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In this issue
CMS
eliminates consultation codes
In the final
2010 physician fee schedule, the Centers for Medicare & Medicaid
Services (CMS) eliminates the use of all consultation codes (inpatient and
office/outpatient codes for various places of service except for telehealth
consultation G-codes) on a budget-neutral basis. Instead, CMS increases the
work relative value units (RVUs) for new and established office visits, as
well as initial hospital and initial nursing facility visits, and
incorporating the increased use of these visits into practice expense and
malpractice RVU calculations.
To learn
the most effective strategies for adapting to these changes, join national
coding experts Nancy Enos and Joan Gilhooly on Nov. 18, from 2-3:30 p.m.
EST, for the MGMA Webinar "Consultation
Codes Eliminated: Now What? " They will provide an in-depth
analysis and discuss the impact these changes will have on your practice’s
revenue, evaluation and management coding and providers’ documentation requirements.
2010
PQRI details announced
Last
week the Centers for Medicare & Medicaid Services (CMS) released the final
2010 physician fee schedule, which includes, among other issues, many
changes to the 2010 Physician Quality Reporting Initiative (PQRI). The 2010
PQRI will include:
- 175
individual PQRI measures (145 measures are retained from the 153
measures offered in the 2009 PQRI reporting period, plus the agency
finalized 30 new measures)
- 26 measures
reportable through qualified clinical registries
- 10 measures
available only for PQRI-qualified electronic health records (EHRs)
- 13 PQRI
measure groups
- 26 measures
reportable for the new PQRI group practice reporting option
As advocated
for by the Medical Group Management Association (MGMA), CMS has indicated
that it will publish quarterly reports on aggregate-level
data-submission errors. The reports will help participating practices
identify their own potential reporting errors. The agency also indicated
that it intends to complete testing and offer a new PQRI reporting option
via qualified EHRs. The agency is expected to release further details on
this new reporting mechanism soon.
Unlike
previous PQRI reporting periods, the agency will offer a new six-month
claims-based reporting option for individual measures. Due to opposition by
MGMA and others, the agency is not finalizing their proposal to increase
the minimum number of consecutive patients reported from 15 to 30 for one
of the 2010 PQRI reporting options.
The
agency finalized a new PQRI reporting option for group practices that have
at least 200 providers, despite MGMA comments urging
the agency to offer this option to any group practice regardless of
size. However, the agency accepted MGMA's recommendation not to
publically post group practices’ performance results online. CMS is
expected to issue further details about this option by Nov. 15. Interested
group practices must notify CMS by Jan. 31 of their intent to use this
reporting option. CMS requires groups that use this new PQRI option to also
participate in the 2010 electronic prescribing reporting option for group
practices.
Learn
more about the 2010 PQRI and other changes made in the 2010 final physician
fee schedule by signing up for MGMA's Dec. 3 "Medicare
Update 2010: The Good, the Bad, and the Downright Ugly" Webcast,
and discover how policy and procedural changes made in the Medicare program
for 2010 will affect your reimbursement and practice operations.
Register now
for a free conference call hosted by CMS on the PQRI. This call will
take place from 1-3p.m., EST, on Tuesday, Nov. 10.
Updated
Medicare enrollment toolkit available
The
Centers for Medicare & Medicaid Services (CMS) has begun a limited
provider enrollment revalidation effort that focuses on the top 50 Part B
individual practitioner supplier billers within each state for each
contractor’s identification number. Once a physician receives a revalidation
request, he/she has 60 days to respond to the contractor. This is critical.
If physicians do not respond in this time frame they could face revocation
of their Medicare billing privileges.
Physicians
who enrolled in Medicare more than five years ago may want to re-enroll –
regardless of whether they receive a revalidation request – to ensure they
comply with CMS' regulations. It is important for practices and physicians
to keep their Medicare enrollment information accurate and up to date. To
assist members, MGMA recently updated its Medicare
provider enrollment toolkit. It is available for download as a benefit
of MGMA membership.
HHS
allows for Section 1135 waivers due to H1N1 concerns
As a result
of the recently declared H1N1 emergency, the Health and Human Services
(HHS) Secretary invoked her waiver authority to allow for modifications of
certain Medicare, Medicaid and Children’s Health Insurance Program (CHIP)
requirements to ensure that sufficient health care items and services are
available to meet the needs of enrolled individuals in the emergency area
and for the time periods covered by the 1135 authority.
Requests
by providers to operate under the flexibilities afforded by the waiver
should be sent to the state survey agency or CMS regional office. Read
about the 1135
waiver process or visit the Centers
for Medicare & Medicaid Services H1N1 site.
Additionally,
HHS will host a related conference call on Tuesday, Nov. 10, from 2-3 p.m.,
EST. Interested participants should call 800.837.1935 and use conference
ID: 3H1N1. A recording of this call will be available two hours after it
ends by calling 800.642.1687 and entering conference ID 3H1N1.
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