In a significant move to reduce Fraud Waste and Abuse CMS has developed and is providing ‘Comparative Billing Reports’ to Medicare providers with the exception to Physicians and Inpatient hospitals. I would expect to see many more investments in new processes, transparency and compliance requirements to identify errors and outliers in billing and the...
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From CMS via HPMS on Sept 3, 2010: “On August 11, 2010, we issued a memo describing corrections to the 2011 Annual Notice of Change/Evidence of Coverage. We have the following additional corrections. 1 – Under the bullet, EOC Chapter 4, section 2.1, Your medical benefits and costs as a member of our plan,...
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That time of year again! CMS has distributed via HPMS the 2011 MA and PDP Readiness memo. Make sure you incorporate in your plan a review of the checklist and implement any corrective action to ensure your plan is in compliance. CMS has been increasing their review of plans and this checklist is your...
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There’s a lot of talk right now about electronic health records, and how health care professionals and hospitals are going to pay for them. So you probably have a lot of questions about them as well: Am I eligible to receive incentive payments under the Medicare & Medicaid Electronic Health Record (EHR) Incentive Programs?...
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Join CMS on Aug 19, 2010 from 2p-3:30p ET for an update on DOTPA, the “Developing Outpatient Therapy Payment Alternatives” program. The conference call is intended for all providers of Medicare Part B outpatient rehabilitation therapy. CMS is now actively seeking providers to participate as data collection sites. This Special ODF is intended for...
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Wednesday Barack Obama appointed Dr. Donald Berwick as the Administrator to the Centers of Medicare and Medicaid Services using a recess appointment. Dr. Berwick is a Harvard professor and a patient care specialist. He would be able to serve in his role though next year without Senate approval. Currently there are no hearings scheduled...
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CMS has posted an update their 2010 MA Part C and Cost Plan Technical Reporting Specifications. The update contains clarifications to commonly asked questions from plans. Part C reporting is a compliance requirement and plans that fail to submit data on time and in good fail will receive a compliance letter and notification. The...
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A key change included in the health reform legislation of 2010 was a change to the payment methodology for Medicare Advantage plans. As of today, CMS has not released their policy or the methodology for applying the STARs rating to payment adjustments but the legislation does provide some insights in to the overall approach....
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CMS has planned a major overhaul of their MARx system impacting enrollment file layouts and changes to TRR processing in April 2011. Here is a run down of the changes: IMPACTED SYSTEM / INTERFACE DESCRIPTION FROM TO Enroll Disenroll File Combining transaction codes 60, 61, 62 and 71 in to a single transaction code...
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On June 25, 2010, President Obama signed into law the “Preservation of Access to Care for Medicare Beneficiaries and Pension Relief Act of 2010.” This law establishes a 2.2 percent update to the Medicare Physician Fee Schedule (MPFS) payment rates retroactive from June 1 through November 30, 2010. The Centers for Medicare & Medicaid...
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