Practice News & Headlines
On March 2, 2010, President Obama signed into law the “Temporary Extension Act of 2010.” Among other things, this law extends through March 31, 2010, the zero percent update to the Medicare Physician Fee Schedule that was in effect for claims with dates of service January 1, 2010, through February 28, 2010. Consequently, effective immediately, claims with dates of service March 1 and later which were being held by Medicare contractors will be released for processing and payment. Please keep in mind that the statutory payment floors still apply and, therefore, clean electronic claims cannot be paid before 14 calendar days after the date they are received by Medicare contractors (29 calendar days for clean paper claims).
As part of the HITECH Act in 2009, CMS administers the Electronic Health Record (EHR) incentive programs under Medicare and Medicaid. CMS prepared a proposed rule on the EHR incentive programs for public comment. This proposed rule includes the definition of meaningful use and other requirements for qualifying for incentive payments. The comment period for this proposed rule closes on March 15, 2010. CMS welcomes your comments which may be submitted through http://www.regulations.gov. For additional information on the proposed rule, visit http://www.cms.hhs.gov/Recovery/11_HealthIT.asp on the web. Here you will find fact sheets, presentation materials summarizing the proposed rule, and links to the proposed rule itself.
The Philadelphia Regional Office is please to share with you the Winter 2010 edition of “The Pulse of CMS” provider newsletter. In this edition, you will find articles on the HITECH initiative, new RAC documentation guidance, delays on the implementation of the ordering/referring provider edits, among other topics. Please feel free to share this newsletter with your partners via any list servs to which you belong. Also, we encourage you to post the newsletter to your organization’s website.
Dear MGMA and ACMPE members,
After serving as your president and CEO since 1999, I will be retiring in the fall of 2011. I informed the MGMA and ACMPE Boards of Directors of my decision at their meetings this past weekend. I wanted to be sure that the Boards had ample notice in order to ensure a smooth transition process. I am very proud of the work we have all accomplished together---members, leaders and staff--- and I look forward to reaching a number of additional goals as I complete my tenure over the next 19 months.
MGMA and ACMPE will soon begin the search for my successor with the goal of ensuring a smooth transition and minimal disruption for our members across the nation. According to our well-established CEO succession policy, the search committee will be co-chaired by the immediate past chair of the MGMA Board (Chris Schon, FACMPE) and the immediate past chair of the ACMPE Board (Rebecca Dean, MA, FACMPE).
I thank you for the opportunity to work on your behalf for the medical group practice management profession.
William F. Jessee, MD, FACMPE
President/CEO
Medical Group Management Association and
American College of Medical Practice Executives
Last week, the president requested that Congress move forward with an “up or down” vote on final healthcare reform legislation. The White House had released a broad overhaul plan in late February and, following a summit with congressional leaders, indicated the changes he was willing to make to his plan in a letter to Capitol Hill released on March 2. To date, the administration has not submitted a formal bill to Congress for consideration.
Democratic leaders continue to discuss a legislative strategy for passing broad healthcare reform that recognizes their 59-seat Senate majority subsequent to the Jan. 19 election of Scott Brown, a Republican from Massachusetts, to fill the seat of the late Ted Kennedy. Senate leaders are considering calling upon the House to approve without changes the Senate-passed healthcare reform bill H.R. 3590. That bill would then become law. Then both chambers would approve a series of substantive changes to the bill before it became effective through a budget process known as “reconciliation”, which would require only 51 votes to pass the Senate rather than the 60 needed to prevent a filibuster.
Multiple hurdles remain before House Democrats will agree to pass the Senate bill without changes, including:
- Eliminating the provision that gives Nebraska full federal funding for Medicaid expansion
- Modify the excise tax on high-cost insurance plans
- Adjusting the premium subsidies and close the coverage gap in the Medicare Part D prescription drug benefit.
In addition to trying to reach agreement on these issues, a group of House members who originally voted for the House version of the healthcare reform, H.R. 3962, are concerned that use of the reconciliation process will eliminate language that they had supported concerning use of federal funds for abortion.
No action is anticipated by the House on the Senate-passed bill until a majority of its members are comfortable with the legislative language yet to be produced and the Congressional Budget Office scores the bill. Votes on these issues may occur before Congress adjourns for its "Spring District Work Period” which is scheduled to begin on March 29.
The HFMA Appalachian Chapter will hold their Annual Hospital/Physician Collaborative Meeting on
Tuesday, March 30, 2010 at the Eden Resort located in Lancaster, PA! The program will run from 8 a.m. to 5 p.m. Pennsylvania MGMA can attend at the discounted member rate! Download the registration brochure!
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Late last night, the president signed H.R. 4691, the Temporary Extension Act of 2010 into law. This legislation includes a provision that freezes Medicare physician payments at their current level until March 31, 2010. The legislation also extends the therapy cap exception process through until March 31, 2010. The bill passed the Senate by a vote of 78 – 19. The House of Representatives had unanimously approved a companion bill by voice vote on Feb. 25.
The Senate is also currently debating H.R. 4213 the American Workers, State, and Business Relief Act of 2010. This legislation extends the freeze on Medicare physician payments until Sept. 30, 2010. It also provides an extension to the therapy cap exception process through Dec. 31 , 2010 and an extension of the geographic practice cost index floor through Dec. 31, 2010. If approved by the Senate, the bill would have to be approved by the House before transmittal to the president.
MGMA does not support these continued short-term congressional interventions and urges members to contact their senators and representatives to support permanent repeal of the sustainable growth rate formula.
Though the House of Representatives unanimously passed a short-term measure that would extend Medicare’s current physician payment rates and therapy cap exception process through March 31, the Senate failed to act on similar legislation prior to adjourning last week due to Sen. Jim Bunning’s, R-Ky., objections to how to pay for the bill. By law, the 21.2 percent cut to Medicare physician payments will take effect today, March 1.
The Senate returns Tuesday, March 2, and will likely attempt to bring up the measure again. Regardless of congressional action, by law, Medicare contractors must hold all claims payments for at least 13 business days after receipt. CMS indicates it will also hold all processing of claims at the reduced rate for the first 10 business days of March, giving the Senate a window to act.
MGMA members and their staffs should contact their Senators and urge them to permanently address this issue by repealing the sustainable growth rate formula. You can contact your senators via the MGMA Advocacy Center or by calling the American Medical Association Grassroots Hotline, 800.833.6354.
The Centers for Medicare & Medicaid Services (CMS) is working with Congress, health care providers, and the beneficiary community to avoid disruption in the delivery of health care services and payment of claims for physicians, non-physician practitioners, and other providers of services paid under the Medicare physician fee schedule. As you are aware, the Department of Defense Appropriations Act of 2010 provided a zero percent (0%) update to the 2010 MPFS effective for dates of service January 1, 2010, through February 28, 2010.
We believe Congress is working to avoid the negative update that take effect today, March 1. Consequently, CMS has instructed its contractors to hold claims containing services paid under the MPFS for the first 10 business days of March. The holding of MPFS claims will only affect claims with dates of service March 1, 2010, and forward. This hold should have a minimum impact on provider cash flow because, under current law, clean electronic claims are not paid any sooner than 14 calendar days (29 for paper claims) after the date of receipt. Be on the alert for more information about the 2010 Medicare Physician Fee Schedule Update.
As you are already aware, on Dec. 21,2009 the President signed into law the Department of Defense appropriations bill delaying a 21.2%reduction in physician fees for 60 days. On December 23, 2009, the Centers for Medicare&Medicaid Services (CMS) released the January 2010 Physician Fee Schedule file that contains the 2010 relative value units and temporary conversion factor of $36.0846. This conversion factor will be effective for Medicare services rendered on or after January 1, 2010 through February 28,2010.
To date, there is no clear path for legislation to avoid the March 1, 2010 Medicare conversion factor reduction after a proposed bill to delay the reduction for seven months (known as the "Doctor Fix") was removed from the Senate Jobs Bill.
Upon receiving the CMS publication,UnitedHealthcare immediately engaged in our 2010 annual fee schedule update process in order to comply with relevant contractual and regulatory requirements for in-network physicians and to comply with regulatory requirements for out-of-network physicians who render services to members of UnitedHealthcare and our affiliates, as well as members of SecureHorizons®, Evercare®and AmeriChoice®.
If you participate in our network and your fee schedule is not tied to Current Year or 2010 Medicare rates, you are not affected by this change.It is important to note that the majority of in-network physicians who serve our commercial and AmeriChoice members are not affected by this change .Please refer to your contract to refresh your understanding of your fee schedule.
Most of the physicians, who participate in our network serving SecureHorizons and Evercare members, as well as a small number of physicians who serve commercial and AmeriChoice members, are affected by this temporary change .During this system update,claims will be paid at the 2009 Conversion Factor but will not reflect 2010 relative value units and geographic practice cost indicies.We are expediting updates of relevant fee schedules and anticipate completion by February 27, 2010.
We will communicate any additional changes, if Congress takes action over the coming days.
Amerigroup will follow CMS’s lead regarding consultation codes. Amerigroup providers are reimbursed according to the Medicare-based CMS fee schedule. Read Provider Alert
The Centers for Medicare & Medicaid Services’ (CMS) Provider Communications Group will host a national provider conference call on the 2010 Physician Quality Reporting Initiative (PQRI) and Electronic Prescribing Incentive Program (eRx). This toll-free call will take place from 1:30 p.m. – 3:30 p.m., EST, on Wednesday, March 10, 2010.
The PQRI is voluntary quality reporting program that provides an incentive payment to identified individual eligible professionals (EPs), and beginning with the 2010 PQRI, 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 PQRI 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 beginning with the 2010 eRx Incentive Program, group practices).
Following a few program announcements and updates, the lines will be opened to allow participants to ask questions of CMS PQRI and eRx subject matter experts.
Educational products are available on the PQRI 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 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 10, 2010
Conference Title: Physician Quality Reporting Initiative (PQRI) - 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 9, 2010, 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/031010 Fill in all required data.
- Verify your time zone is displayed correctly 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.
For those of who will be unable to attend, a transcript of the call will be available at least one week after the call at http://www.cms.hhs.gov/pqri on the CMS website.
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