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Medicare - Medicaid
2012 Medicare Fees
12-22-11
WASHINGTON -- House Republicans have agreed to
pass the payroll tax break extension bill that would
postpone a 27% cut in Medicare payments to doctors for
two months.
HIPAA 5010
12-29-11
Date:
(12/29/2011)
Notice ID:
14706 |
CMS
announced
that it would not initiate enforcement action with
respect to any Health Insurance Portability and
Accountability Act (HIPAA)-covered entity that is
non-compliant with the ASC X12 Version 5010 (Version
5010), NCPDP, Telecom D.0 (NCPDP D.0) and NCPDP
Medicaid Subrogation 3.0 (NCPDP 3.0) standards until
90 days after the upcoming January 1, 2012,
compliance date. Although compliance will not be
enforced for Version 5010 until April 1, 2012, it is
important to continue to take the necessary steps to
complete your transition to Version 5010 as soon as
possible.What the 90-Day Enforcement
Discretionary Period Means for Medicare
Fee-for-Service (FFS)
Medicare FFS has experienced significant
increases in 5010 production transactions during the
last few months. However, there are many submitters
that have tested but not taken the step to move into
production for 5010 and D.0. In addition, there are
many submitters that have not yet initiated testing
with their Medicare Administrative Contractor (MAC).
Therefore, to ensure that progress continues to
be made, Medicare FFS is planning to take the
following steps for submitters and receivers of
Medicare Part B and Durable Medical Equipment (DME)
transactions:
 | In December 2011, submitters/receivers that
have tested and been approved for 5010/D.0 will
be notified that they have 30 days to cut over
to the 5010/D.0 versions.
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| Submitters/receivers that have not yet
tested will be notified in December 2011 that
they must submit their transition plan and
timeline to their MAC in 30 days.
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| MACs will notify the submitters/receivers
but submitters/receivers have the responsibility
to notify the providers they service. |
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All Providers will be required to
Revalidate their Medicare Enrollment
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Date:
(8/11/2011)
Notice ID:
14481
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Note:
The Affordable Care Act reference in the first
paragraph has been revised to indicate Section
6401(a). In addition, the time frame providers have
to respond to the revalidation request has been
added.
SE1126 provides no new policy. It provides further
information regarding the revalidation requirements
based on Section 6401(a) of the Affordable Care Act.
Through March 23, 2013,
Medicare Administrative Contractors (MACs) will send
notices on a regular basis to begin the revalidation
process for each provider and supplier.
All providers and
suppliers enrolled with Medicare prior to March 25,
2011, must revalidate their enrollment information,
but only after receiving notification from their
MAC.
Upon receipt of the revalidation request, providers
and suppliers have
60 days from the date of the letter to
submit complete enrollment forms.
Failure to submit the
enrollment forms as requested may result in the
deactivation of your Medicare billing privileges.
When providers and suppliers receive notification
from their MAC to revalidate, they must:
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Update their enrollment through Internet-based
Provider Enrollment, Chain and Ownership System
(PECOS) or complete the 855 application.
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Sign the certification statement on the
application. |
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If applicable, pay their fee through
pay.gov.
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Mail their supporting documents and
certification statement to their MAC.
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Note:
Newly enrolled providers and suppliers that
submitted their enrollment applications on or after
March 25, 2011, are not affected. |
Signature Required on all Documentation
Medicare wants your signature on all your
documentation.... that is ink on paper.... if you have your
name typed at the bottom of your documentation... be sure to
sign or initial above your printed name.........
Electronic Signatures
Providers using electronic systems need to
recognize that there is a potential for misuse or abuse with
alternative signature methods. The individual whose name is
on the alternative signature method and the provider bear
the responsibility for the authenticity of the information
being attested to. Physicians are encouraged to check with
their attorneys and malpractice insurers concerning the use
of alternative signature methods.
The following are examples of acceptable electronic signatures:
Chart "Accepted By" with provider’s name, "Electronically
signed by" with provider’s name, "Verified by" with
provider’s name, "Reviewed by" with provider’s name,
"Released by" with provider’s name, "Signed by" with
provider’s name,"Signed before import by" with provider’s
name, "Signed: John Smith, M.D." with provider’s name,
Digitalized signature: Handwritten and scanned into the
computer, "This is an electronically verified report by John
Smith, M.D.", "Authenticated by John Smith, M.D.",
"Authorized by: John Smith, M.D.","Digital Signature: John
Smith, M.D.", "Confirmed by" with provider’s name, "Closed
by" with provider’s name. "Finalized by" with provider’s
name.
Timely Filing
Requirements for Medicare Fee-For-Service Claims
from CMS 4-1-10
On March 23, 2010,
President Obama signed into law the Patient Protection and
Affordable Care Act (PPACA), which amended the time period
for filing Medicare fee-for-service (FFS) claims as one of
many provisions aimed at curbing fraud, waste, and abuse in
the Medicare program.
The time period for filing Medicare FFS
claims is specified in Sections 1814(a), 1835(a)(1), and
1842(b)(3) of the
Social
Security Act and in the
Code of Federal Regulations (CFR), 42 CFR Section
424.44. Section 6404 of the PPACA amended the timely filing
requirements to reduce the maximum time period for
submission of all Medicare FFS claims
to one
calendar year after the date of service.
Chiropractic LCD
12-14-09
Advantage
Plans requiring "Fraud, Waste & Abuse Training"
Every Year
| CMS now requires
Medicare Advantage plans to provide Fraud, Waste and
Abuse
(FWA) training programs that must be taken annually by
providers. Plans
were required to put an FWA training program in place by
January 1, 2009--so
this is the first year we are seeing this requirement.
However, CMS has
gotten some push back regarding the requirement and they
are proposing to
change the guidelines. In the October 22 Federal
Register Proposed Rule, CMS
proposed that individuals who were enrolled as Medicare
providers should not
be required to do the FWA training because it was
redundant to the Medicare
requirements for enrollment. This hasn't yet become a
final regulation,
however. CMS may make this a final rule before year's
end and we will keep
providers aware of whether this change is finalized.
(from ACA)
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OptumHealth has a training program on their website...
it is 18 pages with the final page for proof that you
read the information.
click here for link
to the document or go to their website at
https://www.myoptumhealthphysicalhealth.com/
(click for link)
you must have your provider ID and password |
OIG REPORT
5-8-09
ICD-10
| HIPAA 5010 Mandatory
1-1-12 |
ICD10 diagnosis codes - Effective date 10-1-2013
ICD-10 will have 155,000 codes compared to
ICD-9's 17,000
NPI
(see link below for look-up)
check your
NPI to make sure all PTINs crossover
https://nppes.cms.hhs.gov/NPPES/Welcome.do
| Check how your NPI
crosses over...... |
Advantage
Plans
| Verify
whether your Medicare patient is with Trailblazers or an
Advantage Plan |
877-567-9230 Automated Response System |
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