Medicare Compliance & Reimbursement

As most practices remember, the Affordable Care Act, which was signed into law in 2010, offered Medicare bonus payments to primary care physicians -- and now it looks like Medicaid providers could see similar boosts.

On May 9, Health and Human Services (HHS) director Kathleen Sebelius announced a new proposal sparked by the Affordable Care Act that would give states more than $11 billion in new funds to distribute to primary care practitioners who serve Medicaid patients.

"The increase would bring Medicaid primary care service fees in line with those paid by Medicare," the news release notes. The rule would "reimburse family medicine, general internal medicine, pediatric medicine, and related subspecialists at Medicare levels in 2013 and 2013," it said.

In 2011, over 150,000 primary care providers collected nearly $560 million in higher Medicare payments due to the Affordable Care Act, the HHS news release notes.

To read the news release in its entirety, visit www.hhs.gov/news/press/2012pres/05/20120509b.html.

Differentiate Your PTAN From Your NPI

Medicare maintains so many acronyms that it can be a full-time job to keep track of them. CMS aims to dispel confusion between at least two of their common abbreviations with new MLN Matters article SE1216, which breaks down the difference between National Provider Identifiers (NPIs) and Provider Transaction Access Numbers (PTANs). Some practices have used these numbers interchangeably, or confused them, which prompted CMS to issue the clarification.

According to the article your NPI is the ten-digit number that you enter on your claims to identify your practice as an entity eligible to bill Medicare for services performed.

The PTAN, however, is a number that authenticates you when you contact Medicare contractors. Both numbers are important, but cannot be used interchangeably. Think of the NPI as similar to your bank account number (identifying your specific account), and the PTAN being similar to the PIN number you use to access your money (which identifies that you are who you say you are).

To read the complete article, visit www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/Downloads/SE1216.pdf.

CMS Assigns New Specialty Codes to Sports Medicine, Sleep Medicine

Codes went into effect on April 2, so you can use them now. Rumors of new specialty codes have been swirling for months, but finally CMS came through and confirmed two new specialties that Medicare payers will accept effective April 2.

According to MLN Matters article MM7600, dated April 27, you'll use specialty code C0 for sleep medicine services. For sports medicine, you should report specialty code 23 when submitting claims to durable medical equipment (DME) MACs for sports medicine services.

You can report your physician's services using one of these new specialty codes if the doctor self-designates his specialty as such during PECOS registration. If you are unsure of whether your physician has enrolled as a particular specialty, you can check your PECOS record using the Medicare online system at https://pecos.cms.hhs.gov.

Resource: To read the complete MLN Matters article, visit www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/Downloads/MM7600.pdf.