Making sense of Medicare payment changes With the new 2014 fee schedule, the temporary halt to the sustainable growth rate (SGR) cut and an interim .5 percent payment increase, Medicare physicians are understandably confused about what impact these changes will have on their practices. Below is a quick summary of the various Medicare payment changes facing physicians in 2014: 2014 Fee Schedule: While the 2014 Medicare fee schedule contains a 3.7 percent conversion factor increase, the overall fee schedule is budget neutral due to myriad relative value unit (RVU) changes. These changes will impact providers differently ... January 14, 2014 Medicare Medicare, Insurance/Reimbursement 0 0 Comment Read More »
House passes budget with three month SGR patch The U.S. House of Representatives today passed a bipartisan two-year budget deal that includes a three-month patch that will stop the 24 percent Medicare physician payment cut that would otherwise take effect January 1, 2014—and replace it with a 0.5 percent payment raise—which will give lawmakers a little more time to finalize the long-term Medicare payment reforms currently making their way through Congress. The budget now goes to the U.S. Senate, which is expected to approve the measure next week. December 13, 2013 Medicare Advocacy, SGR, Sustainable Growth Rate, Medicare 0 0 Comment Read More »
2014 Medicare fee schedule confirms 24 percent cut Demonstrating yet again how broken the Medicare sustainable growth rate (SGR) formula is, physicians will face a 24 percent Medicare payment cut next year if Congress does not seize the opportunity to put a stop to the formula's annual threat of drastic payment cuts. This figure was confirmed by the Centers for Medicare and Medicaid Services (CMS) last week, when the agency released its final physician fee schedule for 2014. The California Medical Association (CMA) is currently reviewing the final rule, which was released much later than usual because of ... December 3, 2013 Medicare Medicare, SGR, Sustainable Growth Rate, Advocacy, Insurance/Reimbursement 0 0 Comment Read More »
Both houses of Congress working together in an unprecedented collaboration to repeal SGR http:///On Thursday, the Senate Finance Committee and the House Ways and Means Committee released an unprecedented bipartisan and bicameral “discussion draft” proposal that would fully repeal the flawed Medicare Sustainable Growth Rate (SGR) formula. The draft legislation would not provide automatic payment increases for 10 years. However, starting in 2016 physicians can choose to participate in new payment models (such as medical homes) and qualify for 5 percent annual bonuses. In 2017 and beyond, physicians remaining in the fee-for-service program can participate in a new “value-based performance payment program,” which ... November 5, 2013 Medicare Insurance/Reimbursement, Medicare, SGR, Sustainable Growth Rate, Advocacy 0 0 Comment Read More »
CMA part of national effort to urge House leadership to act on Medicare SGR payment overhaul before the year ends The California Medical Association (CMA) is part of a national multi-state, multi-specialty effort headed by the American Medical Association to keep bipartisan momentum going to address Medicare fee-for-service sustainable growth rate (SGR) reform. CMA has asked the California congressional delegation to sign a letter to House Speaker John Boehner and House Minority Leader Nancy Pelosi urging them to make it a priority to reform the Medicare physician payment system before the end of the year. The joint letter is being circulated in Congress by Rep. Bill Flores (R-TX) and ... October 28, 2013 Medicare Insurance/Reimbursement, Medicare, SGR, Sustainable Growth Rate, Advocacy 0 0 Comment Read More »
Medicare transition update September 16, 2013, marked the transition to the new Medicare Administrative Contractor, Noridian. In the first few days, the California Medical Association (CMA) heard about only minor problems with technology, including phone systems that went up and went down, a few issues with the online provider service tool and problems with printing of -PDF files from the Noridian website. Most issues have been resolved. Traffic on the Noridian Provider Contact Center phone line is high, as expected. Wait times are sometimes four to five minutes, but practices report satisfaction with ... September 25, 2013 Medicare Medicare, Noridian, Insurance/Reimbursement 0 0 Comment Read More »
Medicare transition to Noridian is just a week away! We are just one week away from the September 16 cutover date from Palmetto to the new Medicare Part B fee-for-service contractor, Noridian. Although efforts have been made to minimize the burden to practices and to ensure that physicians continue to receive their Medicare payments in a timely fashion after the transition, there are a number of things physicians should be aware of, including: Last day to submit to Palmetto: September 11, 2013 is the last day providers may submit electronic claims to Palmetto (2:00 p.m. cutoff time), and the ... September 10, 2013 Medicare Medicare, Medicare Transition, Noridian, Palmetto, Insurance/Reimbursement 0 0 Comment Read More »
Medicare transition is less than two weeks away September 16, 2013, is the cutover date for transition of the Medicare Part B fee-for-service contractor from Palmetto GBA to Noridian. Although efforts have been made to minimize the burden to practices and to ensure that physicians continue to receive their Medicare payments in a timely fashion after the transition, physician practices will have to make some changes in their processes, including but not limited to the following: •Electronic claim submitters must change the contractor ID (payor ID) on their transmissions. The new ID for the Northern California jurisdiction is ... September 3, 2013 Medicare Insurance/Reimbursement, Medicare Transition, Medicare, Noridian 0 0 Comment Read More »
Medicare transition is three weeks away September 16, 2013, is the cutover date for transition of the Medicare Part B fee-for-service contractor from Palmetto GBA to Noridian. Although every effort has been made to minimize the burden to practices and to ensure that physicians continue to receive their Medicare payments in a timely fashion after the transition, physician practices will have to make some changes in their processes. Practices are encouraged to review the resources available to you to ensure you are aware of and prepared for the transition. Physician practices that submit their claims electronically, ... August 26, 2013 Medicare Medicare, Medicare Transition, Noridian, Insurance/Reimbursement 0 0 Comment Read More »
State delays duals pilot project until April 1 The California Department of Health Care Services (DHCS) announced today that it would delay by three months implementation of the state's "pilot project" to redesign care for Medicare/Medi-Cal dual eligibles. The program, called CalMediConnect, is now expected to begin no earlier than April 2014. The project was authorized by the Assembly 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 would see a large portion of the state's ... August 15, 2013 Managed Care, Medi-Cal, Medicare DHCS, Medi-Cal, Medicare, Dual Eligible, Insurance/Reimbursement 0 0 Comment Read More »
