Medicare Claims processing, Sequestration and 2% Cut

As you know, on March 1^st, President Obama issued a sequestration order as required by the Budget Control Act of 2011.  Although for most federal programs the effects of sequestration began immediately, for Medicare Part A and Part B, the sequestration related cuts do not take effect until April 1^st.

February 28th is the Last Day for EPs to Submit Medicare Part B Claims

February 28, 2013, is the deadline for EPs to submit any pending Medicare Part B claims from calendar year (CY) 2012, as CMS allows 60 days after December 31, 2012, for all pending claims to be processed. This means that EPs have 60 days in 2013 to submit claims for allowed charges incurred in 2012.

Medicare and Medicaid electronic health record payments are estimated to have blasted through $10.3 billion to a total of 180,200 physicians and hospitals through December since the program's inception. December's payments of $1.25 billion were driven by the largest amount of hospital payments for an individual month, according to Robert Anthony, a specialist in CMS' Office of eHealth Standards and Services.

The Stage 2 rule for the Electronic Health Record (EHR) Incentive Programs included changes to the Stage 1 meaningful use objectives, measures, and exclusions for eligible professionals (EPs), eligible hospitals, and critical access hospitals (CAHs). Some of these Stage 1 changes took effect on October 1, 2012, for eligible hospitals and CAHs, or January 1, 2013, for EPs. Several are optional, but others are required.

The Centers for Medicare and Medicaid Services (CMS) has received numerous questions regarding Specialists meeting the EHR Meaningful Use (MU) criteria to either receive the bonus payments or avoid the penalties.  In response to those inquiries, CMS has created a "Tipsheet" to provide some insights and suggestions on how Specialists can meet the Meaningful Use criteria.

A proposed federal rule nips and tucks previously issued regulations governing the testing, certification and use of electronic health-record systems.

The proposed rule, issued jointly by the CMS and the Office of the National Coordinator for Health Information Technology, tweaks several of the meaningful-use criteria that healthcare providers must meet to qualify for payment under the federal EHR incentive program.

For example, it adds an alternative meaningful-use criterion for the electronic transmission of structured lab results from hospitals to ambulatory-care providers who ordered the lab test.

Under the new alternative criterion, hospitals must send structured electronic clinical lab results to the ordering ambulatory-care provider for more than 20% of total lab orders received from ambulatory providers, regardless of whether the orders were received electronically or by phone, fax or other communications method.

The CMS issued a final rule late Thursday temporarily increasing primary care physician payments from Medicaid.

The rule (PDF), which implements a provision of the Patient Protection and Affordable Care Act, details the extent and target of the increase, which takes effect in January and lasts through 2014.

The provision is designed to match Medicare rates, but the rule specifically covers only the difference between the Medicare rate and states' Medicaid rates as of July 1, 2009. The additional federal funding may not be enough to increase the rate to Medicare levels because some states have enacted Medicare provider rate cuts since mid-2009.

The Office for Civil Rights appears to be sending a stern and serious message to practices nationwide as the first stage of Meaningful Use wraps up. Less than four months after the Alaska DHHS’s $1.7 million settlement we reported on in August, another practice has been slammed with a $1.5 million fine for a potential breach of the Health Insurance Portability and Accountability Act.

Read CMS' Press Release and Fact Sheet to Learn More about the Stage 2 Final Rule

Today, U.S. Department of Health and Human Services Secretary Kathleen Sebelius announced that the Centers for Medicare & Medicaid Services (CMS) published the final rule for Stage 2 of the Medicare and Medicaid Electronic Health Record (EHR) Incentive Programs. The rule provides new criteria that eligible professionals (EPs), eligible hospitals, and critical access hospitals (CAHs) must meet in order to successfully participate in the EHR Incentive Programs.

“The changes we’re announcing today will lead to more coordination of patient care, reduced medical errors, elimination of duplicate screenings and tests and greater patient engagement in their own care,” Secretary Sebelius said.

Rule Provisions

Through the Stage 2 requirements of the EHR Incentive Programs, CMS will expand meaningful use of certified EHR technology. The rule made consolidated several existing Stage 1 objectives and added new objectives for Stage 2. There will be 20 measures for EPs (17 core and 3 of 6 menu) and 19 measures for eligible hospitals (16 core and 3 of 6 menu) in Stage 2.