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Hello
President
releases FY 2010 budget proposals
On
Thursday, the Obama administration released its 2010 budget
proposals, including recommended changes to the Medicare program. The
proposal acknowledges that the current Medicare physician payment system
“needs to be reformed” and that “the administration would support
comprehensive, but fiscally responsible reforms to the payment formula.”
In
documents attached to the budget submission, the president indicates that
spending to account for additional Medicare physician payments would total
$329.6 billion over the next 10 years. This baseline, if accepted by the
Congress, appears to provide sufficient funding to mitigate the scheduled
21 percent physician payment cut for 2010 and the additional cuts slated
due to the sustainable growth rate formula.
This
preliminary budget document also contains proposals for policy changes to Medicare
Advantage plans, hospital readmission payments, home health service
payments, post-acute care services and imaging services. The administration
will release details on these and other health-related issues in
April.
MGMA
to offer guidance on critical ICD-10 and HIPAA transactions issues
The Centers for Medicare & Medicaid Services (CMS) recently issued a
final rule requiring the health care industry to adopt the International
Classification of Diseases, 10th revision, Clinical Modification
(ICD-10-CM), for outpatient diagnoses codes, replacing ICD-9-CM. At the
same time, CMS released regulations outlining the complex transition to the
new electronic transactions, originally mandated as part of the Health
Insurance Portability and Accountability Act. These include the claim,
insurance eligibility verification, claim status and remittance.
Medical
practices will have to:
• Update or replace practice management-system software;
• Train clinical and administrative staff;
• Review and modify organizational work flow;
• Evaluate vendor, clearinghouse and health plan contracts and data
requirements; and
• Develop appropriate processes and budgets to implement these new
requirements.
MGMA will offer resources to help members prepare and execute an
implementation plan to maximize efficiency and minimize cost and disruption
to the practice. On March 5, we’re offering a Webinar that will cover these
critical regulations in detail and allow you to ask questions. Faculty for
this important program are:
• Karen
Trudel, deputy director, CMS Office of E-Health Standards and Services;
• Larrie Dawkins, MBA, CMPE, chief compliance officer, Wake Forest
University Health Sciences, Winston-Salem, N.C., a former MGMA board chair;
and
• Robert Tennant, MA, MGMA senior policy adviser.
Click here
to register and for more information on this program.
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CMS
releases instructions to contractors on implementing new anti-markup rule
The
Centers for Medicare & Medicaid Services (CMS) recently released a
transmittal to its contractors instructing them on processing claims
subject to the new anti-markup rule that took effect Jan. 1. The new rule,
which replaces the purchased diagnostic test rule, places limits on
reimbursement for diagnostic tests (excluding clinical diagnostic lab
tests) when the performing physician does not share a practice with the
billing entity. The payment limitation applies when a test is ordered and
billed by the same or a related entity.
The
transmittal directs contractors to reject paper claims for “anti-markup
tests” (a new term meaning a test subject to the anti-markup payment
limitation) with more than one service with a TC or 26 modifier. In other
words, each component of a test subject to the anti-markup rule must be
submitted on a separate claim form, and no other services with a TC or 26
modifier can be submitted on a claim form with an anti-markup test.
However, you may submit multiple anti-markup tests on the same claim if you
are filing electronically using the 837P electronic claim. The transmittal
does not go into effect until July 1, but the payment limitation in the
rule is effective as of Jan. 1.
Given
the limitations of the CMS-1500 form, the agency’s directive appears to be
the only way to accurately file claims for such tests. Therefore, we
recommend that practices submitting claims for anti-markup tests consider
adopting this billing method immediately.
Read the
transmittal.
Read
more about the anti-markup
rule.
Resources
available to help bill for durable medical equipment
Many
MGMA members have received notifications from the Centers for Medicare
& Medicaid Services (CMS) or other carriers regarding durable medical
equipment (DME) prosthetics and orthotics (DMEPOS) accreditation. CMS has
provided a temporary exemption for all accreditation deadlines related to
physician and licensed health-care professionals who supply DME. They will
continue to be exempt as long as CMS does not develop new quality standards
applicable to those professionals. While the future of accreditation for
these exempt professionals remains uncertain, members can obtain DME resources
in the following areas:
Fee
schedule
Enrollment
Accreditation
Competitive
Bidding Program
Articles
Physicians
and licensed health professionals exempted from DME accreditation – September
11, 2008
CMS
preparing Web-based Medicare provider enrollment – Jan. 17, 2008
Physicians
and licensed health professionals exempted from DME accreditation –
September 11, 2008
DME
accreditation deadlines remain – July 28, 2008
Changes
to DME accreditation deadlines halted – July 3, 2008
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Feb. 27, 2009
- President releases FY 2010 budget proposals
- MGMA to offer guidance on critical ICD-10 and HIPAA
transactions issues
- CMS releases instructions to contractors on implementing new
anti-markup rule
- Resources available to help bill for durable medical
equipment
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