April 2013 Client Newsletter
Now that sequestration has taken
effect, unless Congress & the President can get their collective acts
together, Medicare payments will be cut by 2% for dates of service April 1 and
after. So, what does that mean financially?
The reduction applies to the
amount Medicare will actually pay to the provider - AFTER - the appropriate
deductible or copayment has been calculated. So, if the allowable is $100.00, the co-payment is 20% or $20.
Medicare's payment was - pre-sequestration supposed to be $80.00
(80% of the allowable).
the $80.00 will be reduced by 2% ($1.60). So instead of the Medicare payment
being $80.00, it will be $78.40. Unfortunately, providers are not
authorized to collect the sequester related reduction from the patient.
The patient will still owe the full $20.00 (20%) co-insurance amount. If
the pt has no 2' insurance, it can be collected during the office visit.
If anyone needs to know the
monthly average amount of Medicare payments or has any questions, contact Rich.
Lots of partisan politics going on for the benefit of some BIG congressional
Be sure to watch for a letter from Medicare requiring you to
revalidate your information with them. You have a very limited time period to do this. Failure to do so results in de-activation of your provider # - and a stoppage of all payments - until the
revalidation has been completed.
MEANINGFUL USE As you
may know, Medicare providers who do not achieve 90 days of Meaningful Use by
12/31/2013 will lose $15,000 in Medicare EHR Incentive Funds. This means you need to START using your EHR
no later than 10/1/2013. Allowing 6-8 weeks to implement and train, you need to
purchase by July. Plus, it is expected
many others will delay getting started also, thereby creating a backlog. CPB can offer some suggested vendors.
management codes 99495 & 99496 So far, only Medicare &
Horizon will pay. Aetna does not. Horizon & Medicare are allowing the same
amount: 99495 = $176.73 & 99496 =
Only one physician may bill Medicare for the TCM for any one
patient's discharge from the hospital, and the physician must wait until 30
days after the discharge to bill for the service. The first physician who submits a claim will
Can we bill any services during the 30-day
post discharge period? Yes. Second
and subsequent E/M services after the initial bundled E/M service may be reported.
Other diagnostic or therapeutic services may be billed.
Anything else we can't report with these codes? Yes. Some of the codes that may not be
billed with the TCM codes during the time period covered by the TCM codes (29
days post discharge), are:
- Care Plan Oversight (99339, 99340, 99474-99380)
- Prolonged services without patient contact (99358, 99359)
(with patient contact is allowed)
- Anticoagulant management (99363, 99364)
- End stage renal disease services (90951-90970)
Medicare & REFERRING
Effective May 1, 2013, the long delay in requiring only
currently validated providers to be able to refer will end. On that date, if your referring provider is
not in PECOS or in the carrier's system, you will not be paid for any services
(Radiology, Lab, etc.) or equipment, that were referred to you.
Good news, sort of.
On January 18, 2013 CMS instructed its contractors to start the process
to update CPT code National Coverage Determinations to ICD-10 codes (now
Medicare uses that list to
determine medical necessity for many CPT & HCPCS payments.
Just a reminder that Medicare is requiring providers to
participate in the PQRS program to avoid a loss of Medicare payments.
If you need assistance with that, please let
me know ASAP as the measures require more participation than in past years.
AnnuAl wellness visits required documentation If you need to know what Medicare requires to be
documented for each of the 3 AWV codes, you can use this link: http://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/downloads/AWV_chart_ICN905706.pdf