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February 2017 Client Newsletter

URGENTIt's Not Too Late to Succeed With 2016 PQRS.  
You can still avoid the 4 percent penalty in 2018 and succeed with PQRS for 2016!  Deadline for submission is March 31st but you need to address now before the last minute rush.  If you need assistance, please contact Rich.
2017 Medicare- MIPS, MACRA, etc. - Holy Cow, Batman!
At the end of December, the Centers for Medicare and  Medicaid Services (CMS) unveiled a number of resources and information critical to participating in the Merit-Based Incentive Payment System (MIPS) and Alternative Payment Models (APMs) in 2017, including the highly-anticipated 2017 quality measure specifications and performance benchmarks practices will be scored against, a new fact sheet and measure specifications for the MIPS EHR category known as Advancing Care Information (ACI), as well as an updated comprehensive list of APMs.
Just a reminder to be sure you are participating in one of the Medicare Quality programs which are available to independent providers as well as groups.  Solo providers do not need to sell their practice to a group and become employees in order to meet the requirements.  2017 is a transition year with relaxed requirements that are easy to meet in order to avoid a cut in 2019. 
Not meeting the MIPS requirements in 2017 will result in a 4 percent decrease in Medicare payments in 2019.  The penalty increases in 2020 to 5 percent, 2021 is 7 percent, and 2022 and beyond is 9 percent. Meeting the requirements either avoids a decrease or allows as much as the same amount of increase. 
Call Rich if you would like to discuss. 
2016 Meaningful Use Attestation now open through Feb. 28
The registration and attestation portal for the 2016 EHR Incentive Program is now open and will run through February 28. In that time, eligible professionals (EPs) must attest to meaningful use of EHRs in 2016 to avoid a payment penalty in 2018. Since there have been system issues in the past related to the high volume of users close to the deadline, providers are encouraged to complete the attestation process as soon as possible.
In conjunction with the portal's opening, CMS also released a new resource intended to educate EPs on the current Stage 2 requirements and help guide them through the attestation process. The worksheet includes all program requirements, as well as potential exclusions for specific measures. For more information and exclusive content on meaningful use, visit MGMA's Meaningful Use Resource Center
Geisinger Insurance
Geisinger Health Plan has now stopped issuing paper checks.  They offer only two options:
  • EFT (Free)
  • Virtual Credit Card (same cost as a credit card!)
In addition, they also have stopped sending EOB's - we have no option other than to go to the InstaMed website.  Every client has received the required paperwork to fix this issue. 
Horizon and Taxonomy codes
You may have received a letter from Horizon notifying you that on April 1 they will begin requiring the Taxonomy code when billing.  This is an internal change for Cape Medical Billing to implement and it has already been scheduled with our software vendor for late February. 
We have captured the Taxonomy codes for all clients, and all Referring physicians (we expect that to happen at some point also) for quite a few years.  So we already have the data in our system.  We use the Primary Taxonomy code from the NPI Registry to ensure it will be correct.  It is effective April 1 and we will be ready to go by early March.
We will not begin sending sooner because we expect Horizon will have a few "glitches" and prefer other providers/vendors to find them first.  That avoids a cash flow issue for our clients. 
Medicare Revalidation - Every 5 Years
The Centers for Medicare and Medicaid Services (CMS) requires providers who submit claims to Medicare to revalidate the accuracy of their enrollment information every five years. Most Medicare Administrative Contractors (MAC) have been sending reminders to providers in their jurisdictions to check their revalidation status for their enrollment in the Medicare program.
Providers can also use the online Medicare Revalidation List at or the Provider Enrollment, Chain and Ownership System (PECOS) to obtain their revalidation due date.
In addition to PECOS, providers will receive a communication from their MAC notifying them of the need to revalidate six months in advance of the deadline. Providers will not have a revalidation due date listed on PECOS until they are within six months of their due date.
If a PECOS database search is undertaken outside the six-month window, you will see "To Be Determined" listed as the provider's revalidation due date. The revalidation deadline will not be listed until the provider is within the six month window.
Provider Enrollment Application Fee Amount for 2017
Effective January 1, 2017, the CY 2017 application fee is $560 for institutional providers (including ambulance) that are:
  • Initially enrolling in the Medicare or Medicaid program or the Children's Health Insurance Program (CHIP);
  • Revalidating their Medicare, Medicaid, or CHIP enrollment; or
  •  Adding a new Medicare practice location.
This fee is required with any enrollment application submitted from January 1, 2017, through December 31, 2017.
Ankle-Foot/Knee-Ankle-Foot Orthosis 
(HCPCS L1970, L4360, L4361)
Quarterly Results of Service Specific Prepayment Review
The Jurisdiction A, DME MAC, Medical Review Department is conducting a service specific review of HCPCS code(s) L1970, L4360 and L4361. The quarterly edit effectiveness results from July 2016 through October 2016 are as follows:
  • The L1970 review involved 126 claims, of which 106 were denied. Based on dollars, this resulted in an overall claim potential improper payment rate of 84%.
  • The L4360 review involved 479 claims, of which 476 were denied. Based on dollars, this resulted in an overall claim potential improper payment rate of 99%.
  • The L4361 review involved 600 claims, of which 478 were denied. Based on dollars, this resulted in an overall claim potential improper payment rate of 80%.
The top reasons for denial are:
  • Documentation does not support custom fit criteria.
  • Documentation was not received in response to the Additional Documentation Request (ADR) letter.
  • Proof of Delivery (POD) was not received.
  • Documentation does not support coverage criteria.
Advanced Care Planning Coverage
Just a reminder that Advanced Care Planning (99497) is only a Medicare covered service at this time.  Only traditional Medicare and the Medicare Advantage plans cover.  However, the Advantage Plans do pay less - Medicare pays about $90, while United Healthcare allowed about $70, and Aetna about $64.  
2017 Client Newsletter Archive