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Contact: David Ford, (916) 551-2554 or dford@c
Palmetto Conducting Audits of Physician Claims

October 19, 2011 - For the past two years Palmetto GBA has received payment error rates from the Comprehensive Error Rate Testing (CERT) Contractor that have been almost twice the national rate. A large portion of the errors are attributed to insufficient and illegible documentation, and lack of or illegible signatures. Palmetto is now taking steps to correct these errors by reviewing claims to identify potential areas for provider education.

Palmetto will notify affected physicians by mail that a small sample of their claims will be selected for medical review. The notice will also provide recommended resources on documentation and coding. Physicians who are notified will receive a request for medical records in the form of an Additional Document Request (ADR) for each claim selected, along with an example of the information that should be returned. Failure to respond to these requests will result in non-payment of the claim.

Palmetto may also make unannounced site visits to physician offices to establish a date for an educational meeting. Failure to participate in this education will result in 100 percent pre- and post-payment audit of claims. CMA is discussing the nature of these audits with Palmetto and the disruption and burden they will be to physician offices.

We hope to have more detailed information next week. 

Medicare Fee Schedule - Palmetto GBA 

Medicare Part B 2011 Important Changes: What They Mean to Your Practice - (12/21/10)

The Centers for Medicare & Medicaid Services (CMS) issued a final rule that updates payment policies and Medicare payment rates for physicians' services furnished in 2011. The final rule also addresses a number of provisions of the Affordable Care Act (ACA) that are not directly related to the Medicare payment system. Read more.

Important Update on PECOS and Ordering/Referring - (12/13/10)

The Centers for Medicare and Medicaid Services (CMS) announced a delay in the start of automatic denials for ordered services by physicians whose enrollment is not yet updated in the Provider Enrollment Chain and Ownership System (PECOS).

CMS has yet to notify contractors to turn on the automated edits that would deny claims for services that were ordered or referred by a physician or other eligible professional simply for lack of an approved file in PECOS.

CMS is working diligently to resolve backlog and other systems issues and will provide ample advance notice to the provider and beneficiary communities before CMS begins any such automatic denials.

Physicians are urged to complete the application process as soon as possible. Applications are generally processed within 60 days, but can take longer if the application is incomplete or additional information is needed.

Physicians who wish to take advantage of the incentive payments available for electronic prescribing, Physician Quality Reporting Initiative (PQRI), and electronic health record program must be enrolled in PECOS.

Physicians who need help with the enrollment process can contact CMA's member service center, 800/786-4CMA or memberservice@cmanet.org for assistance.

For more information on PECOS visit CMA's website - Click Here 

Federal Health Reform - Medi-Cal and Healthy Families (5/13/10) 
Read more...(PDF document). For more information, call CMA's Member Help Line at 800-786-4CMA.merican Recovery and Reinvestment Act of 2009 (ARRA, or the "Stimulus Act"), physicians are eligible for financial incentives for demonstrating "meaningful use" of an electronic health record (EHR) system. Medi-Cal providers who meet certain patient volume thresholds will qualify for up to $63,750 paid out over six years, beginning as early as 2011 or as late as 2016.In the first year that a physician is enrolled in the incentive program, he or she can receive up to $21,250 for purchasing, implementing or upgrading an EHR system. Physicians will not have to demonstrate "meaningful use" until their second year in the program.

Accessing these incentives will require a two-part enrollment. Physicians must first register with the Centers for Medicare & Medicaid Services (CMS) at https://ehrincentives.cms.gov. They must then enroll in the Medi-Cal Incentive Program at http://medi-cal.ehr.ca.gov.

Physicians qualify for incentives if:Medi-Cal patients make up at least 30 percent of their patient They are a pediatrician with at least a 20 percent Medi-Cal patient volume. (However, pediatricians with 20 to 30 percent Medi-Cal patient volume only qualify for two thirds of the total incentive.)They practice in a federally qualified health center, rural health center, or Indian health clinic and at least 30 percent of their patient volume is "needy individuals," such as Medi-Cal, Healthy Families, sliding scale, or uncompensated

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