Medicare Cut Delayed Again And Other Developments Affecting Claims

Confusion abounds over the 21{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} cut in Medicare reimbursements. Although not repealed, the payment cut has been again delayed until April 1, 2010 by the Temporary Extension Act of 2010. You should get paid the same amount for services that you have been getting in January and February.

The act also extended the therapy-cap exceptions which had expired Jan. 1. To obtain payment for claims in excess of the therapy caps from Jan. 1 through March 31, however, you should attach the modifier KX. The 2010 caps are $1,860 for physical, speech, and occupational therapy.

Meanwhile, on March 10, the House of Representatives passed a tax bill, the American Workers, State, and Business Relief Act of 2010, which includes a section addressing the sustainable growth rate (SGR) Medicare cut, the therapy-cap exceptions, and an extension of the minimum geographic practice cost indices (GPCI) work floor of 1.000. If and when it becomes law, this bill would extend the 21{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} cut until Sept. 30, 2010, extend the therapy-cap extensions until Dec. 31, 2010 and would extend the GPCI work floor to Dec. 31, 2010. Stay tuned.

CMS Error Could Cost You Money

On another subject, a billing glitch by the Centers for Medicare & Medicaid Services (CMS) failed to automatically forward certain Part B claims to secondary payers during the first six weeks of 2010. You may have missed this because the explanation of benefits (EOB) that you received stated that these were properly forwarded.

Although CMS acknowledges its fault, you must follow up to get your money. You should be alerted by your Medicare carrier how to get your money. This happened to certain claims submitted between Jan. 5 and Feb. 12, 2010.

E-prescribing Made Easier

On a positive note, the requirements for an e-prescribing bonus have been made easier in 2010. CMS has dramatically lowered the minimum reporting threshold to earn the bonus and has made new ways available to successfully e-prescribe.

CMS has reduced the number of successful e-prescriptions you must report in 2010 to 25 encounters for the entire year. That’s down from a requirement of 50{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} of all eligible patient encounters in 2009.

There are two caveats to the lowered number of encounters. First, it doesn’t count when you e-prescribe unless the patient has received one of the services approved by CMS for e-prescribing. Second, at least 10{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} of your physician’s total Medical Part B charges must consist of codes eligible to be reported under the e-prescribing bonus for your provider to receive the entire bonus.

Here’s how to report. You’ll report HCPS code G8553 in 2010 to signify that at least one of the prescriptions given to the patient during the encounter was electronically prescribed. The encounter codes eligible to be reported under the e-prescribing program are:

  • 90801, 90802, 90804, 90805, 90806, 90807, 90808, 90809, 90862
  • 92002-92004, 92012-92014
  • 96150-96152
  • 99201-99205, 99211-99215
  • 99304-99310, 99315-99316
  • 99324-99328
  • 99334-99337
  • 99341-99345, 99347-99350
  • G0101, G0108, G0109

CMS-approved EHR Systems

There are three ways to report quality data codes for PQRI and e-prescribing incentives. These are through claims submission, through a registry, and through an EHR system approved by CMS. Most practices are using claims submissions. CMS had not yet published a list of registries as of the end of 2009. On March 10, 2010, CMS announced the following list of approved systems:

  • Allscripts Enterprise HER, versions 11.1.7 and above
  • DocSite Certified HER, versions 3.62 and above
  • EClinicalWorks, version 8.0.100
  • eHealth Made EASY, version 3
  • Epic, versions Spring 2008, Summer 2009, and Epic 2010
  • MedAppz iSuite, version 4.0
  • MedLink Total Office 3.1 and 4.0
  • MedLink EHR Lite+

Whichever method you choose to use, 4{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} of your total Medicare revenue hinges on participating in the PQRI and e-prescribing programs. Also, your participation in both of these is a requisite to receiving the EHR incentive payments of up to $44,000 per provider.

James B. Calnan, CPA, is partner-in-charge of the Health Care Services Division of Meyers Brothers Kalicka, P.C., in Holyoke.

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