Hot Topics:

        Provider Enrollment Revalidation - Important Information:

• CMS has reevaluated the revalidation requirement in the Affordable Care Act, and believe it affords the flexibility to extend the revalidation period for another 2 years. According to CMS, this will allow for a smoother process for provider and contractors. Revalidation notices will now be sent through March of 2015. IMPORTANT: This does not affect those providers which have already received a revalidation notice. If you have received a revalidation notice from your contractor, respond to the request by completing the application either through internet-based PECOS or completing the appropriate 855 application form.

  The first set of revalidation notices went to providers who are billing, but are not currently in the Provider Enrollment, Chain and Ownership System (PECOS). To identify these providers, contractors searched their local systems and if a Provider Transaction Access Number (PTAN) for a physician was not in PECOS, a revalidation request for that physician was sent. Noridian is asking all providers who receive a request for revalidation to respond to that request.

  For providers NOT in PECOS - the revalidation letter will be sent to the special payments or primary practice address because Noridian does not have a correspondence address. For providers in PECOS - the revalidation letter will be sent to the special payments and correspondence addresses simultaneously; if these are the same it will also be mailed to the primary practice address. If you believe you are not in PECOS and have not yet received a revalidation letter, contact your Medicare contractor. Contact information may be found at http://www.CMS.gov/MedicareProviderSupEnroll/downloads/contact_list.pdf.

  Institutional providers (i.e., all providers except physicians, non-physicians practitioners, physician group practices and non-physician practitioner group practices) must submit the application fee with their revalidation. In mid-September, CMS revised the revalidation letter that contractors sent to providers to clarify who must pay the fee. 

  CMS has posted a list of of all providers and suppliers who were mailed a revalidation letter. To download the complete list click here.
   

        New ABN Form

• Starting November 1, 2011, CMS will require physicians and other providers to use the revised version of the ABN (Form CMS-R-131), which was released on May 16, 2011.

Click here to access the new form go to the website below, scroll down to Downloads and click on the Revised ABN CMS-R-131 Form and Instructions zipped document.

Medicare

• Medicare Program Overview
• Oregon's Medicare Part B Carrier-Noridian Administrative Services
• 2011 Medicare Physician Fee Schedule
• Medicare Part B Enrollment Information
• Medicare Private Contract and Opt Out Affidavit
• Medicare Reimbursement Resources
• Medicare News 
• Medicare Frequently Asked Questions
• Medicare Fraud and Abuse
• Medicare Legislative Advocacy
• Physician Quality Reporting System (PQRS, Formerly PQRI)

Medicare Program Overview

From the Centers for Medicare and Medicaid

Medicare is a health insurance program for:

• people age 65 or older,
• people under age 65 with certain disabilities, and
• people of all ages with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a kidney transplant).

Medicare has:

Part A Hospital Insurance - Most people don't pay a premium for Part A because they or a spouse already paid for it through their payroll taxes while working. Medicare Part A (Hospital Insurance) helps cover inpatient care in hospitals, including critical access hospitals, and skilled nursing facilities (not custodial or long-term care). It also helps cover hospice care and some home health care. Beneficiaries must meet certain conditions to get these benefits.

Medicare Part B (Medical Insurance) helps cover doctors’ services and outpatient care. It also covers some other medical services that Part A doesn’t cover, such as some of the services of physical and occupational therapists, and some home health care. Part B helps pay for these covered services.

Medicare deductible and premium rates may change every year in January.

Prescription Drug Coverage - Most people will pay a monthly premium for this coverage. Starting January 1, 2006, new Medicare prescription drug coverage will be available to everyone with Medicare. Everyone with Medicare can get this coverage that may help lower prescription drug costs and help protect against higher costs in the future. Medicare Prescription Drug Coverage is insurance. Private companies provide the coverage. Beneficiaries choose the drug plan and pay a monthly premium. Like other insurance, if a beneficiary decides not to enroll in a drug plan when they are first eligible, they may pay a penalty if they choose to join later.

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Oregon's Medicare Part B Carrier

Noridian Administrative Services is the Medicare Part B carrier for Oregon. Their website, https://www.noridianmedicare.com/p-medb/, is very useful for obtaining the latest news regarding Medicare Part B as well as obtaining any necessary Medicare forms needed for your practice.

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2011 Medicare Fee Schedule

The 2011 Medicare Physician Fee Schedule can be accessed through the Noridian website. Noridian is the Medicare Part B carrier for Oregon: www.noridianmedicare.com/p-medb/fees/index.html.

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Enrollment

Noridian Administrative Services has a comprehensive website on Medicare Part B Enrollment information, which includes necessary forms and educational resources at https://www.noridianmedicare.com/p-medb/enroll/.

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Medicare Reimbursement Resources

The Sustainable Growth Rate (SGR) is a component of the CMS formula used  to calculate physician payments for providing services to Medicare patients. It is based on the GDP and not on actual healthcare practice costs.

• The SGR will lead to steep cuts in physician compensation for services to Medicare patients. The SGR is a target expenditure growth number. If actual expenditures exceed the SGR, physicians’ payments are cuts.

For more information on how the flawed formula is affecting physician Medicare payments, please visit http://www.ama-assn.org/ama1/pub/upload/mm/399/nac_ppfacts.pdf.

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Medicare News

Medicare Payment Cut Reversed, Rates Extended through May

On the evening of April 15, President Obama signed into law HR 4851, the Continuing Extension Act of 2010, thereby reversing the 21.3 percent Medicare physician payment cut that went into effect on April 1. This fix extends 2009 Medicare payment rates through the end of May and retroactively applies the 2009 rates to all physician services provided to Medicare patients in April. The law also extends other expiring programs, including COBRA and unemployment benefits to those who have lost their jobs.

After drawn-out deliberations in the Senate, an amended version of the legislation finally passed by a vote of 59-38, and shortly after 8:00 pm on April 15, it passed the House by a vote of 289-112.

As reported previously in PRN, CMS ordered its carriers to hold all claims for services provided in April to give Congress more time to prevent the payment cut. That hold expired yesterday, but CMS has indicted that any claims processed at the reduced rates will be reprocessed automatically with no action required of physicians.

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