Medicaid in the future – Michelle of AddVal would like to know your thoughts…

As of last Tuesday’s election, the future of health care reform is in doubt. However, most pundits agree that “something” will be implemented in the coming years requiring everyone to have some kind of health care coverage. More than likely, that “something” will be handled at the individual state level and will probably be a convolution of current Medicaid products.

The current statistics show only 25-40% of physicians accept Medicaid patients. If Medicaid evolves into the “something” for universal coverage, what aspects of Medicaid programs need improvement for your physicians to consider joining?

• Realistic & reasonable reimbursement rates
• Timely claims processing
• Assistance dealing with cancellations/ no-shows

Please take a minute to join our discussion blog on healthcare reform & Medicaid by adding your comment below now:

AddVal, Inc. | Autumn 2010 Newsletter

Inside this Issue:   PECOS Medicare Claims for CPT Codes 99204 & 99205 Fee Schedules PECOS Medicare PECOS (Provider Enrollment, Chain & Ownership System) is Medicare's online data base. Physicians and other providers can now register with Medicare using this online system. There has been tremendous confusion about the "deadline" to be registered with PECOS. In May, the Federal Register issued reference to a deadline of July 7, 2010 for PECOS registration where the previous deadlines had referred to January 2011. In order to meet this new deadline, AddVal and many physician practices worked furiously to ensure PECOS Medicare registration was completed by July. Due to the influx of thousands of applications and requests, the PECOS system was overwhelmed and basically not usable during work hours. In June, AddVal learned that the July deadline was not going to be implemented. Confusion remains, however, because the DME suppliers have been directed to only accept orders from physicians who are active on PECOS. We have verified that all of our clients who order DME are active on PECOS. January 2011 is not far away. If your practice has not completed the PECOS Medicare registrations, the time to do so is now. If you're not sure if your physicians are active on PECOS, check their status at: https://pecos.cms.hhs.gov/pecos/login.do. NPI logins are needed to enter this site and verify listing with PECOS. If your physicians have not made any changes to their Medicare registration in the last 5-6 years, they need to be entered in the PECOS system. Call AddVal at 215-396-8972 if you need assistance with this important process – don't let your Medicare payments be held up any longer than they already are! Claims for CPT Codes 99204 & 99205 (up) Commercial payers and Medicare contractors are devoting a tremendous amount of time and effort to the investigation of claims submitted for procedure codes 99204 & 99205. These Evaluation and Management (E/M) codes for new outpatient visits require documentation of a comprehensive history and examination for the visit.   Comprehensive History Requirements: Extended history of the present illness; Complete review of systems; and, Complete review of past medical family & social history. Comprehensive Examination Requirements: A complete review of eight (8) or more systems It is NOT possible in this newsletter to detail the complexities in the requirements for procedure codes 99204 & 99205. Your local Medicare contractor has documentation worksheets that your practice can use to ensure compliance with the requirements for these codes. It is important to be aware that all payers are working under the assumption that your patients will fall into the "normal" distribution of complexity. In other words, if physicians in your specialty are billing for 99204 only 25% of the time and you are billing 99204 for 40% of your patients, you will be scrutinized. It is very important to ensure that careful and complete documentation will support your code levels – especially if your practice is outside of the "norm". All documents reviewed by Medicare and the other payers are required to be authenticated by the author. This means that your signature must be legible (electronic signatures are acceptable). If the legibility of your signature is questionable, be sure to submit an attestation statement with any documentation sent to Medicare or other payers. Fee Schedules (up) Do you know your fee schedule? As part of the contracting process, the commercial payers include a fee schedule for the physician. It is crucial to know your fee schedule for each payer to ensure that your claims are being paid at the agreed upon rates. Some practices have received "adjustment checks" from commercial payers when the fee schedule was not being paid accurately. This influx of cash is a nice surprise. However, this also means that your practice has not had the deserved level of cash – you have loaned it to the payer (without interest). Medicare has a convenient fee schedule look up tool: http://www.cms.gov/apps/physician-fee-schedule/overview.aspx Since some commercial payers determine their rates as a percentage of Medicare, it is very important to have a solid understanding of your Medicare fee schedule. Remember… "Mistakes are part of the dues one pays for a full life." ~ Sophia Loren

PECOS Medicare DEADLINE July 6, 2010 Misinformation

Many DME suppliers are sending notices out to physicians requiring them to complete their PECOS registration online by July 6, 2010. As many of you know, we have been working over the last few months to make sure our clients are current with PECOS in advance of that deadline.

Currently the PECOS online system is being inundated by applicants & is not working correctly all of the time. In addition, during business hours, the PECOS system is very, very slow and frequently kicks the applicant out of the system because it has “timed itself out”.

In speaking with CMS, PECOS & DME today, I was made aware that the PECOS deadline is July 6, 2011. If any DME supplier is requesting you to complete PECOS by 7/6/10, please refer them to CMS, PECOS or DME for the correct deadline – next year!

In the meantime, we will continue to finish our clients on PECOS well in advance of the 2011 deadline. If you need any assistance or have any questions about any of this, please contact me.

If you are not our client, you need to be, the next two years will be quite the credentialing ride.

just released from the Centers for Medicare and Medicaid Services (CMS):

On June 25, 2010, President Obama signed into law the “Preservation of Access to Care for Medicare Beneficiaries and Pension Relief Act of 2010.” This law establishes a 2.2 percent update to the Medicare Physician Fee Schedule (MPFS) payment rates retroactive from June 1 through November 30, 2010. The Centers for Medicare & Medicaid Services (CMS) has directed Medicare claims administration contractors to discontinue processing claims at the negative update rates and to temporarily hold all claims for services rendered June 1, 2010, and later, until the new 2.2 percent update rates are tested and loaded into the Medicare contractors’ claims processing systems. Effective testing of the new 2.2 percent update will ensure that claims are correctly paid at the new rates. We expect to begin processing claims at the new rates no later than July 1, 2010. Claims for services rendered prior to June 1, 2010, will continue to be processed and paid as usual.

Claims containing June 2010 dates of service which have been paid at the negative update rates will be reprocessed as soon as possible. Under current law, Medicare payments to physicians and other providers paid under the MPFS are based upon the lesser of the submitted charge on the claim or the MPFS amount. Claims containing June dates of service that were submitted with charges greater than or equal to the new 2.2 percent update rates will be automatically reprocessed. Affected physicians/providers who submitted claims containing June dates of service with charges less than the 2.2 percent update amount will need to contact their local Medicare contractor to request an adjustment. Submitted charges on claims cannot be altered without a request from the physician/provider. Physicians/providers should not resubmit claims already submitted to their Medicare contractor.

Special update: Medicare physician payment cut blocked

The House of Representatives just passed the Preservation of Access to Care for Medicare Beneficiaries and Pension Relief Act of 2010 (H.R. 3962) by a vote of 417 to 1. This legislation contains provisions that block the 21.3 percent cut to Medicare physician payments until Nov. 30. The Senate passed identical legislation late last week. The president is expected to sign the bill into law shortly. Practices will then see a 2.2 percent increase to Medicare physician payment for claims with dates of service from June 1 through Nov. 30.

New Rule Released for Medicare Enrollment & Claims

Earlier this month, the Centers for Medicare & Medicaid Services (CMS) released a rule that impacts Medicare and Medicaid enrollment and claims. The rule applies several Patient Protection and Affordable Care Act (PPACA) provisions.
To avoid unpaid claims, you must understand the requirements of this new rule.
Effective July 6, 2010:
* Providers must list National Provider Identifiers (NPI) on Medicare and Medicaid enrollment applications and claims.
* Suppliers of Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS), laboratory, imaging, or specialist services, need to identify the ordering/referring supplier by legal name and NPI on Medicare Part B claims.
*Ordering/referring suppliers must be a physician or an eligible professional with an approved enrollment record in the Provider Enrollment Chain and Ownership System (PECOS). This stipulation significantly changes the existing Jan. 3, 2011 deadline CMS established for accurate provider enrollment records in PECOS.
*Part A claims for Part A and B covered home health items or services must meet these same provisions and be ordered by physicians.
Providers must now maintain documentation, including the ordering/referring physician’s NPI, for seven years on any covered, ordered DMEPOS, laboratory, imaging or specialist services.
Claims not meeting these requirements will be rejected by Medicare contractors. So protect your claim payments by understanding, and complying with, the new rule!
AddVal is working with our clients to complete the PECOS registration. We will be contacting all of our clients in the next few weeks (if we have not done so already), to coordinate the PECOS registration for your physicians.