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In
this issue
Senate
Fails to Obtain Cloture on S. 1776
This afternoon,
the Senate failed in an attempt to proceed to debate on S.
1776, the "Medicare Physicians Fairness Act of 2009."
The bill would repeal the Sustainable Growth Rate (SGR) formula used to
determine Medicare Reimbursement rates for physician services. Since an
objection was filed by the Republican leadership, 60 votes were required to
begin debate. The vote failed 47-53. The Democratic leadership has
indicated its intention to reconsider canceling the 21.5 percent pending
cut to Medicare physician payments and reforming the SGR formula either
during or subsequent to debate by the full Senate on broader healthcare
reform legislation. Look for further details regarding the next steps in
the effort to the repeal the SGR formula in the next edition of the MGMA
Washington Connexion.
CMS
sends 2008 PQRI incentive payments and feedback reports; revised 2007 payments
to go out in November
Practices
that participated successfully in the 2008 Physician Quality Reporting
Initiative (PQRI) began receiving their incentive payments last week from
the Centers for Medicare & Medicaid Services (CMS). Additionally, CMS
announced that it will send incentive payments in early November to 2007
PQRI participants that were deemed "successful" after the agency revised
data analytics. CMS will route electronic payments or checks via
participants' tax identification numbers. Remittance advice should indicate
whether the payment is associated with the 2007 or 2008 PQRI program. The
agency asks providers to contact their Medicare
Administrative Contactor (MAC) or carrier to determine whether the
incentive was sent, the amount of the payment and an explanation of the
remittance advice.
CMS
expects to release the revised 2007 and 2008 PQRI feedback reports at the
end of this month. Physicians can use a new method to access the feedback
reports however this option unfortunately is not available for group
practice administrators. Individual providers can call their MACs or
carriers and request a 2007 re-run and/or a 2008 PQRI feedback report(s).
The report(s) will be e-mailed to the provider within 30 days of the
request.
Despite
objections raised by MGMA, practice administrators who request feedback
reports for a group practice must still use the PQRI Portal after
registering in the Individuals Authorized Access to the CMS Computer
Services (IACS), which is the same burdensome process CMS used for the
original 2007 PQRI feedback report distribution process. You can find the
portal at http://www.qualitynet.org/pqri.
For further feedback report assistance, contact QualityNet at 866.288.8912
or qnetsupport@sdps.org.
For
further assistance with IACS registration, contact External User Services
at 866.484.8049 or EUSsupport@cgi.com.
Read
more about these incentive
payments and feedback reports.
Download
a PQRI
support guide.
In
November, MGMA will conduct member research regarding the 2007-2010 PQRI
reporting periods. Look in future MGMA Washington Connexion
newsletters for future PQRI updates and the results of the research, which
MGMA will use for legislative and regulatory advocacy purposes.
CMS
changes claims process for ordering/referring physicians
In an
expansion of the Social Security Act, the Center for Medicare and Medicaid Services
(CMS) is requiring providers who order/refer services to be enrolled in the
Medicare Provider Enrollment, Chair and Ownership System (PECOS), as well
as be a practice type or specialty eligible to order/refer these services.
Currently, providers or suppliers are required to include the name and
National Provider Identifier (NPI) of the ordering/referring physician on
claims. CMS is implementing the expanded requirements in two phases, the
phase requirements differ slightly for durable medical equipment
prosthetics, orthotics, and supplies (DMEPOS) providers than for all other
services.
Phase 1
began on Oct. 5. For claims submitted for all other services wherein the
ordering/referring provider is not in PECOS or the claims system and/or an
eligible specialty, CMS will process the claim either electronically or by
paper – depending on how it is submitted – and include a warning. The
agency will process claims submitted for durable medical equipment wherein
the ordering/referring provider is not in PECOS and/or an eligible
specialty, but only providers submitting claims electronically will receive
a warning.
Phase 2
begins Jan. 4, 2010. CMS will reject claims submitted for all other
services if the ordering/referring provider is not listed on the claim, in
PECOS or the claim systems. Likewise, CMS will reject DME claims if the
ordering/referring provider is not listed in PECOS. In cases where the
ordering/referring provider is not in PECOS or an eligible specialty, the
agency will reject the claim and provide notification on the remittance
advice or CEDI GenResponse Report.
Read more
about these changes.
Access
instructions on how to enroll in PECOS in the Medicare
Enrollment Toolkit.
Medicare
interest rate released
The
Department of the Treasury recently notified the Department of Health and
Human Services that, effective Oct. 22, the first quarter FY 2010 interest
rate for Medicare overpayments and underpayments is 10.875 percent. The
previous interest rate, effective July 17 through Oct. 21, 2009, was 11.25
percent.
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