As most of you are aware, the 2012 Medicare fee schedule was scheduled to be reduced by 27.4% unless Congress acted to avoid the fee cuts.  The WVSMA has been closely following the actions of Congress in order to keep our physicians and their practices updated.   The following summary, provided by the AMA, explains what has transpired most recently. 
  
On Tuesday, December 20th, the U.S. House of Representatives rejected a Senate bill that would have averted a 27.4 percent Medicare physician payment cut scheduled for Jan. 1 and extended an expiring payroll tax reduction and unemployment insurance benefits. The net result was to leave 2012 Medicare payment rates in limbo.

Votes on H.R. 3690: As originally passed by the House Dec. 13 by a vote of 234-193, the House's version of the bill would have provided Medicare physician payment updates of 1 percent a year for two years, followed by a return to the current negative trend line produced by the sustainable growth rate (SGR) formula. But as a result of disagreements over financial offsets and other policy issues unrelated to the SGR, the legislation could not attract a sufficient number of votes to pass the Senate.

On Dec. 17 the Senate voted 89-10 to pass an amended version of the bill that would extend all the expiring policies—including current Medicare physician payment rates—for two months. The rationale for the short-term extension was to avoid disruptions on Jan. 1 and provide time for further negotiations on financing longer-term extensions.

House action on Dec. 20: Following the Senate's action, a significant number of House Republicans expressed strong opposition to the two-month extension, and several relevant votes were scheduled for today. In the most important vote, the House approved by a vote of 229-193 a resolution that disagrees with the Senate and calls for appointing members to a House-Senate conference committee, which is charged with working out differences between the two versions of the bill.

Prior to the House votes, Senate leadership announced that the Senate would not reconvene over the holidays to engage in further negotiations and votes. In addition, members of the House are departing this evening for the holidays with the understanding that they could be called back to Washington, D.C., on short notice.

At this time, it does not appear likely that the outstanding issues will be resolved before Jan. 1.

Outlook for January: On Dec. 19 the Centers for Medicare & Medicaid Services announced that it would hold claims for 2012 physician services for 10 business days—until Jan. 17—to avoid processing payments at the lower rate. After that date, claims will be processed on a first-in, first-paid basis at the reduced rates until the situation is resolved.
The House currently is scheduled to return to Washington on Jan. 17, while the Senate is scheduled to return on Jan. 23. However, there are reports that the House may move the date of its return up to Jan. 3.

AMA views: The AMA issued strong statements following the House and Senate votes, reaffirming its opposition to any short-term patches to the SGR formula, denouncing the political brinkmanship that left the issue unresolved until Congress was adjourning, and calling for a bipartisan effort to repeal the flawed and disruptive formula once and for all.

Throughout the year, the AMA has been pursuing a strategy to repeal the SGR that was developed in consultation with state medical societies and national medical specialty societies. We continued to oppose short-term remedies that serve to make future cuts deeper and the cost of permanent payment reform increasingly steep.

Throughout the year, bicameral and bipartisan support has been expressed in Congress for permanently addressing the Medicare physician payment crisis. Nevertheless, physicians and their patients once again find themselves confronting uncertainty and instability. It is long past time for Congress to act decisively and protect access to care for senior citizens and military families who rely on TRICARE—they and their physicians deserve better.

WVSMA Note--- The Fee Schedule posted on the CMS Web site reflects the 2012 Physician Fee Schedule Final Rule as published in the November 2011 Federal Register and based on current law (which means it reflects the negative adjustment).
The current fee schedule which is posted on the website reflects the 27.4% reduction in reimbursement. 

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The WVSMA’s recent 2012 Coding and Medicare Update Course, held in Charleston, received high praise from attendees.   Comments included “Very good and very informative course”, “content was very well presented and the information will be implemented in our practice”, and “I would definitely recommend this course!”

If you missed the Charleston class, you still have an opportunity to attend the class in January, 2012, in Morgantown, Beckley or Huntington.   In order to better accommodate your schedule, two sessions will be held in each location.  Each session will cover the same material so you may choose the session you wish to attend.  Be aware, though, that classes are filling up quickly, so now is the time to register

To register, please visit our website, www.wvsma.com to download a registration form.  You may fax your form to the WVSMA (304) 025-0345.  If you have additional questions, you may contact Karie Sharp (304-925-0342, ext 12) or via email (karie@wvsma.com).

2012 will bring many coding and reimbursement changes!   Make sure you’re ready for the changes!

The WVSMA and Practice Management Institute (PMI) are partnering to ensure that you are fully aware of all the coding changes so that you may code and bill correctly in order to receive the maximum amount of reimbursement for your services.

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(information supplied by CMS)

New Obesity Program

The Centers for Medicare & Medicaid Services (CMS) announced on November 29, 2011, that Medicare is adding coverage for preventive services to reduce obesity. This adds to Medicare’s existing portfolio of preventive services that are now available without cost sharing under the Affordable Care Act. It complements the Million Hearts initiative led jointly by CMS and the Centers for Disease Control and Prevention in partnership with other HHS agencies, communities, health systems, nonprofit organizations, and private sector partners across the country to prevent one million heart attacks and strokes in the next 5 years.

“Obesity is a challenge faced by Americans of all ages, and prevention is crucial for the management and elimination of obesity in our country,” said CMS Administrator Donald M. Berwick, MD. “It’s important for Medicare patients to enjoy access to appropriate screening and preventive services.”

Over 30% of both men and women in the Medicare population are estimated to be obese. Obesity is directly or indirectly associated with many chronic diseases, including those that disproportionately affect racial and ethnic minorities such as cardiovascular disease and diabetes. Addressing the prevention of obesity related disparities has the potential to reduce obesity prevalence while also closing the gap on health disparities among Medicare beneficiaries.

Screening for obesity and counseling for eligible beneficiaries by primary care providers in settings such as physicians’ offices are covered under this new benefit. For a beneficiary who screens positive for obesity with a body mass index (BMI) ≥ 30 kg/m2, the benefit would include one face-to-face counseling visit each week for one month and one face-to-face counseling visit every other week for an additional five months. The beneficiary may receive one face-to-face counseling visit every month for an additional six months (for a total of 12 months of counseling) if he or she has achieved a weight reduction of at least 6.6 pounds (or 3 kilograms) during the first six months of counseling.

Through the end of October, 22.6 million people with Original Medicare have received one or more of the free covered preventive services this year.

CMS Requires new ABN Form for 2012

The Centers for Medicare and Medicaid Services (CMS) has revised the Advanced Beneficiary Notice of Noncoverage (ABN), Form CMS-R-131. This form is used by health care providers, including physicians, when they expect Medicare will deny payment. The revised form replaces ABN-G (Form CMS-R-131G), ABN-L (Form CMS-R-131L), and NEMB (Form CMS-20007). 

The latest version of the ABN (with the release date of 3/2011 printed in the lower left hand corner) is now available for immediate use and can be accessed via the link below. 

Use of the revised ABN form will be mandatory starting January 1, 2012.

This date was extended from September of 2011 to January of 2012 to accommodate those with pre-printed stockpiles of ABNs.  All ABNs with the release date of 3/2008 that are issued on or after January 1, 2012 will be considered invalid. Visit the CMS website for copies of the revised form and more information.

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(Information supplied by HHS)
EHR Adoption Increases Dramatically

The  U.S. Department of Health and Human Services (HHS) Secretary Kathleen Sebelius recently released a report showing that doctors’ adoption of health information technology (IT) doubled in two years.  HHS also announced new actions to speed the use of health IT in doctors’ offices and hospitals nationwide, which will improve health care and create jobs nationwide.

While protecting confidential personal information, health IT can improve access to care, help coordinate treatments, measure outcomes and reduce costs.  The new administrative actions were made possible by the HITECH Act and will make it easier for doctors and other health care professionals to receive incentive payments for adopting and meaningfully using health IT.

“When doctors and hospitals use health IT, patients get better care and we save money,” said Secretary Sebelius.  “We’re making great progress, but we can’t wait to do more. Too many doctors and hospitals are still using the same record-keeping technology as Hippocrates. Today, we are making it easier for health care providers to use new technology to improve the health care system for all of us and create more jobs.”

Proposed Meaningful Use Timeline Changes Encourage Adoption of Electronic Health Records (EHRs)

The US Department of Health and Human Services (HHS) department has announced its intention to delay the start of Stage 2 meaningful use for the Medicare and Medicaid Electronic Health Record (EHR) Incentive Programs for a period of one year for those first attesting to meaningful use in 2011. CMS intends to propose such a delay in the Stage 2 meaningful use Notice of Proposed Rulemaking (NPRM), which is scheduled to be published in February 2012.

Physicians meeting criteria in 2011 to earn federal electronic medical record incentives will have more time before the Dept. of Health and Human Services requires them to satisfy tougher standards for attaining additional bonuses.

The move is being viewed by physicians and health policy observers as a goodwill gesture by the Obama administration toward EMR early adopters. Doctors and hospitals who currently meet stage 1 meaningful use criteria would be able to vie for bonuses for an extra year under the same requirements, HHS Secretary Kathleen Sebelius announced on Nov. 30. These bonus recipients would not need to upgrade their EMR systems to comply with stage 2 standards until 2014, instead of 2013 under the initial plan.
 

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Are You Ready for 5010?  

The compliance deadline for the transition to Version 5010 is only days away. Though the Centers for Medicare & Medicaid Services (CMS) has announced an enforcement discretionary period of 90 days for Version 5010 compliance, the deadline remains January 1, 2012.

Expansion of Medicare Telehealth Services for CY 2012

Effective January 1, 2012, physicians may add four smoking cessation services codes to the list of Medicare telehealth services for CY 2012. This includes the initial telehealth consultation codes used for hospital inpatients in an emergency room as well. All other Medicare telehealth qualifications must be met.

Definition of a 'New Patient' for E/M Services

A ‘new patient’ is a patient who has not received any professional services, such as evaluation and management (E/M) service or other face-to-face service (e.g., surgical procedure) from the physician or physician group practice (same physician specialty) within the previous three years.

Evaluation and Management Coding Reminder

Physicians in the same group practice, but who are in different specialties, may bill and be paid without regard to their membership in the same group. Physicians in the same group practice who are in the same specialty must bill and be paid as though they were a single physician. If more than one E/M (face-to-face) service is provided on the same day to the same patient by the same physician or more than one physician in the same specialty in the same group, only one E/M service may be reported unless the E/M services are for unrelated problems.

Multiple Surgeries, Same Day

Avoid delays and denials by submitting procedures subject to multiple surgery payment rules on the same claim whenever possible. Multiple surgeries are separate procedures performed by a single physician or physicians in the same group practice on the same patient at the same operative session or on the same day for which separate payment may be allowed.

New Patient Evaluation & Management Codes: Correct Claim Submission

The Centers for Medicare & Medicaid Services (CMS) has identified a problem in the way claims are being submitted for new patient office or other outpatient visit codes. Please be sure that your claims are submitted correctly.

Therapy Cap Values for Calendar Year (CY) 2012

The outpatient therapy caps for Calendar Year (CY) 2012 have changed.  The therapy caps for CY 2012 will be $1880.00

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(Information supplied by the AMA)

On November 22, 2011, the American Medical Association (AMA) introduced its second app, designed to allow patients to store, carry and share their medical information. The app is now available through the iTunes store for 99 cents.

“The AMA’s new My Medications app provides a place for patients to store their medical information and share it with their physicians. When a physician has access to a patient’s current medications, allergies and immunizations, the risk of medication errors and adverse reactions to medications decreases,” said AMA Chair-Elect Steven J. Stack, M.D.

My Medications lets patients store, carry and share medical information in one place that patients can take with them anywhere they go. It gives patients the ability to create and update a list of medications, including dosing and schedule information. Immunization records and allergy information can also be tracked. The app allows patients to email medical information to health care providers, family members or friends. It also allows patients to maintain a list of their medical team’s contact information. For more information about My Medications, visit  the AMA's website, www.ama-assn.org.   

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• • Latest 2012 Medicare Reimbursement News
• • Attendees Praise WVSMA's 2012 Coding and Medicare Update!
• • Medicare News
• • Health and Human Services Update
• • Palmetto GBA News
• • AMA Introduces "My Medications" App for Patients
• • Happy Holidays!