Medicare Compliance & Reimbursement

IN OTHER NEWS ...• If your head is spinning with all of the changes between PQRI and e-prescribing, CMS has just the tool for you.

Published on Tue Mar 10, 2009

New MLN Matters article MM6394, dated March 20, offers a full breakdown of who is affected by the new PQRI and e-prescribing incentive programs, with a primer on applicable reporting periods and methods.

For example: The article notes, "For purposes of qualifying for the e-prescribing incentive payment for 2009, an eligible professional will be considered a successful e-prescriber if he/she reported the applicable e-prescribing quality measure in at least 50 percent of the cases in which such measure is reportable by the eligible professional during the reporting period."

To access the MLN Matters article, visit the CMS Web site at www.cms.hhs.gov/MLNMattersArticles/downloads/MM6394.pdf.

• What a difference three months makes, especially when it comes to CMS' requirements for filling out its Internet-based Provider Enrollment, Chain and Ownership System (PECOS) forms.

Old way: During a Jan. 13 CMS open-door forum, Medicare officials relayed the frustrating news that physicians or non-physician practitioners (NPPs) had to personally fill out their PECOS enrollment forms -- they were not able to designate an employee or third-party billing service to do the work on their behalf.

New way: CMS changed its tune this week, with an April 1 press release from Valerie Haugen, a director with CMS, announcing that the person filling out the PECOS form "may be an employee of the provider or supplier organization,or an employee of a separate organization."

The only catch: The designated employee must complete a security consent form, which the employer must sign. "More than one person may be approved to use Internet-based PECOS on behalf of a given provider or supplier organization, but the security consent form is completed only one time," the CMS release indicated.

• When you scan the Correct Coding Initiative's (CCI's) new deletion database, don't limit your search to pairs with termination dates of April 1 (column E).

CCI 15.1 made several edit pairs retroactive to Jan. 1, 2009. "If you did not bill one of these pairs because you thought they were prohibited or billed one of these pairs and were not paid due to CCI, you may be able to receive payment," said Frank Cohen, MPA, senior analyst with MIT Solutions Inc. in his CCI 15.1 webinar.

Medicare Compliance & Reimbursement

RED FLAGS RULE:
No Red Flags Program? You Could Be Losing Thousands
Tip: Institute your Red Flags program ASAP. You may think the government is implementing the [...]

MEDICARE ADVANTAGE :
CMS Overhauls Medicare Advantage Program
Oversight of MA could tighten significantly. CMS is buckling down on the Medicare Advantage (MA) [...]

RED FLAGS RULE :
Act Quickly If Your Practice Identifies a Red Flag
Identity theft is nearly a $50 billion industry. You've implemented a Red Flags program at [...]

BILLING :
Make Sure You Charge For All Your Services
Measure charges and take action, experts say. So you've got a handle on your accounts [...]

DIAGNOSIS CODING :
CMS Dismisses Attachment D Concerns
Sequencing, risk adjustment not harmed by new guidance on secondary diagnosis coding, CMS official maintains. [...]

PART B REVENUE BOOST :
Brush Up on Your ICD-9 Know-How With These 3 Tips
Confused about fifth digits or V codes? Look no further. Insurers base your reimbursement on [...]

CODING COACH :
Keep Chronic Pain Denials at Bay With Surefire Diagnosis Tips
Be careful not to put words in your physician's mouth, or risk audit woes. Imagine [...]

INDUSTRY NOTES :
Nevada Radiology Group Gets $2 Million Fine
Plus: One RAC reveals information about how it will evaluate claims during its review process. [...]

IN OTHER NEWS ...• If your head is spinning with all of the changes between PQRI and e-prescribing, CMS has just the tool for you.
New MLN Matters article MM6394, dated March 20, offers a full breakdown of who is [...]

View All