November 2010 Client Newsletter

The Medicare Learning Network® (MLN) has released MLN Matters Article #MM7133 to inform providers that the Centers for Medicare & Medicaid Services (CMS) will cover counseling services to prevent tobacco use for outpatient and hospitalized beneficiaries. Effective for claims with dates of service on and after August 25, 2010, CMS will cover tobacco cessation counseling for outpatient and hospitalized Medicare beneficiaries 1) who use tobacco, regardless of whether they have signs or symptoms of tobacco-related disease; 2) who are competent and alert at the time that counseling is provided; and 3) whose counseling is furnished by a qualified physician or other Medicare-recognized practitioner. This article is available on the CMS website at http://www.cms.gov/MLNMattersArticles/downloads/MM7133.pdf. Code 99406 (3-10 minutes) currently pays $14.61. Code 99407 (> 10 minutes) currently pays $27.92. Effective 1/1/2011 new “G” codes have been created which will waive the Medicare deductible and co-insurance. Let Rich know if you plan to use the new codes.


Each year CPB prepares a table with the Medicare Allowable Amounts for your commonly used office CPT codes. If you would like to receive this again in 2011, please notify Rich by December 10th.

As you know, the Fall elections are just a few days away and Congress still has not passed a long term fix to the Medicare Fee Schedule. The following is HBMA’s (our professional association) Washington representative’s thoughts on the subject as published in early October:

“It appears likely that the House and Senate will conclude whatever business they can agree upon by the end of this week. Although there is still a lot of haggling going on, I do not anticipate anything major occurring prior to their adjournment. Most likely they'll conclude a short-term Continuing Resolution that will allow the government to operate into mid-December and then go home to run for re-election.

Several issues will be carried over to an expected "Lame Duck" session. No official start date for that session but it could "start" as early as the week after the election but it is more likely that serious discussions won't start until after Thanksgiving. This does not bode well for an SGR fix before the November 30th deadline.

Issues for discussion during the lame duck include - funding the government for the remainder of the Fiscal Year, dealing with the Tax Cut/Extenders, fixing the SGR and some defense related matters.

For billing companies and their clients, the most significant issue will be the pending SGR cuts. My conversations with Congressional staff indicate that they still believe that the Congress will move to prevent those cuts from occurring but nothing is certain. I have encountered some staff who are very pessimistic about the prospects for even a short-term fix in late November.

Lame Duck sessions are notoriously unproductive regardless of whose reign they occur under. Given the likelihood that the GOP will gain strength, they will not be in a mood to do anything of substance while the chamber is under Democratic control. Further, should Democrats - legitimately or not - blame their losses on the physician community - they will be in no mood to help physicians.

Not a formula that lends itself to an optimistic outlook but we still need to keep pushing.”


On October 25th, Highmark announced that the incentive payments for the 2009 Physician Quality Reporting Initiative (PQRI) for eligible professionals who met the criteria for successful reporting. Carriers and Medicare Administrative Contractors (MACs) will begin processing and distributing 2009 PQRI incentive payments on October 25, 2010and is scheduled to be completed by November 12, 2010.

The 2009 eRx feedback reports will be available on the Physician and Other Health Care Professionals Quality Reporting Portal at http://www.qualitynet.org/pqri on the internet, starting the second week of November. TIN-level reports on the Portal require an Individuals Authorized Access to CMS Computer Services (IACS) account. Participants may also contact their Carrier or MAC to request individual NPI-level reports via an alternate feedback report fulfillment process, please visit http://www.cms.gov/MLNMattersArticles/downloads/SE0922.pdf on the CMS website.


If you have questions about the status of your eRx incentive payment (during the distribution timeframe), please contact your Provider Contact Center. The Contact Center Directory is available at http://www.cms.gov/MLNProducts/Downloads/CallCenterTollNumDirectory.zip on the CMS website.

Feel free to contact the QualityNet Help Desk with any of the following:

· Physician Quality Reporting Initiative (PQRI) Portal password issues
· PQRI/eRx feedback report availability and access
· PQRI-IACS registration questions
· PQRI-IACS login issues

The QualityNet Help Desk is available Monday through Friday from 7:00 a.m. – 7:00 p.m. CST at 1-866-288-8912 or via qnetsupport@sdps.org on the internet. The QualityNet Help Desk is also available to assist with PQRI and eRx measure-specific questions.