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Dr. Berwick nominated as CMS administrator
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President signs law increasing pre-June 1, 2010 fee schedule by 2.2%
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ASP drug pricing is “OK” per CMS report released 4-14-2010. A study report on ASP drug pricing is making the rounds on Capitol Hill, which communicates that everything is “OK” with ASP drug pricing. The dated study (latest data is from 2007) is geared to proving that reimbursement cuts are OK.
The Community Oncology Alliance (COA) is needing an immediate task force of administrators who really know their numbers. COA will be issuing a response and needs a group to go to CMS to respond. MOASC Vice-President, and CAN team member, Ann Womack is asking MOASC members to get involved with this as a priority.
This report is a suspected “set-up” for doing nothing on prompt pay, as well as a possible push down on ASP to +4% and below. Please click onto the link to read the study in its entirety.
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CMS has released the final rule on the 2009 Physician Fee Schedule.
The good news is that E&M reimbursement will increase by 1.1% as mandated by Congress.
The bad news is that oncology-specific services reimbursement will decrease by 1%, according to CMS, and all physician payments fall off a cliff in 2010.
CMS has released other information on PQRI and E-Prescribing.
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The Centers for Medicare & Medicaid Services (CMS) has released the 2009 Physician Fee Schedule (PFS). You can access a copy, prior to official release in the Federal Register, on the Community Oncology Alliance (COA) website at http://www.communityoncology.org under Breaking News, or clicking on the link below:
http://www.cms.hhs.gov/HCPCSReleaseCodeSets/ANHCPCS/itemdetail.asp?filterType=none&filterByDID=-99&sortByDID=1&sortOrder=descending&itemID=CMS1216705&intNumPerPage=10
Congress passed a Medicare bill this year (the Medicare Improvement for Patients and Providers Act of 2008) that averted the 10.6% cut in physician service fees. On the surface this was a short-term positive because it averted the 10.6% cut in services reimbursement, and replaced it with a stated increase of 1.1%. However, the devil is in the details at CMS.
In order to actually increase services payments by 1.1%, CMS has announced the following changes:
- The Medicare PFS conversion factor falls from $38.09 in 2008 to $36.07, which is approximately a 5% cut.
- The physician work value units increase by approximately 12%.
The net is that some codes, such as basic E&M services, will increase. On the other hand, oncology-specific codes, such as those relating to drug administration, will go down. CMS states that the impact on hematology/oncology will be an approximate 1% cut in services reimbursement.
There are other changes that impact community oncology that COA will provide additional information on in subsequent communications. However, you should note that the PQRI bonus has been increased to 2% of services in 2009/2010, and the new e-prescribing bonus is an additional 2% beginning in 2009. COA will provide more information on these initiatives. In the interim, we suggest you go to http://www.ehealthinitiative.org to learn more about e-prescribing.
All of these changes take place on January 1, 2009.
As we have related previously, congressional action to avert the 10.6% payment cut unfortunately sets up a cliff starting in 2010 of a 21% reimbursement cut. As a result, Congress is going to have to act to avert this cut and a collapse of Medicare. However, the annual band-aids to the system are gone and the likely action is an overhaul in the way that Medicare reimburses physicians. This presents the prospect of major Medicare legislation in 2009. |
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Information for Eligible Professionals Who Participated in the
2007 Physician Quality Reporting Initiative (PQRI)
The Centers for Medicare & Medicaid Services (CMS) is pleased to announce that 2007 PQRI Final Feedback Reports are available on a secure website. Two MLN Matters articles on accessing the reports are now available that can assist individual eligible professionals and group practices that reported valid 2007 PQRI quality measures data to Medicare. The reports are organized by Tax Identification Number (TIN). For eligible professionals reporting measures for 2007 PQRI under a group practice TIN, the group practice determines who can access the Feedback Report for the group practice or organization.
The first article, “Steps for Individual Eligible Professionals to Access Their 2007 PQRI Feedback Reports Personally”, MM SE0830, can be accessed at, http://www.cms.hhs.gov/MLNMattersArticles/downloads/SE0830.pdf
The second article, “Steps for Organizations to Access Their 2007 PQRI Feedback Reports”, is available at, http://www.cms.hhs.gov/MLNMattersArticles/downloads/SE0831.pdf.
Once you are registered in the Individuals Authorized Access to CMS Computer Services (IACS) system and have access to the PQRI feedback report application, any questions about the Feedback Report should be directed to the Report Delivery System Help Desk referenced at the end of the end of the MLN Matters articles. Additional educational resources and information about the PQRI program is available at, http://www.cms.hhs.gov/PQRI. |
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Palmetto Advance Payment Requirements
Advance Payments to Providers of Part B Services: Summary of the Requirements
Palmetto GBA and the Centers for Medicare & Medicaid Services (CMS) will consider, in limited circumstances, an advance payment for Part B providers who are experiencing financial hardship due to claims that are unable to process within established time limits. This applies to claims that have been submitted, but payment has not been made due to a system malfunction. This does not apply to claims that have not paid due to claims submission errors.
Advance payment may be made if all of the following conditions are met:
- Palmetto GBA is unable to process the claim timely.
- CMS determines that the prompt payment interest provision specified in section 1842(c) of the Act is insufficient to make a claimant whole.
- CMS provides written approval to Palmetto GBA, to make an advance payment.
Advance payment cannot be made if any of the following conditions is met. The provider:
- Is delinquent in repaying a Medicare overpayment.
- Has been advised of being under active medical review or program integrity investigation.
- Has not submitted any claims.
- Has not accepted claims' assignments within the most recent 180-day period preceding the system malfunction.
If you meet all required conditions and would like to request advance payments, you must submit a written request to Palmetto GBA. The request must include the reason your cash balance is seriously impaired, along with financial information to show hardship.
The following is an example of an acceptable format:
a. Cash on hand as of ________ |
$_____ |
b. Expected payments from all sources (not including any advance payments) in the next 30 days |
$_____ |
c. Expected expenses in next 30 days |
$_____ |
d. Cash position in next 30 days (a + b - c) |
$_____ |
Palmetto GBA then calculates the amount of the advance payment and forwards the request to CMS for approval. The amount of the advance payment is calculated at 80 percent of the anticipated payment based on historical data for claims paid. Historical data is defined as a representative 90-day assigned claims payment trend within the most recent 180-day experience before the system malfunction. Generally, the advance payment will be no more than the amount paid, on a daily average, for the 90 day period before the system malfunction.
If approved, you agree that Palmetto GBA will recover the advance payment by applying the amount due to future payments. The decision to approve an advance payment and the amount of the payment are at CMS's discretion and are not subject to review or appeal.
The complete listing of the requirements for advance payments for Part B services are found in the Federal Register at www.gpoaccess.gov/cfr/index.html. Click on "Retrieve by CFR Citation," and type 42 in the Title box, 421 in the Part box and 214 in the Section box. Then click on "Go."
Please note that CMS expects these requests to be limited. In most cases, corrections can be made and claims finalized before an advance payment request can be processed.
J1 Advance Payment Requests should be sent or faxed to:
J1 MAC – Palmetto GBA
Attn: Vicky Bowers AG-325
"MSC J1-4084"
17 Technology Circle
Columbia, SC 29203-9591
Fax number 803-763-5575 |
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On July 16, 2008, the Centers for Medicare & Medicaid Services (CMS) announced steps it is taking to implement certain Medicare provisions in the Medicare Improvements for Patients and Providers Act of 2008. On Tuesday, July 15, Congress voted to override the President's veto of the Medicare Improvements for Patients and Providers Act (H.R. 6331). The House vote was 383-41, while the Senate voted 70-26 in favor of enacting H.R. 6331 into law.
As a result, the mid-year 2008 Medicare Physician Fee Schedule (MPFS) rate of -10.6 percent has been replaced with a 0.5 percent update, retroactive to July 1, 2008.
Physicians, non-physician practitioners and other providers of services paid under the MPFS should begin to receive payment at the 0.5 % update rates in approximately 10 business days, or less. Medicare contractors are currently working to update their payment system with the new rates.
In the meantime, to avoid a disruption to the payment of claims for physicians, non-physician practitioners and other providers of services paid under the MPFS, Medicare contractors will continue to process the claims that have been on hold on a rolling basis (first in/first out) for payment at the -10.6% update level. After your local contractor begins to pay claims at the new 0.5% rate, to the extent possible, the contractor will begin to automatically reprocess any claims paid at the lower rates.
Under the Medicare statute, Medicare pays the lower of submitted charges or the Medicare fee schedule amount. Claims with dates of service July 1 and later billed with a submitted charge at least at the level of the January 1 – June 30, 2008, fee schedule amount will be automatically reprocessed. Any lesser amount will require providers to contact their local contractor for direction on obtaining adjustments. Non-participating physicians who submitted unassigned claims at the reduced nonparticipation amount also will need to request an adjustment.
To read the CMS Fact Sheet at: http://www.cms.hhs.gov/apps/media/fact_sheets.asp
More information on physician pay issues is available at http://www.cms.hhs.gov/PhysicianFeeSched/
More information on therapy caps is available at http://www.cms.hhs.gov/TherapyServices/
More information on DME is available at http://www.cms.hhs.gov/DMEPOSCompetitiveBid/ |
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© 2008 Medical Oncology Association of Southern California
P.O. Box 161 •
Upland, CA 91785
Phone: (909) 985-9061 •
Fax: (909) 985-8581 • email: moasc@moasc.org
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