Wednesday, August 24, 2016

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Read the latest medical news for the San Bernardino County area.


Last chance for some providers to prevent deactivation by Medicare

Noridian, Medicare’s administrative contractor for California, will soon begin deactivating billing privileges for physicians who received revalidation notices from Noridian but have not submitted completed applications to the Centers for Medicare and Medicaid Services (CMS). Last month, Noridian reported that only 19 percent of providers had responded to the most recent Medicare Part B revalidation notices.

Since the passage of the Affordable Care Act (ACA), all Medicare providers and suppliers have been required to revalidate their Medicare enrollment information under new enrollment screening criteria in an effort to prevent fraud within the Medicare system. Once a Medicare enrollment application is validated, the clock starts ticking on a five-year revalidation cycle. Now that five years have passed since the ACA's revalidation requirement took effect, CMS has initiated a second cycle of revalidation requests.

Noridian will send revalidation notices two or three months prior to each provider’s revalidation due date.

The first revalidation due date for this second cycle was May 31, 2016. Effective August 14, 2016, Noridian will deactivate the Medicare billing privileges for affected physicians who failed to complete their revalidation applications CMS prior to the May deadline.

The due date for the second revalidation round was June 30, 2016. Noridian will deactivate billing privileges for physicians who missed the June deadline on September 13, 2016.

To prevent deactivation, the California Medical Association recommends that practices look up their revalidation dates through the CMS look-up tool. If it shows that your practice missed the deadline, you should submit and sign your application online through the PECOS system immediately to prevent deactivation

If you are ultimately deactivated for failure to respond to a revalidation notice, you will be required to submit a reactivation application. The date of receipt of the reactivation application will be the new effective date for your Medicare billing privileges. Noridian will not apply a retroactive effective date, and no payments will be made for the period of deactivation. If a revalidation application is received but incomplete, Noridian will contact you for the missing information. If the missing information is not received within 30 days of the request, Noridian will deactivate your billing privileges.

If your revalidation application is approved, no further action is needed

For more information on the revalidation process, see MLN Matters #SE1605. CMA is also hosting an upcoming webinar on this topic, “Medicare Provider Enrollment: Strategies for Revalidation, Reporting Changes and Avoiding Deactivations,” on Wednesday, August 17 from 12:15 to 1:15 p.m. This webinar will provide guidance on maneuvering the Medicare revalidation and enrollment process. Noridian experts will review how to avoid top errors and other key issues, including finding revalidation due dates, filling out the correct information on enrollment applications, responding to requests for additional information and keeping your enrollment record up to date. This webinar will also review new enrollment tools and tutorials.

If you have questions about the revalidation process, click here or contact Noridian at (855) 609-9960.


CMA publishes MACRA preparation checklist

On April 16, 2015, President Obama signed into law the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), changing the health care financing system in the most significant and far-reaching way since the program's inception in 1965.

To help physicians understand MACRA payment reforms, and what they can do now to start preparing for the transition, the California Medical Association (CMA) has published an important checklist titled, “MACRA: What Should I Do Now to Prepare?

The checklist is available in CMA's MACRA resource center at www.cmanet.org/macra. There you will also find an overview of MACRA, and a comprehensive list of tools, resources and information from CMA, the American Medical Association and the Centers for Medicare and Medicaid Services.

Also available is CMA’s recent webinar, "MACRA: What Is CMA Doing to Improve It? What Steps Can You Take to Prepare Now?" This on-demand webinar is available free to CMA members.


MACRA webinar now available on-demand

A recording of the California Medical Association’s (CMA) recently held webinar – MACRA: What Is CMA Doing to Improve It? What Steps Can You Take to Prepare Now? – is now available to download in CMA’s online resource library. The webinar is available free to members; the cost is $99 for nonmembers.

In this webinar, CMA Vice President of Federal Government Relations Elizabeth McNeil provides a brief overview of the new Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) payment changes. She also discusses CMA’s advocacy efforts with the Centers for Medicare and Medicaid Services to significantly improve the MACRA regulations for physicians.

The webinar offers tips on what steps physicians can take now to be ready for the implementation of Medicare payment reform.

For more information on MACRA, see CMA’s new MACRA resource center at www.cmanet.org/macra.

CMA Webinar Series

Through its robust webinar series, CMA gives physicians and their staff the opportunity to watch live presentations on important topics of interest from the comfort of their homes or offices. The webinars are free to CMA members and their staff and provide the timely information needed to help run a successful medical practice. What’s more, all webinars are available on-demand immediately following the live airing, providing an ever-growing resource library accessible at any time. Visit www.cmanet.org/webinars for a list of all live and archived webinars.


United Healthcare extends clinical data submission deadline to Sept. 2

At the request of the California Medical Association (CMA), United Healthcare (UHC) has delayed the expansion of its Clinical Data Submission Protocol in California. Originally scheduled to take effect July 1, the expansion will now be pushed back until September 2.

First introduced in 2015, the program originally targeted only Medicare benefit plans and required physicians to submit all laboratory test results for UHC Medicare patients. The expansion of the program will require practices to submit laboratory tests for all UHC Medicaid and commercial benefit plans.

For more information about the protocol and requirements for submitting data to UHC, physicians should refer to the updated Clinical Data Submission Protocol Frequently Asked Questions and Methods of Clinical Data Exchange.

While UHC lauds the sharing of clinical patient data as an opportunity to support quality and cost-effective patient care, CMA has expressed concerns about the administrative burden, impact on physician practices and proper notice to physicians.

UHC has stated, however,that it will help practices establish the transmission method that works best with their current capabilities. For more information or to speak to the UHC clinical data team, contact the UHC Provider Call Center at (877) 842-3210 or your local Network Account Manager or Provider Advocate.


Noridian reports low response rate for Medicare Part B revalidations

Noridian, Medicare’s administrative contractor for California, reports that only 19 percent of physicians have responded to the most recent Medicare Part B revalidation notices. Noridian is in the process of deactivating Medicare billing privileges for physicians who received a revalidation notice from Noridian but did not turn in a completed application to the Centers for Medicare and Medicaid Services (CMS) prior to the most recent deadline of May 31.

If you are deactivated for failure to respond to a revalidation notice, you must submit a reactivation application. The date of receipt of the reactivation application will be the new effective date for your Medicare billing privileges. Noridian will not apply a retroactive effective date and no payments will be made for the period of deactivation.

If a revalidation application is received but incomplete, Noridian will contact you for the missing information. If the missing information is not received within 30 days of the request, Noridian will deactivate your billing privileges.

If your revalidation application is approved, no further action is needed.

If you do not know when you are up for revalidation, you can look up your revalidation date through the CMS look-up tool. Those due for revalidation in the near future will display a revalidation due date. All other providers/suppliers will see "TBD" in the due date field.

For more information on the revalidation process, see MLN Matters #SE1605.

If you have questions about the revalidation process, click here or contact Noridian by calling (855) 609-9960.


Noridian begins deactivation of providers who failed to revalidate

The due date for physicians to revalidate their Medicare enrollment information has passed for the most recent cycle of physician revalidation required by the Centers for Medicare and Medicaid Services (CMS). Physicians who received a revalidation notice from Noridian, CMS’ Medicare contractor for California, and who did not turn in a completed application to CMS prior to the May 31 deadline, will have their Medicare billing privileges deactivated.

If you are deactivated for failure to respond to a revalidation notice, you must submit a reactivation application. The date of receipt of the reactivation application will be the new effective date for Medicare billing privileges. No payments will be made for the period of deactivation.

If a revalidation application is received but incomplete, Noridian will contact you for the missing information. If the missing information is not received within 30 days of the request, Noridian will deactivate your billing privileges.

If your revalidation application is approved, the provider will be revalidated and no further action is needed.

If you do not know if you received a notice, you can look up your revalidation date through the CMS look-up tool. Those due for revalidation in the near future will display a revalidation due date. All other providers/suppliers will see "TBD" in the due date field.

For more information on the revalidation process, see MLN Matters #SE1605.

If you have questions about the revalidation process, click here or contact Noridian by calling (855) 609-9960.

Reminder: CMS meaningful use hardship exception deadline is July 1

Physicians should be aware that July 1, 2016, is the extended deadline for physicians to file hardship exception applications from the electronic health record incentive program meaningful use requirements.

In mid-December 2015, Congress adopted a last-minute bill that gave the Centers for Medicare and Medicaid Services (CMS) the authority to grant a blanket exception for all eligible physicians who applied for an exception from the 2015 meaningful use penalties.

CMS reports the extension is being granted “so providers have sufficient time to submit their applications to avoid adjustments to their Medicare payments in 2017."

CMS also released new “streamlined” hardship exception application forms “that reduce the amount of information that eligible professionals must submit to apply for an exception,” the agency said. The new application forms and instructions on filing a hardship exemption are on the CMS website.

To help physician members navigate the hardship exemptions process, the California Medical Association (CMA) has published “Meaningful Use Hardship Exception Frequently Asked Questions.” This document answers questions about the blanket exemption, including who should apply, deadlines and more.

This free members-only resource is available in CMA's online resource library.


DHCS suspends planned passive enrollment for duals project

The Department of Health Care Services (DHCS) announced last week that it would not move forward with its planned annual passive enrollment of dual eligible beneficiaries under the Coordinated Care Initiative (CCI) after it received feedback from the California Medical Association (CMA) and 40 other stakeholders asking the agency to pursue enrollment strategies that support voluntary "opt-in" enrollment.

Instead, DHCS said it will implement a voluntary "opt-in" enrollment effort beginning in July 2016. The new streamlined enrollment strategy will include mandatory Managed Medi-Cal Long-Term Supports and Services (MLTSS) plan enrollment. DHCS said it would monitor participation in the program; should voluntary enrollment not prove to be a viable option for program sustainability, passive enrollment remains an option in the future.

In April, DHCS released a series of proposals that would have changed the CCI enrollment process to 1) passively enroll beneficiaries into Cal MediConnect; and to 2) streamline enrollment by allowing plans to eliminate or dramatically reduce the role of the enrollment broker.

CMA, in partnership with Justice in Aging and other patient advocacy groups, signed a joint letter strongly opposing the proposals.

“Experience shows that passive enrollment strategies result in high opt-out rates, confusion, disruption in care, distrust of managed care and high costs to plans,” the letter to DHCS said. “(P)assively enrolling over 100,000 beneficiaries in a two-month period is staggering. The plans, HICAPs, Ombudsman, enrollment broker, and the broader community lack the capacity to meet the needs of the affected beneficiaries, especially on the expedited timeline DHCS has proposed, under which the first set of notices would be mailed to beneficiaries.”

The Coordinated Care Initiative was authorized by the state in July 2012 in an effort to save money and better coordinate care for the state’s low-income seniors and persons with disabilities. The program began with a three-year demonstration project that expected to see a large portion of the state's dual eligible beneficiaries transition to managed care plans.

Although the state is not going forward with passive enrollment in 2016, DHCS has stated they are still considering a passive enrollment strategy for 2017.

Click here to read CMA's letter to DHCS on this issue.

For more about the duals program, visit www.cmanet.org/duals.

Contact: Lishaun Francis, (916) 551-2554 or lfrancis@cmanet.org.


Maintaining your Medicare opt-out status

Physicians who intend to opt-out, or who have previously opted-out of Medicare, should be aware of changes to the Medicare opt-out period as a result of the Medicare Access and CHIP Reauthorization Action of 2015 (MACRA).  

Validated opt-out affidavits signed on or after June 16, 2015, will automatically renew every two years. Previously, physicians who opted out of the program would have to renew their affidavit every two years to maintain their opt-out status. Under the new rules, affidavits will automatically renew every two years unless the physician cancels in writing with at least 30 days notice prior to the start of the next two-year opt-out period. Cancellation notices must be sent to all Medicare contractors with which they filed their original affidavits.

Opt-out affidavits signed prior to June 16, 2015, will expire two years after the effective date. If you have an opt-out affidavit signed prior to June 16, 2015, and you wish to extend your opt-out period, you must submit an opt-out renewal affidavit to Noridian (California’s Medicare contractor) no later than 30 days after the current opt-out expiration date. Subsequent renewals will happen automatically every two years per the new rules.

More information about opting out and maintaining opt-out status is available here.


CMS releases draft MACRA regulations

The Centers for Medicare and Medicaid Services (CMS) on Wednesday released a 962-page proposed rule that lays out the agency's plan for implementing last year's groundbreaking Medicare reform law, the Medicare Access and CHIP Reauthorization Act (MACRA).

Ahead of CMS’ release of the rule, physician leaders testified before the U.S. House of Energy and Commerce Committee’s Subcommittee on Health during a special MACRA hearing last week. The physicians expressed cautious optimism and said the law represents a critical opportunity to enhance flexibility and innovation in health care that can lead to improved care and better outcomes for patients, but the law also needs to allow physicians to focus on practicing medicine by aligning and simplifying quality reporting programs.

“MACRA makes significant improvements over the current system, including the repeal of the flawed sustainable growth rate formula and giving the Centers for Medicare and Medicaid Services an opportunity to reset and improve performance measurement as well as other requirements,” said Barbara McAneny, M.D., immediate past chair of the American Medical Association (AMA) Board of Trustees, who testified at the hearing. “By increasing the availability of alternative payment models, CMS will spur innovative delivery models focused on enhanced care coordination that can lead to better outcomes for patients.”

The proposed regulations
While there has not yet been time to digest and dissect the entire 962-page regulation, initial reviews indicate that CMS has listened to the input provided by the California Medical Association (CMA), AMA and others in organized medicine over the past year. Since MACRA was passed last spring, organized medicine has been providing extensive physician feedback on MACRA implementation.

Among other issues, the proposed rule addresses questions about elements of MACRA's Merit-Based Incentive Payment System (MIPS), including:

Quality: Clinicians would choose six measures to report, rather than the current requirement of nine, from among a range of options that accommodate differences among specialties and practice settings.

Advancing care information: Clinicians would be able to choose customizable measures that reflect how they use technology in their day-to-day practice. Unlike the existing meaningful use program, this category would not require all-or-nothing electronic health record measurement or redundant quality reporting.

Clinical practice improvement activities: Physicians would be rewarded for clinical practice improvements, such as activities focused on care coordination, patient engagement and patient safety. Clinicians would select activities that match their practices’ goals from a list of more than 90 options.

CMA and AMA will continue to work closely with CMS as the agency revises the regulations over the coming months.


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