Good news has been reported from HBMA (http://www.hbma.org/) regarding cutting Medicare physician fee schedule payments and implementing ICD-10.
The United States Senate has joined the House of Representatives and passed legislation to prevent a 24% cut in physician fee schedule payments from occurring April 1, 2014. Instead, Medicare physician fee schedule payments will continue to be paid as they have been for the past 3 months.
On April 1, President Obama signed into law a bill to delay the planned ICD-10 implementation until Oct. 1, 2015. Specifically, the bill prohibits CMS from enforcing a mandate to switch from ICD-9 to ICD-10 until Oct. 1, 2015
The so-called SGR Patch approved by Congress will be in effect for 12 months, expiring on March 31, 2015. Between now and then, Congress will have to enact a permanent fix or enact another patch to prevent a huge drop in Medicare Physician payments next April 1.
In addition to preventing the SGR related reduction, Congress approved language extending various other Medicare provisions slated to expire at Midnight tonight. These include:
• Extends Medicare work Geographic Practice Cost Index (GPCI) floor for 1 year
• Extends Medicare therapy cap exception process for 1 year
• Extends Medicare ambulance add-on payments for 1 year
• Extends Medicare adjustment for Low-Volume hospitals for 1 year
• Extends Medicare-dependent Hospital (MDH) program for 1 year
In addition to these “extenders” Congress also approved a one-year delay in the effective date of the ICD-10 transition. As you know, ICD-10 has been scheduled to take effect on October 1, 2014. Due to Congressional intervention, the new effective date will be October 1, 2015.
A major Electronic Prescribing (eRx) Incentive Program deadline is approaching for both individual eligible professionals (EPs) and group practices participating in the Group Practice Reporting Option (GPRO). If you are an EP or an eRx GPRO participant, you must successfully report as an electronic prescriber before June 30, 2013 or you will experience a payment adjustment in 2014 for professional services covered under Medicare Part B's Physician Fee Schedule (PFS.)
The 2013 eRx Incentive Program 6-month reporting period (January 1, 2013 to June 30, 2013) is the final reporting period available to you if you wish to avoid the 2014 eRx payment adjustment.
If you do not successfully report, a payment adjustment of 2.0% will be applied, and you will receive only 98.0% of your Medicare Part B PFS amount for covered professional services in 2014.
Avoiding the 2014 eRx Payment Adjustment
Individual EPs and eRx GPRO participants who were not successful electronic prescribers in 2012 can avoid 2014 eRx payment adjustment by meeting specified reporting requirements between January 1, 2013 and June 30, 2013.Below are the6-month reporting requirements:
- Individual EPs – 10 eRx events via claims
- eRx GPRO of 2-24 EPs – 75 eRx events via claims
- eRx GPRO of 25-99 EPs – 625 eRx events via claims
- eRx GPRO of 100+ EPs – 2,500 eRx events via claims
Exclusions and Hardships Exemptions
Exclusions from the 2014 eRx payment adjustment only apply to certain individual EPs and group practices, and CMS will automatically exclude those individual EPs and group practices who meet the criteria. More information on exclusion criteria and hardship exception categories can be found on the Electronic Prescribing (eRx) Incentive Program: 2014 Payment Adjustment Fact Sheet.
Resources from CMS
Additional resources on the 2014 payment adjustment are available on the eRx Incentive Program Payment Adjustment Information webpage, including the resource Electronic Prescribing (eRx) Incentive Program: Updates for 2013.
Questions about eRx?
Medicare has released an announcement regarding Revalidation of Medicare Enrollment(http://www.wpsmedicare.com/j8macpartb/departments/enrollment/revalidation-med-enrollment.shtml):
"All providers who enrolled with Medicare prior to March 25, 2011, will be required to revalidate their Medicare enrollment by submitting the appropriate CMS-855 Medicare enrollment form(s) to their Medicare contractor in response to notices sent between September, 2011, and March, 2015. This requirement for revalidation is based on Section 6401 of the Patient Protection and Affordable Care Act., which also requires that all providers be reevaluated under the screening guidelines established in Section 6028 of the law. Providers have 60 days from the date of the revalidation notice to submit their complete enrollment information.
Providers are to submit their CMS-855 revalidation enrollment applications only after receiving notification that they are required to do so. Wisconsin Physicians Service is sending these notification letters on a regular, intermittent basis.
The initial, Phase 1, revalidation notices were sent to providers who did not have complete information in the Provider Enrollment, Chain & Ownership System (PECOS). Revalidation mailings have been sent to the remaining providers subject to revalidation and will continue to be sent on an ongoing basis until March 2015. The names and National Provider Numbers of the providers who have been sent revalidation notices are listed, by mailing date, in the Downloads section of the Centers for Medicare & Medicaid Services' Revalidations websiteExternal Link.
Revalidation notices are mailed simultaneously to the provider's primary special payments address and correspondence address. Providers must submit revalidation applications for all provider transaction access numbers (PTANs) reported on the revalidation notice.
Providers can revalidate their CMS-855 Medicare enrollment applications via Internet-based PECOS(external link) or the paper application process with applications downloaded from the CMS website(external link).
- Copies of diplomas and/or academic transcripts, certifications, and any other documents needed to establish that non-physician practitioners meet Medicare's eligibility requirements for their specialty.
- A CP-575 or other form issued by the Internal Revenue Service to document the legal business name and employer identification number (EIN) of organizations.
- A CMS-588 Electronic Funds Transfer (EFT) Authorization Agreement, if the provider (other than those reassigning their benefits) is not already receiving Medicare benefits electronically, or if the provider is making a change to existing EFT arrangements.
- Documents relating to adverse legal actions reported in Section 3 of the application
- Copies of other documents, if applicable, as specified in Section 17 or elsewhere on the CMS-855 form.
- Other documents may also be required on a case-by-case basis, e.g., a copy of the provider's driver's license for signature verification purposes.
With the exception of physician group practices and non-physician practitioner group practices, organizations submitting a CMS-855B to revalidate their enrollment information must submit documentation of payment of the application fee and/or a request for a hardship exception to the application fee. For Calendar Year 2013, the application fee is $532.00. Providers submitting paper applications should pay the application fee prior to submitting the application via the CMS website(external link). It can be paid by electronic check, debit card, or credit card. Providers submitting Internet-based PECOS applications will be prompted to pay the fee during the application process.
Hardship Exception Request
Providers may submit a letter and financial statements to request a hardship exception in lieu of the application fee along with their application or certification statement. Revalidations are processed only when fees have cleared or the hardship exception has been granted. Providers are notified by mail if their hardship exception request has been granted or if a fee is required.
The mailing addresses to which paper applications, and certification statements and required documents for Internet-based PECOS applications, should be sent are:
Wisconsin Physicians Service
Medicare Provider Enrollment
1707 W. Broadway
Madison, WI 53713-1834
Wisconsin Physicians Service
Medicare Provider Enrollment
P.O. Box 8248
Madison, WI 53708-8248
Failure to Revalidate
Failure to submit complete enrollment application(s) and all supporting documentation within 60 calendar days of the postmark date of the revalidation notice letter may result in providers' Medicare billing privileges being deactivated.
- The CMS-855O form cannot be used for revalidation. This form is used only by physicians and practitioners who enroll in Medicare for the sole purpose of being the ordering/referring provider on Medicare claims. The revalidation requirement does not apply to these providers.
- The revalidation requirement does not apply to physicians and practitioners who have opted out of Medicare.
- "You are revalidating your Medicare enrollment" should be checked as the Reason for Application in Section 1A of the CMS-855I or CMS-855B enrollment form.
- Physicians and nonphysician practitioners who reassign their Medicare benefits to a group practice or organization must submit both a CMS-855I and CMS-855R to revalidate their Medicare enrollment.
- One CMS-855I and CMS-855R may be submitted to revalidate all PTANs for reassignment to the same legal business entity (tax identification number). A separate revalidation application form(s) should be submitted to revalidate PTANs associated with each legal business entity.
- The revalidation notification letter or a copy of it should be enclosed with the revalidation application or certification statement.
- A CMS-588 Electronic Funds Transfer (EFT) Authorization Agreement is required only if the provider is not already receiving Medicare payment via electronic funds transfer or if changes are being made to existing EFT arrangements.
- A CMS-460 Medicare Participating Physician or Supplier Agreement should not be submitted; the revalidation process does not affect the current participation status of providers.
- Providers who receive notification to revalidate a PTAN for a practice at which they are no longer active should submit the appropriate CMS-855 as a change of information to notify us of the termination.
Questions regarding revalidation may be directed to our Provider Enrollment Department by calling our toll-free telephone number between the hours of 8:00 a.m. and 4:00 p.m. (C.T.) Monday through Friday. Our toll-free telephone number is (855) 280-5484 begin_of_the_skype_highlighting (855) 280-5484 FREE end_of_the_skype_highlighting.
- Centers for Medicare & Medicaid Services (CMS) - Revalidations(external link)
- MLN Matters MM7350, "Implementation of Provider Enrollment Provisions in CMS-6028-FC"Adobe Portable Document Format
- MLN Matters SE1126, "Further Details on the Revalidation of Provider Enrollment Information"Adobe Portable Document Format
- MLN Matters SE1130, "Implementation of Pay.gov Application Fee Collection Process through PECOS"Adobe Portable Document Format
- Sample WPS Revalidation LetterAdobe Portable Document Format
WPS has updated all EDI forms to include a version number at the bottom of each form. Effective March 1, 2013, the only forms accepted by WPS will be the forms that include a version number on the bottom of the form. If you are currently enrolled, a new form is not required.
The new EDI forms can be downloaded from the following website: http://www.wpsic.com/edi/files/medb_enroll.pdf
Due to the inability of the President and Congress to reach an agreement preventing sequester, it will take place as scheduled on March 1. However, due to a provision in a law passed in 2010, mandatory cuts to Part A and Part B of Medicare are delayed for 30 days from the date the sequester order is issued. This means that provider payment cuts will not take effect until April 1, 2013.
HBMA Director of Government Relations