Medicare Compliance & Reimbursement

Congress Hears AMA Plea to Consider Physician Payment Reform

Congress may have passed a one-year Medicare payment fix for 2011, but that doesn't mean your payment woes are permanently gone. Physicians are still facing potential steep cuts for 2012, and the AMA wants lawmakers to fix those issues before they happen.

AMA President Cecil B. Wilson, MD testified before the House Energy and Commerce Health Subcommittee on May 5 to recommend a repeal of the current payment formula (the sustainable growth rate, or SGR) and implementation of a five-year period of stable Medicare payments, followed by a new Medicare physician payment system that Medicare can develop and demo over the five-year stabilization period.

It remains to be seen whether Congress takes up the AMA's recommendation, or whether a different model will be put into place before payment cuts hit physicians again in 2012.

Use CMS resources to ensure you're ready for new 5010 standards. The Jan. 1 compliance date for the new HIPAA 5010 standards is fast approaching. Take advantage of the following opportunities from CMS to help you get ahead of the mandate.

CMS held another "National Provider Call on Medicare FFS Implementation of HIPAA Version 5010 and D.0 Transactions" on May 25. This call covered "a HIPAA 5010 status update for Medicare Fee-For-Service, HETS Eligibility Transaction, Coordination of Benefits Contractor, and Medicaid," CMS says. "In addition, resources and guidance will be provided for 5010 testing and to help the audience through the transition to implementation."

CMS is also holding a "National Version 5010 Testing Day" on June 15. "All HIPAA-covered entities should be taking steps now to get ready, including conducting external testing to ensure timely compliance," CMS reminds providers. Your local MAC will have more information about the testing day soon, CMS promises. In the meantime, if you're ready to test your 5010 transactions, you can go ahead now. The testing day "does not preclude trading partners from testing transactions immediately with their MAC," the agency says. "Don't wait." The day just provides "the added benefit of real-time help desk support and direct and immediate access to MACs."

More information is at www.CMS.gov/Versions5010andD0.

CMS paid first EHR incentive bonuses last month. Part B practices that have been using electronic health  records (EHRs) under CMS's guidelines cashed in last month, when CMS sent out the first incentive payments under the EHR Incentive Program. Eligible professionals (EPs) who participate in the program receive a payment based on 75 percent of their Medicare allowed charges, with a maximum 2011 incentive payment of $18,000, according to a May 18 CMS news release.

EPs cannot collect incentive payments until they meet a $24,000 threshold in allowed Medicare charges. You will collect your EHR incentive payment via electronic funds transfer or by paper check, and the money will be issued to the taxpayer identification number (TIN) selected during EHR Incentive Program registration. The payments will not come from your MAC, but from a separate contractor working with CMS. Therefore, CMS encourages you not to call your MAC regarding EHR incentive payment issues. Instead, the EHR Information Center can be reached at 888-734-6433.