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December 2011 Client Newsletter

Medicare Provider Revalidation

“All providers and suppliers who enrolled in the Medicare program prior to Friday, March 25, 2011, will be required to submit their enrollment information so they can be revalidated under new risk screening criteria required by the Affordable Care Act (section 6401a). Providers/suppliers who enrolled on or after Friday, March 25, 2011 have already been subject to this screening, and need not revalidate at this time.Do NOT submit your revalidation until you are notified to do so by your MAC. You will receive a notice to revalidate between now and March 2015.” CMS extended the time frame early in November from 2013 to March 2015 and physicians will be among the last required to revalidate.Be advised that you/we only have 60 days from the date of the letter to submit the revalidation application – and non-physicians will be charged $505. Failure to submit within 60 days results in stopping your Medicare payments. Payment can be made online and is required before the application can be done on PECOS.


Due to phenomenal growth, CMB has now reached the point that we began to send patient statements twice a month in order to spread patient calls out and further improve cash flow.

2012 Medicare FEE SCHEDULE

SGR Update: Congress has made no progress on legislation to avoid the SGR related 27.4% reduction in the Conversion Factor for Medicare physician fee schedule payments that is slated to take effect on January 1, 2012. You should be prepared for the possibility that Congress will fail to enact even a temporary SGR fix and a significant cut in physician fee schedule payments could occur on January 1.

CMS announced on November 2nd:
“In addition to the SGR related fee schedule adjustment, CMS is also announcing other changes for 2012 as well. Some of the other major changes being adopted in the final rule include:

* CMS is expanding its multiple procedure payment reduction policy to the professional interpretation of advance imaging services to recognize the overlapping activities that go into valuing these services. This policy better recognizes efficiencies that are expected when multiple imaging services are furnished to the same patient, by the same physician or group practice, in the same session on the same day.
* CMS is adopting criteria for a health risk assessment (HRA) to be used in conjunction with Annual Wellness Visits (AWVs), for which coverage began Jan. 1, 2011 under the Affordable Care Act. The HRA is intended to support a systematic approach to patient wellness and to provide the basis for a personalized prevention plan. CMS is increasing AWV payment modestly to reflect the additional office staff time required to administer an HRA to the Medicare population.
* CMS is expanding the list of services that can be furnished through telehealth to include smoking cessation services. CMS is also changing the criteria for adding services to the telehealth list to focus on the clinical benefit of making the service available through telehealth. This change will affect services proposed for the telehealth list beginning in CY 2013.
* CMS is updating or modifying aspects of a number of physician incentive programs including the Physician Quality Reporting System, the ePrescribing Incentive Program and the Electronic Health Records Incentive Program.
The announcement finalizes quality and cost measures that will be used in establishing a new value-based modifier that would adjust physician payments based on whether they are providing higher quality and more efficient care as required by the Patient Protection and Affordable Care Act. The PPACA requires CMS to begin making payment adjustments to certain physicians and physician groups on Jan. 1, 2015, and to apply the modifier to all physicians by Jan. 1, 2017.
* CMS announces that they will implement the third year of a 4-year transition to new practice expense relative value units, based on data from the Physician Practice Information Survey that was adopted in the MPFS CY 2010 final rule.”


On January 1, 2012 the medical billing industry must begin submitting claims and applying payments using the 5010 version. CPB and our vendor are testing and do not anticipate any problem meeting this deadline.
2011 Client Newsletter Archive