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CMS issues final 2016 Medicare payment rule; includes reimbursement for end-of-life discussions

On Friday, the Centers for Medicare and Medicaid Services (CMS) released the final 2016 Medicare physician fee schedule. One of the biggest changes in the CMS proposal is the assignment of codes to pay physicians for end-of-life consultations. Key policies finalized in the 2016 payment rule include: Advanced care planning: The final fee schedule includes two CPT codes to reimburse for advance care planning. Compensating health care professionals for time spent with patients discussing treatment wishes and goals of care is a critical step forward in honoring patient treatment preferences, particularly ...

CMS announces 30-day period of Physician Compare

On October 5, 2015 The Centers for Medicare and Medicaid Services (CMS) opened the 30-day preview period on October 5, 2015 for the 2014 quality measures that will be reported on the Physician Compare website later this year. The Affordable Care Act required CMS to create a website that would allow consumers to search for and compare physicians and other health care professionals who provide Medicare services. That site—the "Physician Compare" website, initially launched in 2010—provides contact information, specialties and clinical training, hospital affiliations and group practice information. In 2014, the ...

New CMS rule changes meaningful use requirements

The Centers for Medicare and Medicaid Services (CMS) this week published new rules for the current and final stages of the electronic health record (EHR) incentive program. In publishing the rule, CMS acknowledged the difficulties physicians have experienced with meeting meaningful use requirements. The regulations announced are intended to ease the reporting burden for providers, support interoperability and improve patient outcomes. While the modified rules for years 2015-2017 are final, the stage 3 portion of the final rules were released with the opportunity for public comment, with the expectation that CMS ...

Members of Congress urge HHS to pause meaningful use stage 3

The California Medical Association (CMA) and the American Medical Association (AMA) are urging the U.S. Department of Health and Human Services (HHS) to delay implementing stage 3 of the electronic health record (EHR) meaningful use program, as it is fraught with problems that need to be fixed before the next stage is implemented. CMA and AMA are also pushing for an automatic hardship exemption for physicians who were unable to successfully report in 2015. To that end, at AMA and CMA’s urging, Congress sent a bipartisan letter to HHS ...

Noridian Medicare announces web-based provider enrollment workshops

Noridian, the Medicare Administrative Contractor for California, announced that it will offer web-based workshops focusing on provider enrollment. These webinars are intended for the Part B provider using the online Provider Enrollment, Chain and Ownership System (PECOS) to change enrollment information, track revalidation or set up a sole proprietorship. The Internet-based PECOS process can be used in lieu of the Medicare enrollment application (i.e., paper form CMS-855). The advantages of PECOS are: Faster than paper-based enrollment (45-day processing time in most cases, vs. 60 days for paper) ...

ICD-10 Has Arrived!

The ICD-10 implementation date has finally arrived. While concerns remain as to the preparedness of physician practices, vendors and payors for this monumental transition, the full impact of the ICD-10 conversion will likely not be felt for several weeks or until the first payment remittances are received. In an effort to help practices navigate the transition, CMA has just published an FAQ titled, “Surviving ICD-10: An FAQ for physician practices." This resource is available free for CMA members (it is not accessible at all for non-members). We will be ...

CMS clarifies ICD-10 grace period guidance

In early July, the Centers for Medicare & Medicaid Services (CMS) announced that for a period of one year, it will allow for flexibility in claims payment, auditing and quality reporting processes as the medical community gains experience using the new ICD-10 code set. CMS specifically clarified its statement that during the 12 months after ICD-10 implementation, contractors would not deny claims based solely on the specificity of the ICD-10 diagnosis code. However, according to the latest FAQ, claims will be rejected if they do not contain a valid ICD-10 ...

CMS to hold webinars for providers on Physician Compare website

The Centers for Medicare and Medicaid Services (CMS) will host a series of one-hour webinars about public quality reporting and the Physician Compare website. The Affordable Care Act required CMS to create a website that would allow consumers to search for and compare physicians and other health care professionals who provide Medicare services. That site—the "Physician Compare" website, initially launched in 2010—provides contact information, specialties and clinical training, hospital affiliations and group practice information. In 2014, the website also began phasing in physician quality data from the Physician Quality Reporting System ...

Gallup poll says rates of uninsured continue to drop in most states

According to a Gallup poll released Monday, the national uninsured rate has fallen to 11.7 percent, down from 17.3 percent in 2013. The poll shows that states that have expanded Medicaid under the Affordable Care Act – and have at least helped in the running of their health insurance marketplaces, rather than leaving it entirely to the federal government – have seen larger drops in uninsured rates. In the 22 states that took both of those measures, including California, the uninsured rate dropped to an average of 7.1 percent. California's uninsured ...

Noridian announces new audits

Noridian, California's Medicare administrative contractor, has announced it will be conducting service-specific targeted audits of procedure codes 99205 and 99233 when rendered by providers with specific specialties: 99205 performed by cardiology (Centers for Medicare and Medicaid Services specialty designation 06) and pulmonary (29) 99233 performed by internal medicine (11) and hematology/oncology (83) Noridian conducts these targeted reviews based on data analysis. An analysis of these procedure codes, when performed by physicians in these specialties, indicated a higher utilization by California providers when compared ...