Medicare Medicaid
Information for psychiatrists who serve patients through Medicare, the federal health insurance program for the elderly and disabled; and Medicaid, the federally supported state-run health insurance programs for the poor.
Learn more about Medicare and Medicaid.
Information is available to Members through the Practice Management HelpLine by phone [800.343.4671] or email [hsf@psych.org]
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Medicare/Medicaid Electronic Health Records (EHR) Incentive Payment Programs.
Reprocessing Claims Alert from CMS posted 2.8.2011: Adjustments to claims subject to retroactive payment changes in the first several months of 2010 are scheduled to begin in the near future, most of the adjustments will be made automatically but in some instances where the submitted bill was lower than the revised payment rate, physicians will need to request an adjustment. [Click to read more.]
Medicare Extender Act of 2010 stabilizes Medicare physician payments at current rates for 12 months, through the end of 2011.
In addition to providing a 12-month reprieve from the 25 percent Medicare physician payment cut that was scheduled to take effect on January 1, 2011, the law extends the 5% increase in payments for psychotherapy codes that first went into effect in 2008, and was retroactively reinstated for 2010 as part of the health reform legislation last March.
Although the bill essentially extended the current fee schedule, there may be some changes in fees allowed for specific procedures because of adjustments made to the conversion factor, work values of the codes, etc.
It is vital to check your Medicare Contractor’s website to be sure you have the correct 2011 fees. The AMA has more information about this at http://www.ama-assn.org/ama/pub/physician-resources/solutions-managing-your-practice/coding-billing-insurance/medicare/payment-action-kit-medicare.shtml .
It is significant that the Extenders Act includes funds to enable Medicare contractors to reprocess claims for physician services affected by provisions of the Patient Protection and Affordable Care Act passed last spring with a retroactive effective date of January 1, 2010.
There had been some question as to what psychiatrists needed to do to receive their retroactive payments, and now it appears that the contractors should be taking care of this without the need to request that individual claims be reprocessed; for exceptions see http://www.psych.org/MainMenu/PsychiatricPractice/MedicareMedicaid/2010-Claims-Reprocessing.aspx.
We’ll post more information when it is available.
Reprocessing Claims Update from Jan 11: CMS announced they were “closer” to finalizing plans for reprocessing claims from the first half of 2010 to pay for the retroactive increases in physician payments—including the 5% increase in fees for psychotherapy services.
Electronic Prescribing Alert [posted 12.15.2010]
Medicare Claims Filing Reminder: Medicare claims now need to be filed in a much more timely manner than was required previously. If you see a patient in the first 9 months of a year, you have until December 31 of the following year to file a claim. If the service occurs from Oct-Dec, you have until December 31 of the second year. Note: after the deadline, no payment will be made.
If you’re new to Medicare you may bill back 30 days prior to the submission of an accepted enrollment application.
For additional information about the new maximum period for claims submission filing dates, contact your Medicare contractor, or review the MLN Matters articles listed below:
- MM6960 – “Systems Changes Necessary to Implement the Patient Protection and Affordable Care Act (PPACA) Section 6404 - Maximum Period for Submission of Medicare Claims Reduced to Not More Than 12 Months”
- M7080 – “Timely Claims Filing: Additional Instructions”
- Listen to the CMS podcast on timely claims filing.
Guidelines: Participating or Non-Participating provider in Medicare explained.
Know your options: Medicare participation guide from the AMA [posted 9.30.2010]
CMS to Review PECOS Enrollment Process [posted 6.30.10]:
Medicare is working with ordering and referring providers and supplies to streamline enrollment process to ensure that Medicare beneficiaries continue to receive the health care services and items they need.
CMS will, for the time being, not implement changes that would automatically reject claims based on orders, certifications, and referrals made by providers that have not yet had their applications approved by July 6, 2010.
Additionally, though CMS is taking a more deliberative approach to using the PECOS enrollment system, the agency will employ a contingency plan to meet the ACA requirement that written orders and critifications are only issued by eligible professionals effective July 1.
For more information read the CMS Press release issued June 30, 2010.
PECOS is the electronic system used to enroll physicians and eligible professionals into the Medicare program.
2010 Medicare News From HSF
Reminder: Consultation Code elimination: Medicare eliminated the use of all consultation codes except those for telemedicine. Physicians are to bill for these services using the "most appropriate" remaining evaluation and management codes.
If you have questions about coding under this new policy, please contact Ellen Jaffe at 703-907-8591.
2010 Fee Schedule
CMS Notices:
Scam Alert targeting physician offices [posted 6.18.2009]
Fact Sheet: 1500 At a Glance [pdf document]
CMS Form 1500 Web-based Tutorial
Letter from CMS’s National Correct Coding Initiative (CCI) re inappropriate use of the Advance Beneficiary Notice (ABN) for claims denials based on CCI Medically Unlikely Edits (MUEs) rather than medical necessity. [posted 04/16/2009]
New Profider Authentication Requirements for Medicare Contractor provider Telephone and Written Inquiries [posted 04.15.09]
Posted 02.20.2009:
Internet-based Medicare Enrollment
Tips for Enrolling in Medicare
Posted 9.17.2008:
Reporting Responsibilities for Individual Physicians Enrolled in the Medicare Program
Reporting Responsibilities for Physician Group Practices Enrolled in the Medicare Program
