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Information from CMS on Issues Impacting Providers

Information from CMS on Issues Impacting Providers

The following is communication from the Centers for Medicare & Medicaid Services (CMS) on current affairs that effect providers.

Mandatory Payment Reductions in the Medicare Fee-for-Service (FFS) Program – “Sequestration”

This is the current information on the sequestration impact on Medicare claims. This will be in effect until changes are made through Federal laws. Medicare Fee-For-Service (FFS) program, Part A and Part B claims with dates-of-service or dates-of-discharge on or after April 1, 2013, will incur a 2 percent reduction in Medicare payment. Claims for durable medical equipment (DME), prosthetics, orthotics, and supplies, including claims under the DME Competitive Bidding Program, will be reduced by 2 percent based upon whether the date-of-service, or the start date for rental equipment or multi-day supplies, is on or after April 1, 2013. Questions about reimbursement should be directed to your Medicare claims administration contractor.

Enrollment Date Concerning Ordering and Referrals

Exchange of health information through ordering and referrals is a big part of the CMS EHR Incentive programs. Please note the following requirement when ordering for or referring your Medicare patients. Effective May 1, 2013, physicians who refer or order services for Medicare patients will be required to be enrolled in Medicare. Claims submitted on or after May 1st for a physician who referred or ordered services for a Medicare patient but who is not enrolled in Medicare will be denied. Providers should enroll online through the Provider Enrollment, Chain, and Ownership System (PECOS) or can mail enrollment application CMS-8550. Physicians who have a valid opt-out affidavit on file are not required to enroll in Medicare. Visit the CMS web site for more information.

Request for Information (RFI)

On March 7th the Acting Administrator Marilyn Tavenner and the National Coordinator for Health Information Technology Farzad Mostashari, M.D., announced HHS’s plan to accelerate health information exchange (HIE) and build a seamless and secure flow of information essential to transforming the health care system and published a Request for Information (RFI). The RFI is titled: Advancing Interoperability and Health Information Exchange and seeks input on a series of potential policy and programmatic changes to accelerate electronic health information exchange across providers, as well as new ideas that would be both effective and feasible to implement. Deadline for comment is 5pm ET, April 22nd, and you can comment online at Regulations.gov.