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.

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 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.

CMS has Added a New Webpage on CQMs to the EHR Website

CMS has created a new page of the EHR website dedicated to the clinical quality measures (CQMs) and their role in the Medicare and Medicaid Electronic Health Record (EHR) Incentive Programs. The page intends to help providers better understand the purpose of CQMs and how to report on the measures.

Electronic Prescribing (eRx) Incentive (and penalty) Program – Updates for 2012

Background
The Medicare Electronic Prescribing (eRx) Incentive Program, which began January 1, 2009 and is authorized under the Medicare Improvements for Patients and Providers Act (MIPPA) of 2008, provides incentives for eligible professionals who are successful electronic prescribers. A Web page dedicated to providing all the latest news on the eRx Incentive Program is available on the Centers for Medicare & Medicaid Services (CMS) Web site.

Arizona Medicaid EHR Incentive Program Attestation for Eligible Professionals Opens TODAY!

Arizona Medicaid EHR Incentive Program attestation for Eligible Professionals (EPs) will open today, Thursday, January 12th. AHCCCS will accept EP attestations for the 2011 calendar year through February 29, 2012.

A significant number of medical group practices as well as several state Medicaid programs are not ready for the federally mandated conversion to the ASC X12 Version 5010 electronic transaction standards, according to the Medical Group Management Association-American College of Medical Practice Executives. The group is calling on the CMS to push back the looming Jan. 1 compliance deadline on the upgrade by at least six months.

Centers for Medicare & Medicaid Services’ Office of E-Health Standards and Services Announces 90-Day Period of Enforcement Discretion for Compliance with New HIPAA Transaction Standards

Today the Centers for Medicare & Medicaid Services’ Office of E-Health Standards and Services (OESS) announced that it would not initiate enforcement action until March 31, 2012, with respect to any HIPAA covered entity that is not in compliance with the ASC X12 Version 5010 (Version 5010), NCPDP Telecom D.0 (NCPDP D.0) and NCPDP Medicaid Subrogation 3.0 (NCPDP 3.0) standards. Notwithstanding OESS’ discretionary application of its enforcement authority, the compliance date for use of these new standards remains January 1, 2012 (small health plans have until January 1, 2013 to comply with NCPDP 3.0).

Six more states have launched programs to register providers for Medicaid electronic health-record incentive payments under the American Recovery and Reinvestment Act of 2009, bringing the total number of active states to 39, and the total number of states making payments under the program to 23, the CMS announced.