.hhs.gov/fraud/docs/alertsandbulletins/Retroactive_Beneficiary_Cost-Sharing_Liability.pdf
Please contact your Medicare claims administration contractor with any questions about this information.
Dallas L Alford IV, CPA is a licensed Certified Public Accountant in the state of North Carolina and owner of Atlantic Financial Consulting, a consulting firm that provides comprehensive medical billing services, practice management consulting, coding audits, Medicare compliance, Medicare RAC support and other general medical practice consulting services.
To learn more about Atlantic Financial Consulting you may visit their website at http://atlanticfinancial.us or contact Dallas L Alford IV, CPA directly at 1 888-428-2555, Ext. 200.
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