Last day to change your Medicare participation status for 2019 is December 31 Once again, it’s time for physicians to decide if they want to make changes to their Medicare participation status. Physicians have until December 31, 2018, to make changes for the 2019 participation year. As always, physicians have three choices regarding Medicare: Be a participating provider; be a non-participating provider; or opt out of Medicare entirely. Details on each of the three participations options are as follows: A participating physician must accept Medicare-allowed charges as payment in full for all Medicare patients. A non-participating provider can make assignment decisions on a case-by-case basis and bill patients for more than the Medicare allowance for unassigned claims. Non-participating physician fees are 95 percent of participating physician fees. If you choose not to accept assignment, you can charge the patient 9.25 percent more than the amounts allowed in the participating physician fee schedule (which equates to 15 percent of the non-participating fees). Physicians who opt out of Medicare are bound only by their private contracts with their patients. Medicare's limiting charges do not apply to these contracts, but Medicare does specify that these contracts contain certain terms. When a physician enters into a private contract with a Medicare beneficiary, both the physician and patient agree not to bill Medicare for services provided under the contract. 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 two years after the effective date. Physicians who want to change their participation status for 2019 must send a letter to Noridian, California’s Medicare contractor, postmarked by December 31, 2018. The California Medical Association (CMA) also has information on physicians' Medicare participation options in CMA’s health law library document #7209, "Medicare Participation (and Nonparticipation) Options." Health law library documents are free to members at www.cmadocs.org/health-law-library. Nonmembers can purchase documents for $2 per page. Physicians can also visit CMA’s MACRA resource center at www.cmadocs.org/macra to better understand the payment reforms, how they may impact physician practices and access resources to help with the transition. The center is a one-stop-shop with tools, checklists and information from CMA, the Centers for Medicare and Medicaid Services, the American Medical Association and national specialty society clinical data registries. Contact: Cheryl Bradley, (213) 226-0338 or cbradley@cmadocs.org. October 26, 2018 Medicare Medicare, Public Payors 0 0 Comment Read More »
New Medicare ID card mailing completed in California The Centers for Medicare and Medicaid Services (CMS) recently completed mailing new Medicare ID cards to California beneficiaries. The new Medicare ID cards, required under the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), contain a unique, randomly assigned Medicare Beneficiary Identification (MBI) number, which replaces the previous Social Security-based number. CMS has prepared a “Still Waiting for Your New Card?” handout (in English or Spanish) to provide to patients who did not receive a new Medicare ID card. Patients may be directed to the MyMedicare.gov website or to call (800) 633-4227) to determine the status of their new card. As the California Medical Association previously reported, CMS will allow a 21-month transition period that began in April 2018, where health care providers will be able to use either the patient’s current Medicare number or the patient’s new Medicare number for all Medicare transactions through December 31, 2019. CMS has developed a webpage to help physicians navigate the MBI transition, including slides from the most recent CMS Open Door Forum on the issue. Physicians are also now able to look up their Medicare patients’ new Medicare numbers through Noridian, the Medicare Administrative Contractor’s, secure web portal. Physicians should also talk to their practice managers and health IT vendors now to ensure their systems are ready to accept the MBI. For more information, please visit cms.gov/newcard. August 3, 2018 Medicare Medicare, Patient Privacy, Public Payors 0 0 Comment Read More »
California to begin receiving new Medicare cards in May The Centers for Medicare and Medicaid Services (CMS) began mailing new identification cards to Medicare beneficiaries this month, as required under the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). The new cards contain a unique, randomly assigned Medicare Beneficiary Identification (MBI) number that will replace the current SSN-based Health Insurance Claim Number (HICN). The new MBI will also be used for Medicare transactions like billing, and eligibility and claim status checks. The first wave of cards mailed this month will be to newly-enrolled Medicare beneficiaries. Beginning in May 2018, existing Medicare beneficiaries in California should start receiving their new cards. CMS will allow a 21-month transition period beginning April 2018, where health care providers will be able to use either the patient’s current Medicare number or the patient’s new MBI number. CMS has developed a web page to help physicians navigate the transition to the new MBI number, including slides from the most recent CMS Open Door Forum on the transition. Physicians will be able to look up their Medicare patients’ new Medicare Beneficiary Identifier through Noridian, the Medicare Administrative Contractor’s secure web portal starting in June 2018. Physicians should also talk to their practice managers and health IT vendors now to ensure their systems will be ready to accept the MBI. New Medicare card: Video for your waiting room To help inform Medicare patients the new Medicare Cards are coming, CMS has created a video for your waiting room. The video tells patients when and how they will receive the new card. For more information, please visit www.cms.gov/newcard. April 9, 2018 Medicare Centers for Medicare and Medicaid Services, Medicare 0 0 Comment Read More »
Tip: Get ready for the new Medicare beneficiary cards and ID numbers The Centers for Medicare and Medicaid Services (CMS) will begin mailing new identification cards to California Medicare beneficiaries between April and June 2018, as required under the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). The new cards will contain a unique, randomly assigned Medicare Beneficiary Identification (MBI) number replacing the current Social Security-based number. CMS will allow a 21-month transition period beginning April 2018, where health care providers will be able to use either the patient’s current Medicare number or the patient’s new Medicare number. CMS has developed a web page to help physicians navigate the transition to the new Medicare beneficiary identifier (MBI) number, including slides from the most recent CMS Open Door Forum on the transition. Physicians will be able to look up their Medicare patients’ new Medicare numbers through Noridian, the Medicare Administrative Contractor’s secure web portal starting in June 2018. Physicians should also talk to their practice managers and health IT vendors now to ensure their systems will be ready to accept the MBI. New Medicare card: Video for your waiting room To help inform Medicare patients the new Medicare Cards are coming, CMS has created a video for your waiting room. The video tells patients when and how they will receive the new card. For more information, please visit www.cms.gov/newcard. April 5, 2018 Medicare Medicare, Tip of the Month 0 0 Comment Read More »
Physicians encouraged to warn patients of new Medicare scam Seniors in California are being targeted by a new Medicare card phone scam. Medicare beneficiaries are getting calls from scammers telling them their new Medicare card will arrive between April and June 2018, which is true. However, they go on to state beneficiaries must first buy a temporary card for $5.00 to $50.00 and provide personal information before they receive their new Medicare card. THIS IS NOT TRUE. It is true that Medicare is issuing a newly designed Medicare card, which will contain the unique, randomly assigned Medicare Beneficiary Identification (MBI) number replacing the current Social Security-based number. These new cards are free, and Medicare will not call patients about their new card. Cards will be mailed to the mailing addresses on file with Social Security. Patients who need to update their mailing address should go to www.ssa.gov/myaccount. Physicians are encouraged to warn their Medicare patients of this scam. California Health Advocates has prepared tips on how seniors can protect themselves and where to report such scams. Tip sheets are available in English, Spanish, Chinese, Vietnamese, Korean, Russian and Farsi. The Centers for Medicare and Medicaid Services has also developed a web page to help physicians navigate the transition to the new MBI number, including a recently developed resource on how to talk to your Medicare patients about the new Medicare card. Physicians should also talk to their practice managers and health IT vendors now to ensure their systems will be ready to accept the MBI. April 5, 2018 Medicare Medicare, Scams 0 0 Comment Read More »
On-Demand Webinar: Understanding Medicare Changes: An Impossible Dream? The California Medical Association (CMA) recently hosted a free webinar examining changes to the Medicare program for 2018 and providing tips for regulatory compliance, presented by the medical director of California’s Medicare contractor, Noridian Healthcare Solutions. The webinar is now available for on-demand viewing in the CMA resource library. This download is free for all. This review includes an overview of the Centers for Medicare and Medicaid Services’ (CMS) new Targeted Probe and Educate (TPE) program, a type of Medicare audit, and its review process; changes to Local Coverage Determinations (LCDs); and CMS’ new “Patients Over Paperwork” initiative, which aims to reduce reporting requirements by simplifying documentation and reducing the hassle factor. This webinar also covers simple coding tips for evaluation and management coding and reimbursement. February 5, 2018 CMA, Medicare Government Payors, Medicare, Noridian, Webinars 0 0 Comment Read More »
CMS announces new voluntary bundled payment model The Centers for Medicare and Medicaid Services (CMS) has announced a new voluntary bundled-payment model. Called the Bundled Payments for Care Improvement (BPCI) Advanced Model, it will be considered an advanced alternative payment model (APM) under the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). This new, voluntary model comes less than two months after the CMS eliminated two mandatory bundled-payment models created during the Obama administration. MACRA’s Quality Payment Program (QPP) created two tracks for physician payment – the Merit-Based Incentive Payment System (MIPS) and Advanced APM track. Under MIPS, providers report a range of performance metrics and their payment amounts are adjusted based on their performance. Under Advanced APMs, providers take on financial risk to earn Advanced APM incentive payments. The new BPCI-Advanced model will include 32 clinical-care episodes to choose from, 29 inpatient and three outpatient. Participants will be expected to redesign care delivery to keep Medicare expenditures within a defined budget, while maintaining or improving performance on specific quality measures. Participants can earn payment bonuses if all expenditures for a beneficiary’s episode of care are under a spending target. The performance period for BPCI Advanced starts on October 1, 2018, and runs through December 31, 2023. Applications for the initial enrollment period are due by March 12, 2018, at 8:59 p.m. P.T. Click here for more information about the BPCI-Advanced model and its requirements January 30, 2018 Managed Care, Medicare Alternative Payment Models (APM), MACRA, Medicare, Merit-Based Incentive Payment System (MIPS) 0 0 Comment Read More »
CMA opposes proposed Medicare physician payment cuts The U.S. House of Representatives’ Ways and Means Committee is working to extend the “rural” work Geographic Practice Cost Index (GPCI) payment adjustment, which is set to expire December 31, 2017. In order to pay for the extension, the committee has proposed an overall cut to Medicare physician payments by identifying and lowering payments for “misvalued” services. In 2014, Congress included a physician-opposed provision in the Protecting Access to Medicare Act (PAMA), designed to hold down Medicare spending by requiring the Centers for Medicare and Medicaid Services (CMS) to identify “misvalued” codes. If CMS is unable to meet the savings target in the PAMA legislation, the remaining amount was to be obtained by an across-the-board payment cut to all services. The Ways and Means Committee is now proposing a fourth year of Medicare physician payment cuts to fund the rural work GPCI floor, despite the commitments made under the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) that physicians would be provided automatic, stable payment updates of 0.5 percent per year from 2015-2019. The California Medical Association (CMA) is urging the California Congressional Delegation to oppose the proposed cuts, which will disproportionately harm California physicians. The rural GPCI floor does not help California’s rural areas, while California physicians treat the bulk of Medicare patients in this country. The misvalued code legislation has eroded the modest MACRA payment increases at the same time that physicians were required to make significant investments in their practices to meet MACRA reporting requirements. Physicians are also facing a payment freeze from 2019-2024. If this new proposal takes effect, total physician payment updates for the entire 10-year period of 2015-2024 will be approximately 1 percent. From 2005-2015, physicians’ fees were essentially frozen under the Medicare Sustainable Growth Rate formula, while the costs to operate a medical practice rose more than 20 percent. These Congressional actions will represent more than two decades of nearly frozen payment rates, while all other Medicare provider groups have received updates. Physicians cannot remain in practice and maintain patients’ access to care under these flawed policies. This proposal harms all California physicians, particularly those in the Central Valley, where there are already significant physician shortages and margins to operate a practice are slim because the main payers are the low-paying Medicare and Medicaid programs. CMA is urging Congress to find other funding sources to fund the rural payment floor. December 28, 2017 Medicare Federal Legislative Advocacy, Geographic Practice Cost Index, GPCI, Medicare 0 0 Comment Read More »
CMS unveils new Medicare Beneficiary Identification cards The Centers for Medicare and Medicaid Services (CMS) recently unveiled the newly designed Medicare card, which will contain the unique, randomly assigned Medicare Beneficiary Identification (MBI) number replacing the current Social Security-based number. CMS will begin mailing the new cards to people with Medicare benefits in April 2018, with the deadline for replacing all existing Medicare cards by April 2019 as required under the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). CMS will allow a 21-month transition period beginning no sooner than April 2018, where health care providers will be able to use either the patient’s current Medicare number or the patient’s new Medicare number. CMS has developed a new web page to help physicians navigate the transition to the new MBI number, including a recently developed resource on how to talk to your Medicare patients about the new Medicare card. Physicians should also talk to their practice managers and health IT vendors now to ensure their systems will be ready to accept the MBI. For more information, please visit www.cms.gov/newcard. October 19, 2017 Medicare Medicare 0 0 Comment Read More »
Physicians have until December 1 to dispute 2016 PQRS and QRUR findings The Centers for Medicare and Medicaid Services (CMS) recently released data that indicates which physicians will be subject to the 2018 payment penalties associated with the Physician Quality Reporting System (PQRS) and Value-Based Payment Modifier (Value Modifier) programs. Physicians who have concerns about the findings in their report(s) have until December 1, 2017, to file for an informal review of their data. The penalties stem from policies in effect prior to the enactment of the Medicare Access and CHIP Reauthorization Act (MACRA). Failure to successfully report on PQRS in 2016 will result in a 2 percent penalty in 2018. Value Modifier penalties can range from 1 to 4 percent, depending on the size of the practice and its performance on cost and quality measures. PQRS penalties will be communicated to physicians by mail as well as in the PQRS feedback reports posted on the CMS website. Value Modifier penalties can be found in the Quality and Resource Use Reports (QRUR), which are only posted on the website. Physicians may access both their 2016 PQRS feedback reports and QRURs on the CMS Enterprise Portal using an Enterprise Identity Management account. For details on how to obtain your QRUR report, see “How to obtain a QRUR” on the CMS.gov webpage. For information on obtaining your PQRS report, see the “Quick Reference Guide for Accessing 2016 PQRS Feedback Reports.” For information on understanding your report, see the “2016 PQRS Feedback Report User Guide.” Both of the PQRS guides are available on the PQRS Analysis and Payment webpage. For more information on understanding the reports, CMS is hosting a webcast on October 19 from 10:30 a.m. to 12 p.m. PT, which will provide a QRUR overview and explain how to interpret and use the report information. To register for this event click here, or contact mlnevents@blhtech.com for registration assistance. Physicians who wish to dispute their PQRS findings are urged to submit a request for informal review. While in most cases a successful PQRS review will trigger an automatic review of related Value Modifier penalties, program officials say the safest course is to file separate requests for review of both PQRS and Value Modifier data. All informal review requests must be submitted electronically through the Quality Reporting Communication Support Page by December 1, 2017, at 5 p.m., PT. Practices will be contacted by email with a final decision from CMS within 90 days of the original request for an informal review. All decisions will be final, with no opportunity for further review. Practices that do not receive a response are encouraged to check their junk or spam email folders for the decision, as it will be communicated via email only. CMS also has published the “2018 Value Modifier Informal Review Request Quick Reference Guide.” Physicians who have general questions about the report or have trouble accessing the reports online should contact the Physician Value Help Desk at (888) 734-6433 (select option 3) or pvhelpdesk@cms.hhs.gov. For additional questions, please contact the QualityNet Help Desk at (866) 288-8912 [TTY: (877) 715-6222] or via qnetsupport@hcqis.org between the hours of 5 a.m. and 5 p.m., PT, Monday through Friday. For information regarding other Medicare physician quality programs that apply payment adjustments, please see the Value-Based Payment Modifier website. October 13, 2017 Medicare Medicare, Physician Quality Reporting System, PQRS, Quality Reporting, Value-Based Payment Modifier 0 0 Comment Read More »
