2013 Credentialing & Reimbursement Updates – Important!
Medicaid Primary Care Payment IncreasennThe Affordable Care Act (ACA) enacted changes to Medicaid primary care reimbursement. Eligible physicians will receive supplemental payments for services rendered between January 1, 2013 and December 31, 2014. These supplemental payments will raise the Medicaid reimbursement to Medicare rates. To be eligible for the supplemental payments, physicians must self-attest as having a specialty in family medicine, general internal medicine, and/or pediatric medicine. Only physicians can complete the attestation! Staff or other representatives are not allowed to complete the attestation on the provider’s behalf. Click here to complete provider attestation.nnBeginning in 2013, providers applying for initial credentialing or re-credentialing must submit a Certificate of CME Credit, which is received after completion of the opioid educational webinar. The webinar can be viewed by going to Pinnacol’s website.nnMedicare Electronic Prescribing (eRx) Incentive ProgramnnThose practices that did not meet the reporting criteria established for avoiding the 2013 eRx payment adjustment, or request a hardship exemption by July 2012, are subject to a 1.5% reduction in reimbursement in 2013.nnGood news for practices that did not meet the reporting criteria: CMS has re-opened the Quality Communication Support Page, as of November 1, 2012, to allow individual professionals an additional exemption for the 2013 eRx payment adjustment!nn What you need to do by January 31, 2013 to avoid the payment adjustment:nnSubmit a hardship Exemption Request via the Community Support Page –n
- n
- Hardship exemptions include: Demonstrate the intent to participate in the EHR Incentive Program and adoption of Certified EHR Technology by registering for the EHR Incentive Program. Participants in the EHR Incentive Program must provide their entire EHR Certification Number to receive this hardship exemption.n
- n
- Physicians who are unable to prescribe due to state, federal or local law;
- Physicians with fewer than 100 prescriptions between 1/1/12 and 6/30/12;
- Physicians in rural areas without sufficient high-speed internet access; or
- Physicians in areas without enough pharmacies available for e-prescribing.
n
n
n
n
n
- Meet the reporting criteria:n
- n
- Report the eRx measure for at least 25 denominator-eligible visits from January 1, 2011 through December 31, 2011
- Report the eRx measure’s numerator (G8553) on claims for at least 10 billable Part B Physician Fee Schedule services from January 1, 2012 through June 30, 2012.
n
n
n
n
n
n
Medicare Provider Revalidations
nMedicare is continuing their efforts to re-validate ALL Medicare providers! There is 2 years left in their intended time frame.nnYou will be receiving a notification letter (letters being mailed between late 2011 & March 2015). You (the provider) only have 60 days to complete and submit the proper forms that must be completed. The process is/was to be suspended until after completion of the new MAC transition. However, if you do/ did receive a revalidation notice, don’t ignore it! PTANs will be deactivated if forms are not received and processed.n
Provider credentialing has become increasingly complex! Welter Healthcare Partners offers credentialing and reimbursement management services to support every practice’s needs! Call or email us today for more information!
n
Per AMA guidelines, the new code set should be used for claims filed as of January 1, 2013. Practices are advised to check with their local payers to verify payer implementation date of the new codes, to avoid any unnecessary claims denials and delays in payments!nn
CERTIFIED PROFESSIONAL CODER (CPC) PREPARATION COURSE & CERTIFICATIONnnCertified coders are in high demand! Advance your career in the medical field and get certified now!nnThis course will be offered as a combination live and web-based class to offer maximum flexibility for any student. It is designed to offer the most comprehensive and complete coding information to prepare students for the CPC examination and a career in the medical field. This course will include a brief overview of medical terminology, anatomy, CPT, ICD-9 CM and HCPCS manuals, and coding scenarios for practical application in the work environment.nnUpon completion of this course, participants will be prepared to sit for the nationally accredited American Academy of Professional Coders (AAPC)/Certified Professional Coder (CPC) coding certification examination.nnThis examination will be offered to class participants at the completion of the course.n
Congress passed The American Taxpayer Relief Act of 2012, to avert the “fiscal cliff.” President Obama is expected to sign the legislation shortly.nnIn addition to various tax and spending measures, the legislation includes provisions of direct importance to medical group practices. The legislation:n
A new report from the Agency for Healthcare Research and Quality (AHRQ) highlights the cumulative experiences of more than 100 grantees that implemented major health IT projects between 2004 and 2007.nnThe report, Effective Teamwork and Sustainability in Health IT Implementation, reviews grantee experiences related to planning, long-term use, partnerships, vendor relationships, and end-user perceptions a few years after the end of the project period. According to the grantees, the most important factors affecting the sustainability of health IT were the ability to demonstrate benefits from health IT to grantees’ organizations, clinician support, and cost–related issues. Grantees said that most health IT products that were implemented and upgraded during the study continue to be used. However, they reported that in order for health IT projects to be successful, clinician buy-in and support must be established early in the planning period and be sustained during implementation and maintenance phases. Effective planning, including completing a detailed workflow analysis, implementation plan and process re-design assessment prior to implementation, were strong markers of long-term viability.nn
ceive a 26.5 percent reduction in payments starting Jan. 1 unless Congress intervenes. Action to avert the cut is being considered as part of broader fiscal cliff negotiations on tax and spending policies. However, these discussions remain up in the air, creating uncertainty over the timing of a solution.nnThe latest estimates from the Congressional Budget Office (CBO) indicate that a one-year patch to prevent the SGR cut would cost $25 billion. While most members of Congress agree that the current Medicare payment system must be repealed, the cost is daunting. Details should emerge in the coming week.