Medicare finalizes fee schedule changes for 2015 The Centers for Medicare and Medicaid Services (CMS) published its 2015 Medicare Physician Fee Schedule final rule Thursday in the Federal Register. The 1,200 word payment rule contains several notable changes. As earlier proposed, the rule expands the services eligible for telemedicine reimbursement and extends the new payment policies for non-face-to-face care coordination. It allows primary care physicians to be paid for care management of Medicare beneficiaries with two or more chronic conditions. These are tasks (including managing lab and imaging reports, medications and care plans in addition to talking ... November 17, 2014 Medi-Cal, Medicare , Fee Schedule, Medicare, Centers for Medicare and Medicaid Services, CMS 0 0 Comment Read More »
Ask the Expert: Do I enter a qualifier in box 14 of the claim form if the patient has Medicare prime and a secondary insurance? Recently a number of practices have inquired as to whether Medicare requires the three-digit qualifier to be populated in item/box 14 when submitting a claim. Item/box 14, Date of Current Illness, Injury, or Pregnancy (LMP), identifies the first date of onset of illness, the actual date of injury, or the last menstrual period (LMP) for pregnancy, and contains a field allowing one of two qualifiers to be entered. 431: Onset of Current Symptoms or Illness 484: Last Menstrual Period The Medicare Claims Processing ... November 14, 2014 Medicare Medicare, Billing/Coding 0 0 Comment Read More »
CMA publishes duals project FAQ The 2012 California state budget authorized a three-year demonstration project that transitions dual eligibles into managed care and allows them to receive medical, behavioral, long-term supports and services and home-and-community-based services coordinated through a single health plan. The Cal MediConnect project was approved in 8 counties: Alameda, Los Angeles, Orange, Riverside, San Bernardino, San Diego, San Mateo, and Santa Clara. No more than 456,000 individuals will be allowed to enroll into Cal MediConnect. Los Angeles’ enrollment will be capped at 200,000. To help physicians and their patients better understand the program, ... October 21, 2014 Medi-Cal, Medicare Dual Eligible, Medi-Cal, Medicare, Cal MediConnect 0 0 Comment Read More »
CMA leaders meet with Congress on Capitol Hill before election recess California Medical Association (CMA) physician leaders were in Washington, D.C., for the last week of the Congressional session, reminding California legislators about priority physician issues, such as the repeal of the Medicare sustainable growth rate (SGR) and adoption of long-term Medicare payment reform. Congress has scheduled a very short lame duck session following the November election during which leadership on both sides hopes to come to an agreement on a spending bill to keep the government running. Earlier this year, both houses of Congress were very close to a permanent repeal ... October 10, 2014 General Medicare, SGR, Sustainable Growth Rate, Federal Legislative Advocacy 0 0 Comment Read More »
CMS reopening meaningful use hardship exception deadline The Centers for Medicare and Medicaid Services (CMS) announced that it is reopening the submission period for meaningful use hardship exception applications so that physicians can avoid the 2015 payment penalty. The new deadline will be November 30, 2014. As part of the American Recovery and Reinvestment Act of 2009, Congress mandated payment adjustments under Medicare for eligible professionals that are not meaningful users of Certified Electronic Health Record Technology (CEHRT). The Act allows the Secretary to consider, on a case-by-case basis, hardship exceptions for eligible professionals to avoid the ... October 10, 2014 Medi-Cal, Medicare EHR, Electronic Health Record, Medicare, Centers for Medicare and Medicaid Services 0 0 Comment Read More »
DHCS releases duals project toolkit The California Department of Health Care Services (DHCS) has published a physician toolkit to help providers and their patients understand the Cal MediConnect duals demonstration project. The toolkit has been developed in conjunction with Harbage Consulting and various stakeholder groups, including the California Medical Association. The toolkit contains several documents, including an overview and several fact sheets that include information on the following: How to submit crossover claims to Medi-Cal plans Contracting with Cal MediConnect plans How crossover claims ... October 6, 2014 Medi-Cal, Medicare Dual Eligible, Medi-Cal, Medicare, Cal MediConnect 0 0 Comment Read More »
DHCS announces new continuity of care rules for duals demonstration project The California Department of Health Care Services (DHCS) recently announced new continuity of care rules for the Cal MediConnect duals demonstration project. The project – an effort to save money and better coordinate care for the state’s low-income seniors and persons with disabilities – transitions a large portion of the state's dual eligible beneficiaries to managed care plans. Although the program already had continuity of care provisions, the new rules make it easier for a patient to continue receiving needed care from out-of-network physicians without interruption. The new continuity of care ... September 19, 2014 Medi-Cal, Medicare DHCS, Medi-Cal, Medicare, Cal MedConnect, Dual Eligible 0 0 Comment Read More »
CMA responds to CMS 2015 Medicare fee schedule proposals The California Medical Association (CMA) sent a letter to the Centers for Medicare & Medicaid Services (CMS) commenting on the proposed rules that would impact many aspects of physician payment and federal regulatory programs for 2015. The 39-page letter strongly opposes the agency's plan to accelerate the implementation of the value-based modifier (VBM) payment methodology. CMS has said it will expand the VBM to all physicians in 2017 and increase the potential penalty from 2 percent to 4 percent. CMA also argued that because the agency is ignoring the law that ... September 18, 2014 Medicare Medicare, PQRS, CMS, Physicians Quality Reporting System 0 0 Comment Read More »
DHCS revises Cal MediConnect 'Choice Forms' After advocacy from the California Medical Association (CMA) in conjunction with patient advocacy groups, the California Department of Health Care Services (DHCS) has revised its “Choice Forms” that allow dual eligibles to opt-out of the Cal MediConnect duals demonstration project and remain in traditional Medicare fee for service. The project 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 begins with a three-year demonstration project that transitions a large portion ... September 11, 2014 Medicare Department of Health Care Services, DHCS, Dual Eligible, Medicare, Cal MediConnect 0 0 Comment Read More »
Noridian denies 300,000 claims for E&M services in error Last fall, the Centers for Medicare and Medicaid Services experienced some editing issues with new patient evaluation and management (E&M) codes that resulted in incorrect claim denials. These issues began in October 2013, and were thought to have been corrected in late January 2014. The California Medical Association recently learned, however, that some claims continued to be denied incorrectly through July 15, 2014. In January, Noridian, California's Medicare contractor, began reprocessing claims that had been denied in error and correcting those subjected to overpayment recovery. Unfortunately, while implementing the corrections, ... September 4, 2014 Medi-Cal, Medicare Medicare, Noridian, Billing/Coding 0 0 Comment Read More »
