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CMS Publishes 2014 Medicare Fee Schedule

From CMA's December 16, 2013, CMA Alert On November 27, the Centers for Medicare and Medicaid Services (CMS) released the 1,369-page 2014 Medicare Physician Fee Schedule final rule, which was published in the December 10 Federal Register. Most provisions take effect January 1, 2014, although a few issues are open for public comment by January 27, 2014. The American Medical Association (AMA) has published a summary of the final rule. Below are a few key points: Although the final rule contains the 23.7 percent physician payment cut ...

Federal Legislative and Regulatory Update From CMA

October 1, 2013 CMA leaders have been in Washington, DC, and in district offices meeting with members of Congress on the important issues facing medicine. Below are the highlights of the priority bills and regulations. 1. GOVERNMENT SHUTDOWN Medicare and Medi-Cal will continue to operate but CDC, FDA, public health, and NIH are impacted. On October 1, as the Affordable Care Act (ACA) went live and tens of thousands of Californians called the Covered California Health Insurance Exchange to purchase insurance, Congress’s failure to agree on a 2014 budget and the future of ...

Avoid the Medicare Quality Reporting Penalty in 2015

By the Alameda-Contra Costa Medical Association As part of the Physician Quality Reporting System (PQRS), Medicare will impose a 1.5% penalty in 2015 on physicians and other providers who do not successfully report at least one individual quality measure for at least one patient in 2013. The purpose of this article is to help physicians avoid the penalty in 2015 by providing guidance on how to report at least one measure for at least one patient using Medicare claims. Since most physicians already submit Medicare claims for reimbursement, adding the ...

CMA Comments on the Medicare 2014 Fee Schedule

Click Here to Access the Below Letter in PDF Click Here to Access the Multi-state Letter to CMS Click Here to Access an Excel Spreadsheet on the Impact of the Proposed CY 2014 GPCI Cost Share Weights on Locality GAFs September 6, 2013 Marilyn B. Tavenner Administrator Centers for Medicare & Medicaid Services U.S. Department of Health and Human Services Hubert H. Humphrey Building, Room 445-G 200 Independence Avenue, SW Washington, DC 20201 Re: Payment Policies under the Physician Fee Schedule Proposed Rule for CY 2014 78 Fed. Reg. 43,281 (July 19, 2013); CMS-1600-P; RIN 0938-AR56 Dear Administrator Tavenner: The California Medical Association (CMA) ...

Medicare Transition to Noridian on MONDAY!

We are just days away from the September 16 cutover date from Palmetto to the new Medicare Part B fee-for-service contractor, Noridian. Although efforts have been made to minimize the burden to practices and to ensure that physicians continue to receive their Medicare payments in a timely fashion after the transition, there are a number of things physicians should be aware of, including: Last Day to Submit to Palmetto: September 11, 2013, is the last day providers may submit electronic claims to Palmetto (2:00pm cutoff time), and the last day ...

Incarcerated Beneficiary Recoveries From Providers

In June and July 2013, the Centers for Medicare & Medicaid Services (CMS) initiated recoveries from providers and suppliers based on data that indicated a beneficiary was incarcerated on the date of service. Medicare identified previously paid claims that contained a date of service partially or fully overlapping a period when a beneficiary was apparently incarcerated based on information CMS receives from the Social Security Administration (SSA). As a result, a large number of overpayments were identified and overpayment (demand) letters sent. CMS has since learned ...

Medicare Transition on September 16, 2013!

September 16, 2013, is the cutover date for transition of the Medicare Part B fee-for-service contractor from Palmetto GBA to Noridian. Although every effort has been made to minimize the burden to practices and to ensure that physicians continue to receive their Medicare payments in a timely fashion after transition, physician practices will have to make some changes in their processes, including but not limited to: Electronic claim submitters must change the Contractor ID (Payor ID) on their transmissions. The new ID for Northern California jurisdiction ...

Medicare Transition Is One Month Away!

September 16, 2013, is the cutover date for transition of the Medicare Part B fee-for-service contractor from Palmetto GBA to Noridian. Although every effort has been made to minimize the burden to practices and to ensure that physicians continue to receive their Medicare payments in a timely fashion after transition, physician practices will have to make some changes in their processes, including but not limited to: Electronic Claim Submitters Must Change the Contractor ID (Payor ID) on Their Transmissions: The new ID for Northern California jurisdiction ...

Medicare SGR and GPCI Bill Clears Committee

Medicare Locality Reform ("The California GPCI Fix") Clears House Congressional Committee As Part of the Medicare SGR Overhaul Legislation On July 31, the House Energy and Commerce Committee voted unanimously to approve a BIPARTISAN Medicare Sustainable Growth Rate (SGR) overhaul legislation, HR 2810. Included in the bill is the CMA-sponsored California Medicare locality reform known as the “California GPCI Fix.” The California locality provision is a compromise between Committee Chairman Fred Upton (R-MI) and Ranking Democrat Henry Waxman (D-CA) who insisted the California update be part of the committee bill. ...

Act Now to Avoid Medicare Penalties in 2015

By the California Medical Association (CMA) Over the past six years, the Centers for Medicare and Medicaid Services (CMS) has launched a number of initiatives that offer physicians the opportunity to increase their net revenue by participating in quality reporting programs. Until now, these programs have been voluntary, and physicians have received bonuses for participating. That’s about to change. Failure to participate now means physicians could face significant penalties. The American Academy of Family Physicians estimates that participating in these initiatives in 2013, rather than waiting until 2014, could save a ...