Congress Making Progress on SGR Repeal Two influential committees in the U.S. House of Representatives continue to work on a framework for eliminating the Medicare sustainable growth rate (SGR) formula. With the cost of eliminating the SGR at its lowest point in a decade, the congressional committees have been making progress on draft legislative language to fix the badly broken Medicare payment system. The SGR formula has been threatening severe payment cuts to physician reimbursement for more than a decade. Over the years, moves to repeal the SGR have failed, due in large part to the ... June 3, 2013 Medicare Medicare sustainable growth rate, SGR 0 0 Comment Read More »
ACA: Medicaid Primary Care Rate Increase FAQ Under the provisions of the Federal Affordable Care Act (ACA), state Medicaid programs (Medi-Cal in California) are required to pay primary care physicians at Medicare rates for primary care services for two years. The increase is fully funded by the federal government. The requirement began January 1, 2013 and ends December 31, 2014. The California Department of Health Care Services (DHCS) submitted their state plan amendment (SPA) to implement the rate increase on March 29, 2013. Approval of the SPA is required by the Centers for Medicare and Medicaid Services ... April 19, 2013 Managed Care, Medi-Cal, Medicare ACA, Affordable Care Act, Medicare, Medi-Cal 0 0 Comment Read More »
CMA Webinar: Act now to avoid Medicare penalties in 2015 Over the past six years, the Centers for Medicare and Medicaid Services (CMS) has launched a number of initiatives that offer physicians the opportunity to increase their net revenue by participating in quality reporting programs. Until now, these programs have been voluntary and physicians have received bonuses for participating. That's about to change. Failure to participate now means physicians could face significant penalties. The American Academy of Family Physicians estimates that participating in these initiatives in 2013, rather than waiting until 2014, could save a physician $19,000 in avoided penalties. To ... March 18, 2013 Medicare Bonuses, Penalties, Medicare 0 0 Comment Read More »
Department of Justice to decide Medicare MAC contract protest The Centers for Medicare & Medicaid Services (CMS) announced in September 2012 that Noridian has been named the new Medicare Administrative Contractor (MAC) for Medicare Parts A and B in Jurisdiction E (previously called Jurisdiction 1). Two protests were filed, challenging the award. On January 18, 2013, the Government Accountability Office denied the two protests. As permitted by law, both protestors (Palmetto GBA and CGS) subsequently filed complaints with the U.S. Court of Federal Claims challenging the Jurisdiction E MAC contract award. The protests were filed on February 1, 2013. ... March 18, 2013 Medicare Noridian, Palmetto, Medicare 0 0 Comment Read More »
