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PQRS GPRO registration extended until October 3

The Centers for Medicare and Medicaid services has extended the Physician Quality Reporting System Group Purchasing Reporting Option (GPRO) registration deadline until October 3, 2014, 11:59 PM EDT because of a glitch in the registration system. The deadline was originally supposed to be today, September 30, 2014. The PQRS registration system can be accessed a https://portal.cms.gov/. Group practices can register to participate in the PQRS Group Practice Reporting Option in 2014 via Qualified PQRS Registry, EHR or web interface (for groups with 25 or more eligible professionals only). In order to ...

Late program changes could mean Medicare penalties for some in 2015

The Centers for Medicare and Medicaid Services (CMS) has announced that a small subset of physicians participating in the Medicare electronic health records (EHR) Incentive Program may get hit with Medicare penalties next year because the attestation system will not be updated with the expanded hardship exemptions before the October 1 deadline to apply for an exemption. It is uncertain how many participants are at risk, but they are affected by a narrow set of circumstances. The problem ironically stems from changes authorized in August to provide more flexibility in ...

CMS opens ICD-10 end-to-end testing to volunteers

At the beginning of 2015, the Centers for Medicare and Medicaid Services (CMS) will begin limited Medicare end–to–end testing of ICD-10 billing code submissions to ensure claims with the new codes can be processed from submission to remittance. Earlier this year, Congress pushed back the ICD-10 implementation date a year to October 1, 2015. CMS is looking for volunteers to participate in the testing the week of  January 26-30, 2015. From the volunteers, CMS will select a sample of 50 participants for each Medicare Administrative Contractor to represent a broad ...

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 ...

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 ...

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 ...

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, ...

Huge chunk of data excluded from Open Payments website because of inaccuracies

According to several news sources, the Centers for Medicare & Medicaid Services (CMS) has rejected about one-third of the "Open Payment" records submitted by manufacturers and group purchasing organizations (GPOs) because of "intermingled data." When the data goes public next month, those records will not be included. CMS says it will not publish the withheld data until June 2015, when it expects that manufacturers will have had time to correct the inaccuracies. Physician Payments Sunshine Act is a provision of the Patient Protection and Affordable Care Act. Drug and medical ...

Noridian incorrectly denies 300,000 claims for E&M services

Last fall, the Centers for Medicare and Medicaid Services (CMS) experienced some editing issues with new patient E&M codes that resulted in incorrect claim denials. These problems started in October 2013, and was thought to have been corrected in late January 2014. The California Medical Association recently learned, however, that some claims continued to be paid incorrectly through July 15, 2014. Noridian, California's Medicare contractor, in January began making mass adjustments and correcting claims subjected to overpayment recovery. Unfortunately, while implementing the corrections, Noridian inadvertently subjected established patient E&M codes ...

CMS temporarily takes Sunshine Act system offline

The Centers for Medicare and Medicaid (CMS) announced yesterday that the verification system for financial interactions tracked under the Physician Payments Sunshine Act system has been taken offline temporarily because of physician complaints of inaccuracies. Under the Sunshine Act, drug and medical device manufacturers are required to report their financial interactions with licensed physicians – including consulting fees, travel reimbursements, research grants and other gifts. Any payments, ownership interests and other “transfers of value” will be reported to CMS for publication in an online database. CMS had opened the system for ...