Demonstrating yet again how broken the Medicare sustainable growth rate (SGR) formula is, physicians will face a 24 percent Medicare payment cut next year if Congress does not seize the opportunity to put a stop to the formula's annual threat of drastic payment cuts. This figure was confirmed by the Centers for Medicare and Medicaid Services (CMS) last week, when the agency released its final physician fee schedule for 2014.
The California Medical Association (CMA) is currently reviewing the final rule, which was released much later than usual because of the government shutdown in October. Stay tuned for details.
CMA and others in organized medicine continue to press Congress for SGR repeal this year.
Contact: Elizabeth McNeil, (800) 786-4262 or firstname.lastname@example.org.
A stalemate in Congress over a spending plan for the 2013-2014 fiscal year and a delay in the Affordable Care Act (ACA), has forced a federal shutdown at midnight last night, closing many federal agencies, including a number of departments under the U.S. Department of Health and Human Services (HHS). The new fiscal year began today, October 1. The House Republicans are proposing to continue spending at current levels with a one year delay in the implementation of the ACA. While the Senate Democrats have also agreed to continue government operations at current spending levels, they have resoundingly rejected the House Republican proposals to defund or delay the ACA multiple times in the last week.
Ironically, this shutdown comes on the very day that health benefit exchanges across the country, including Covered California, open for enrollment. Under the ACA, these exchanges are expected to provide health insurance to over 30 million previously uninsured Americans, including 1.3 million in California. The federal government shutdown will not impact open enrollment and exchanges will continue working on implementation as the January 1, 2014, launch date approaches.
Deliberations to fund the government continue and some Congressional leaders anticipate that at least a short-term budget will be enacted in the next few days. In the meantime, however, many government programs have been forced to stop operating until Congress reaches an agreement.
In the short-term, the Medicare program will experience little disruption, and claims will continue to be paid. The transition to the new Medicare claims payment contractor, Noridian, will continue. Other activities conducted by the Centers for Medicare and Medicaid Services (CMS), including health care fraud and abuse control, the Center for Medicare and Medicaid Innovation, and activities related to implementation of the Affordable Care Act, will continue. States will continue to receive funding for Medicaid and the Children’s Health Insurance Program.
Among the activities that will be impacted by the shutdown:
In all, about 52 percent of HHS employees will be furloughed, with grant-making and employee-intensive agencies (e.g., the Agency for Healthcare Research and Quality) experiencing the most severe impacts. Most staff will be retained in agencies that have a substantial direct service component, like the Indian Health Service.
The HHS released a memorandum last week that outlines the department’s contingency staffing and operating plans for the shutdown.
CMA is urging Congress to reach an agreement on the federal budget and get on with the important business of reforming the Medicare payment system and other priority issues before Congress.
We are just one week away from the September 16 cutover date from Palmetto to the new Medicare Part B fee-for-service contractor, Noridian. Although efforts have been made to minimize the burden to practices and to ensure that physicians continue to receive their Medicare payments in a timely fashion after the transition, there are a number of things physicians should be aware of, including:
Last day to submit to Palmetto: September 11, 2013 is the last day providers may submit electronic claims to Palmetto (2:00 p.m. cutoff time), and the last day "early boarders" can submit claims to Noridian with the Palmetto contractor/payer ID. As of September 12, 2013, electronic claims must be submitted to Noridian with the new contractor/payer ID (01102 for Northern CA; 01182 for Southern CA).
Dark Days: In order to transition workloads successfully, Palmetto and Noridian systems will be unavailable from Friday, September 13 until Sunday September 15. Systems will be back up and running on Monday, September 16, the official cutover date.
Remittance Advice: There will be a delay in the delivery of the 835 Remittance Advice when the JE Implementation cutover occurs. The 835 Remittance Advice at cutover will be delivered on September 17, 2013.
Phone Number: Beginning September 16, 2013, Part B providers can contact Noridian through a single toll free service phone number, (855) 609-9960. For more details, see the IVR Guide on the Noridian website.
Mailing Address: Noridian mailing addresses for correspondence have been posted. Routine correspondence, appeals, and reopening should be addressed to the appropriate Northern California or Southern California post office box.
Paper Claims: Effective September 16, 2013, paper claims must meet the Noridian submission requirements, which are slightly different than Palmetto's. Claims not meeting the Noridian requirements will be denied or returned as unprocessable.
Coding: Noridian has published articles detailing its requirements for the following: compounded drugs reimbursement billing; infusion drugs reimbursement billing; unlisted procedure and not otherwise classified codes; avoiding denials on priced per invoice claims. Please refer to these articles to ensure you are submitting your claims in accordance with their coding instructions to avoid unprocessable claims.
If you have not signed up for the mailing list, be sure to check the Noridian website daily for additional changes that may impact your practice.
For more information and the latest news and resources relating to the Medicare transition, see the California Medical Association's Medicare Transition webpage, www.cmanet.org/medicare-transition.
Contact: CMA reimbursement help line, (888) 401-5911 or email@example.com.
September 16, 2013, is the cutover date for transition of the Medicare Part B fee-for-service contractor from Palmetto GBA to Noridian. Although efforts have been made to minimize the burden to practices and to ensure that physicians continue to receive their Medicare payments in a timely fashion after the transition, physician practices will have to make some changes in their processes, including but not limited to the following:
•Electronic claim submitters must change the contractor ID (payor ID) on their transmissions. The new ID for the Northern California jurisdiction is 01112; for the Southern California jurisdiction it is 01182.
Please note, the change to the Contractor ID should not be made before September 12 for Part B claims.
•Paper claims will be submitted to a new address. The new address has not yet been announced. Stay tuned for more details.
•There will be a new toll-free telephone number, (855) 609-9960, for all telephone inquiries to Noridian. (This number will not be activated until September 16, 2013.
Practices are also encouraged to review the resources available regarding the transition:
CMA’s Medicare Transition webpage: CMA has created a dedicated Medicare transition webpage, www.cmanet.org/medicare-transition, offering practices the ability to access updates and important information regarding the transition in one easy-to-access to location. All resources related to the Medicare transition will be accessible through this page.
CMA’s Medicare Transition Guide: This guide, which members can download free from the CMA website, contains information on the transition dates, what will remain the same with the transition and what will change, Noridian’s online provider portal, what practices can do to prepare for the transition and links to additional resources and ways to stay apprised of new information on the transition. The guide also includes a comprehensive preparation checklist.
Noridian’s transition website: The Noridian transition website includes information on what’s new/changing and what will remain the same during and after the transition.
CMA Practice Resources: CMA Practice Resources (CPR) is a free monthly newsletter from CMA’s practice management experts that focuses on critical payor and health care industry issues, including the Medicare transition, and how these issues directly impact the business of a physician practice. To sign up, visit the CMA website (www.cmanet.org/newsletters) or contact CMA Member Services at (800) 786-4262 or firstname.lastname@example.org.
CMA Content Alerts: The CMA website allows registered users to create custom content alerts on the topics that are of interest to you. Once signed up, you will be notified any time there is new content posted in one of your interest areas. To sign up to receive Medicare alerts, users should visit their account dashboard on the CMA website and click on “my alerts,” then under "New Content Alerts" click on the "Alert Settings" tab, and select “Insurance Reimbursement -> Medicare.”
Contact: CMA reimbursement help line, (888) 401-5911 or email@example.com.
September 16, 2013, is the cutover date for transition of the Medicare Part B fee-for-service contractor from Palmetto GBA to Noridian. Although every effort has been made to minimize the burden to practices and to ensure that physicians continue to receive their Medicare payments in a timely fashion after the transition, physician practices will have to make some changes in their processes. Practices are encouraged to review the resources available to you to ensure you are aware of and prepared for the transition.
Physician practices that submit their claims electronically, especially if they are currently direct submitters to Palmetto, may want to consider Early Boarding to avoid any possible issues following the transition. The last day to enroll for Early Boarding is August 30, 2013.