Medicare Compliance & Reimbursement

CMS offered an early holiday gift to medical practices with the Nov. 17 announcement that it would not initiate enforcement action regarding 5010 until March 31, 2012. But even at the time, the agency did tell practices that they need to be able to prove that they're making a "good faith effort" to transition to the new data set. Now CMS puts its money where its mouth is, telling practices that they are being watched carefully -- and that some practices will not actually have until March to switch to 5010.

In Dec. 2011, "submitters/receivers that have tested and been approved for 5010/D.0 will be notified that they have 30 days to cutover to the 5010/D.0 versions"

Submitters/receivers that have not yet tested will be notified in Dec. 2011 "that they must submit their transition plan and timeline to their MAC in 30 days"

MACs will notify the submitters/receivers; "submitters/receivers have the responsibility to notify the providers they service."

To read more about CMS's plan, visit www.cms.gov/Versions5010andD0.

It's clear that Congress plans to take the looming Medicare pay cuts right down to the wire.

Part B practices are facing a 27 percent cut to Medicare rates effective Jan. 1 unless Congress steps in and reverses that cut, which it has done in prior years. However, with the calendar almost about to turn to 2012, the government has not yet taken action.

"Once again, Congress failed to stop the charade of scheduled annual physician payment cuts and short-term patches that spend more taxpayer money to perpetuate a policy all agree is fatally flawed", said AMA president Peter W. Carmel, MD, in a statement. "A decade of uncertainty and repeated threats of steep cuts threaten access to care for seniors and military families who rely on the Medicare and TRICARE programs."

Background: Although it still hasn't implemented the postponed claims edits for physician enrollment in PECOS, CMS wants doctors who order and refer for Medicare services to be enrolled in the online system. You should be checking each of your referring physicians against the PECOS enrollment database and NPI registry, experts advise.