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Business Operations & Finance - News Archive
 Managed Care
American Medical Association's (AMA) releases annual National Health Insurer Report Card
One in five insurers process claim incorrectly. Read More>>
ASC Payment
Surgical Groups Discuss ASC Update with CMS
ASC payments remain relatively unchanged next year, under the 2011 proposed payment rule for hospital outpatient departments and ASCs recently released by CMS. The Academy, along with the Outpatient Ophthalmic Surgery Society and other surgical groups, met with CMS officials who oversee the ASC payment system. The groups raised the concern that CMS’ failure to use the same update system for ASCs as is used for hospital outpatient departments has contributed to a growing gap in the level of payments between the two. Ignoring calls from both the Medicare Payment Advisory Commission and several members of Congress, CMS has indicated in its recently proposed 2011 payment rule that the agency will again use the Consumer Price Index for all Urban Consumers (CPI-U) next year to set ASC payments. The CPI-U is not a good measurement of costs or inflation for businesses because it excludes the cost of energy and technology – two areas that contribute significantly to the cost of running an ASC. CMS acknowledged in the meeting that it does have the discretion to use other measures, but said it has not found a system that was more suitable. Development of alternatives will be explored with the broader ASC community.
Medicare Billing
Computer Issues Indefinitely Halt Mandatory PECOS Enrollment
CMS Encourages Providers to Continue to Enroll
As previously reported, CMS will not implement the Jan. 3 deadline for Part B health care providers to be enrolled in the Provider Enrollment, Chain and Ownership System (PECOS). Originally, CMS would have rejected claims submitted by providers who failed to enroll by the deadline. There are three ways to verify that you have an enrollment record in PECOS:
- Check the Ordering Referring Report (if you are listed on that report, you have a current enrollment record).
- Use Internet-based PECOS to look for your enrollment record (if no record is displayed, you do not have an enrollment record).
- Contact your designated Medicare enrollment contractor and ask if you have an enrollment record (see the “Medicare Fee-For-Service Contact Information” list in the “Downloads” section).
If you are not yet in PECOS, the best way to submit your application is through PECOS online. The agency says that it will make future implementation-date announcements with an appropriate timeline.
Additional Standards for DME Providers Become Effective Sept. 27
Physicians who supply durable medical equipment (DME), including optical shops that provide post-cataract glasses, are required to meet new business standards beginning Sept. 27. Per the final rule providers must:
- Meet applicable state licensing requirements. A DME supplier may hire a licensed W–2 employee on a part-time or full-time basis; CMS will permit contracting for licensed services as long as the state permits contracting for licensed services and the DME supplier complies with state licensure.
- Maintain a minimum 200-square-foot space. Signs for the space must be visible at the main entrance of the facility, visible to the public and post business hours. CMS will establish a three-year phase-in period for DME suppliers who have signed leases to comply with the new facility requirements.
- Notify the National Supplier Clearinghouse (NSC) within 30 days of changes to the business hours.
- Allow CMS, the NSC, or agents of CMS or the NSC, to conduct on-site inspections to make sure suppliers are complying with requirements. If a visit is conducted and no one is present during posted business hours, the NSC will conduct an unannounced follow-up visit prior to denying or revoking billing privileges.
- Maintain ordering and referring documentation for seven years, based on the date of service, not the date of payment.
- Be open and available to the public a minimum of 30 hours per week.
CMS added an exception to this supplier standard for physicians and licensed non-physician practitioners who only furnish DME supplies to their own patients.
Health Care Reform Act Affects Medicare Filing Requirements
One of the lesser-known changes in the Patient Protection and Affordable Care Act has amended the time period for filing Medicare Part B claims. Claims for services furnished on or after Jan. 1 now must be filed within one calendar year of the date of service. Additionally, claims for services furnished this year must be filed no later than Dec. 31. Services provided from Oct. 1, 2009 to Dec. 31, 2009 must be filed by the end of this year or they will be denied. Claims from before October 2009 will follow the previous timeline that allowed a minimum of 15 months (sometimes up to 26 months) to submit claims. CMS indicates it will outline some exceptions to the filing deadlines in upcoming rulemaking.
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