Medicare Compliance & Reimbursement

Part B practices will benefit from three new tests that you'll be able to report as "CLIA-waived," thanks to an Oct. 21 CMS transmittal on the matter. According to MLN Matters article 2321, CMS will now consider these tests CLIA-waived.

You'll have to append Modifier QW (CLIA-waived test) to these codes, which include the following, among others:

• 81003 -- Germaine Laboratories Inc. AimStrip Urine Analyzer and Mediwatch urinewatch Urine Analyzer
• G0434 -- UCP Biosciences, Inc. Drug Screening Test Cups, Diagnostic Test Group Clarity Multiple Drug Screen Cups, and Jant Pharmacal Accutest Drug of Abuse Urine Cup Test

Deadline has passed: With the Nov. 1, deadline gone what hopes are there for those who haven't been successful e-prescribers as indicated by the reporting of the e-prescribing measure? Although some in the provider community had requested that CMS alert them if they will be subject to a penalty in 2012 and would therefore benefit from a hardship exemption, "that turns out not to be feasible," said CMS's Michael Rapp, MD, during an Oct. 18 Open Door Forum.

Timing: CMS is "trying to process the hardships as quickly as we can," CMS's Molly MacHarris said, and practices who have applied will get an email or a hard copy letter when CMS approves or denies the hardship application.

Looking ahead: Hardship exemption categories for the 2013 payment adjustments will be different from those currently on the application, which apply only to 2012. Information about the exemptions possible for 2013 will be in the 2012 Physician Fee Schedule Final rule, which will be available "around Nov. 1," MacHarris noted.

Watch out: The CMS communications won't offer absolute guarantees of which providers might be exempt, because they are based on preliminary PQRS reviews, not final reports, CMS reps added during the call.

Keep in mind: If an individual eligible professional (EP) or Group Practice Reporting Option (GPRO) participating in e-prescribing as a group submits G8553 (indicating a valid e-prescribing event) in addition to submitting a hardship or lack of prescribing privileges code, the hardship/lack of prescribing privileges will take precedence, CMS's Molly MacHarris noted.

Tighter Medicare and Medicaid reimbursement is causing some home care providers to close, and the worst of cuts haven't even hit yet. In Stamford, Conn., Visiting Nurse and Hospice Care of Southwestern Connecticut plans to shut down and turn over its remaining patient load to Masonicare Home Health & Hospice of Wallingford by late November, reports the Stamford Advocate.

Cuts to Medicare and insurance reimbursement rates and the loss of patients with greater ability to pay due to competition are factors in the decision to close, VNHC Board of Directors Chair Mark Santagata told the newspaper. He also cited face-to-face physician encounter requirements as a financial drain. Most of VNHC's staff is expected to be picked up by Masonicare, Santagata says. The agency employs about 69 full-time and 61 per diem staff.

In New York City, Home Services Systems in Astoria, Queens will be shutting down, says its parent HANAC, a Manhattan nonprofit social services organization, reports Crain's New York Business. HANAC cited the state's new managed care system for Medicaid payment, which is replacing its current fee for service system, as a reason.