• Important Medicare/CMS Updates and Links:

The intense drama that has been going on leading up to the Medicare cuts scheduled for July 1 is finally over, and it's official - NO CUTS THIS YEAR....the result of a Congressional override of a presidential veto July 15. New Mexico Senator Jeff Bingaman was instrumental in the success of this measure.  Here are some of the major provisions in the brand new law:

1)   Prevents a 10.6 % reduction to Medicare physician payments (and provides a 1.1 % update) for 18 months. 

2)      Significant provisions to increase access for rural beneficiaries (including bonus payments to physicians serving in rural areas).

3)   Provides teaching anesthesiologists 100% payment for two concurrent cases starting in 2010.

4)      Important new preventative services, and provides Medicare coverage of cardiac and pulmonary rehab services.

5)      Parity in cost-sharing requirements for Medicare mental health services (20% instead of 50%).

6)      $100 million over five years to improve Medicare payments to community health center (in NM Community Health Centers are losing over $1 million annually because of existing cap on Medicare payments.

7)      Very important reforms to Medicare Advantage programs including new network requirements for private fee for service MA plans as well as marketing reforms to make sure abusive marketing practices end.

By statute, Medicare electronic physician claims may not be paid sooner than 14 days after the date of submission, nor can “clean” electronic claims be paid any later than 30 days after the date they are submitted. (Paper claims are paid after the 29th day.)

The Secretary of Health and Human Services announced on June 27 that the Centers for Medicare and Medicaid Services (CMS) had instructed its carriers not to process any physician or non-physician practitioner claims for the first 10 business days of July. According to HHS, this “hold” on claims meant that no payments reflecting the 10.6 percent pay reduction that took effect on July 1 would occur before July 15, at the earliest.

CMS also indicated that it did not have the capacity to hold more than 10 days of claims. The hold was a rolling 10-day hold; therefore, with claims submitted the first days of the hold being processed on the 11th day of the hold, claims submitted the second day being processed on the 12th day, etc. The first payments on claims that physicians would have received reflecting the 10.6 percent reduction would occur on or after July 15.

Now that Congress has passed a law reversing the cuts retroactive to July 1st, Medicare carriers are switching their systems back to the June 2008 rates (and increasing rates for certain mental health services). Some carriers may already have posted the new, correct rates, but others could take a week or more. CMS has stated that it will automatically reprocess any claims paid at the reduced rates and provide the balances due to physician practices that are shortchanged, most likely as a single batched check.

The new law makes other important changes as well, such as reinstating the therapy caps exceptions process as of July 1st. Claims submitted with the therapy cap exception modifier will be processed as soon as the new payment rates have been activated. Claims submitted without the modifier, and rejected or denied, can be resubmitted with the modifier for reimbursement.

Once again, special thanks to Senator Bingaman and all state and specialty societies whose grassroots support was key to our success.  Thanks are also due to our many coalition partners, especially those representing our patients.  This was a remarkable effort that will be remembered in Washington for some time to come.

MORE MEDICARE/CMS: NPI MUST MATCH IRS DATA....Providers have been going through some serious headaches already working to make sure they use their National Provider Identifier number properly to avoid getting claims bounced by Medicare. Now, CMS has raised the stakes again. In a move that surprised most observers, the agency announced that doctors will have to reconcile their NPI data with their IRS legal name data if they want to get their Medicare claims paid.  This is an extremely stringent requirement that should prove quite difficult to meet, experts say. Every aspect of a doctor's data must match in both databases, including exact name spellings, use of initials and even any blank spaces in the data. This new requirement only makes things worse for providers, many of whom continue to have trouble getting CMS to tell them why their claims are bouncing. All CMS will tell most physicians with NPI troubles is to start again with a new NPI enrollment, which could take months to process. Now, with the new and unexpected demand to match IRS data, providers could be faced with yet another reason for getting another NPI number. (from Healthcare Finance News)

IMPORTANT DATE.... May 23. The end of the CMS NPI contingency plan. All HIPAA electronic transactions (837I, 837P, NCPDP, 276/277, 270/271, 835), paper claims and SPR remittance advice must now include only the NPI in all primary and secondary provider fields (on the 837P and 837I). Transactions submitted with legacy identifiers will be rejected. CMS reports that the vast majority of Medicare claims are being submitted with a National Provider Identifier (NPI). Also, according to CMS, the Medicare NPI "crosswalk," is successfully linking NPIs to legacy numbers for most claims (when the name on your NPI application and other Medicare info matches). Anybody out there who hasn't applied for NPI yet? To apply: https://nppes.cms.hhs.gov/.   IMPORTANT NOTE:  If you have incorporated or formed a professional corporation (PC) or a limited liability company (LLC), even if the organization consists of one person - you, an NPI  for your corporation or LLC in addition to your personal NPI will need to be obtained.   RECENT NEWSLETTER FROM MEDICARE...

• NM Medicaid News

COORDINATED LONG-TERM SERVICES (CLTS)....is a new Medicaid managed care program provides and coordinate services for specific Medicaid recipients. Information on the program.  HSD is holding informational events around the state. Schedule.

ELECTRONIC PRESCRIBING...Medicaid is pleased to announce the ability to respond to real-time eligibility, formulary and medication history inquiries for physicians participating in electronic prescribing. This data is available for the fee-for-service client population.  To receive the full benefit of your prescribing software, contact your software vendor to ensure that this information is being accessed.  If you have any questions, please contact Mark Zuliani, New Mexico Medicaid Transformation Grant Project Manager, at 505-827-3162.

TAMPER RESISTANT SCRIPTS...Remember, written prescriptions in the Medicaid program must have one feature to prevent unauthorized copying, another to prevent erasure or modification of information and a third to prevent counterfeiting. EXEMPT FROM THE LAW: prescriptions paid for by Medicaid managed care plans; nursing homes and other institutions; electronic, faxed or phoned prescriptions.  Prescriptions MUST contain your NPI. More.

• NM Medical Board Waives Certain Licesure Fee

The New Mexico Medical Board (NMMB) is waiving the $400 licensure application fee for new applicants who choose New Mexico as their first state of licensure. In collaboration with Governor Richardson’s goal to attract more physicians to New Mexico, the NM Legislature, the NM Medical Society and the University of New Mexico Health Sciences Center, the NMMB voted to waive the application fee during this next fiscal year in an effort to recruit and retain physicians in New Mexico. The Board will review the impact to the budget during the next fiscal year to determine the feasibility of this action annually and to use for future requests to the legislature. The licensure application is available on the Board’s web site:  www.nmmb.state.nm.us. You may also contact the NMMB for additional information at (505) 476-7220 or e-mail to nmbme@state.nm.us.

MORE FROM THE BOARD...Effective July 1, 2007, the New Mexico Medical Board began requiring all applicants for initial licensure and reinstatements to submit fingerprints for a state and national criminal background check. More information.  Health Services Corporation (HSC), a partner of NMMS in many projects, can do this for you at your office or theirs. Call 343-0070 or email: fingerprinting@nmhsc.com

• NMMS Committees Forming

Each summer the incoming NMMS president appoints committees and committee chairs for the upcoming year. NMMS committees are where much of the work NMMS does gets done and where much of what is to become NMMS policy originates.  Serving on one or more NMMS committee is most certainly a way to become part of the process. Are you interested in Medicaid reimbursement? Our committee with the Human Services Department addresses this issue. The committee with the Department of Health deals with all sorts of public health matters, emergency concerns and so forth. We have a committee with managed care, Medicare and much more.  Click here to see a complete list. Please consider participating in the upcoming year.