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 House of Representatives late Tuesday approved the Senate's last-minute fiscal cliff package (PDF) that staves off a sharp Medicare physician pay cut by cutting billions from other Medicare providers, including hospitals, pharmacies and dialysis clinics.

Early on New Year's Day, the Senate voted 89-8 to approve the American Taxpayer Relief Act, an amended version of a tax bill that House Ways and Means Chairman Dave Camp (R-Mich.) introduced last summer. House members on Tuesday considered the Senate-passed legislation in meetings during the day and floor debate in the evening. In a vote of 257 to 167, the House passed the measure, which permanently extends middle-class tax cuts and postpones the automatic spending cuts known as the sequester for two months. The legislation also averts the expected 26.5% Medicare physician payment cut and extends current Medicare payment rates for doctors through Dec.31, 2013.

Now that both chambers have approved the package, Congress will send the legislation to President Barack Obama for his signature. Moments after the House vote, the president said in a brief news conference that Tuesday's agreement helps reduce the nation's deficit by raising $620 billion in revenue from the wealthiest households in America. He also noted there will be more deficit reduction as Congress considers how to address the sequester, and he indicated he's open to reforms in the Medicare program.

“As I've demonstrated throughout the past several weeks, I am very open to compromise. I agree with Democrats and Republicans that the aging population and the rising cost of healthcare makes Medicare the biggest contributor to our deficit," the president said. "I believe we've got to find ways to reform that program without hurting seniors who count on it to survive. And I believe that there is further unnecessary spending in government that we can eliminate. But we can't simply cut our way to prosperity."

In a summary of the agreement (PDF)—which Vice President Joe Biden and Senate Minority Leader Mitch McConnell (R-Ky.) hammered out late Monday—the White House said the president “stood firm against Republican proposals to pay for this fix with cuts to the Affordable Care Act or the beneficiaries."

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 House and Senate have both voted to approve legislation preventing the scheduled 27.4% SGR related cut from taking effect on March 1.  The legislation goes to the President who has indicated that he will sign the bill.

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.

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).