LTPAC providers aren’t eligible for federal EHR incentives. But Dr. Bill Russell, an HIT consultant speaking at June’s LTPAC HIT Summit in Baltimore, urged providers to pursue EHR adoption. Russell suggested that Stage 2 “meaningful use” requirements associated with the EHR incentive program will make it necessary for eligible hospitals to exchange electronic clinical summaries with LTPAC providers. Establishing interoperability now would help providers facilitate better transitions of care, he said. According to McKnight’s Long-Term Care News, Russell and other technology experts at the Summit maintained that EHRs can help LTPAC providers:
Video: Electronic Prescriptions: Is Medicare Slapping You With An E-Prescribing Penalty?
CMS Allows Medicare Providers to Submit Documents Electronically to CMS Contractors
If providers do want to participate in the esMD program, they must first find out if their review contractor accepst esMD transactions. Additionally, providers will have to obtain access to an esMD gateway. To obtain access to a gateway, providers can either build their own or hire a Health Information Handler (HIH) to construct the gateway system. To find out which HIHs offer esMD gateway services to providers, click here. To learn more about requirements for participating in the esMD program, click here.
Getting Your Flu Shots with Medicare
The Medigap Plan’s Coverage of Flu Shots One other way to avoid paying extra for a flu shot or other Medicare-covered services is to purchase a Medigap policy that covers Medicare Part B excess charges. Medicare Supplement Plan F and Plan G both cover these excess charges, along with a number of other Medicare out-of-pocket costs. So even if your Medicare provider does not accept Medicare’s assigned rates, and he is one of the providers who charge extra, your Medicare supplement picks up that excess charge for you. Then you don’t have to pay anything out of pocket.
Compliance with Conditions of Participation Necessary for Reinstatement of Terminated Medicare Billing Privileges or Revoked Medicare Provider Number and Participation Agreement
This entry was posted in Medicare and tagged appeal of decision to terminate, cap, Centers for Medicare and Medicaid Services (CMS), conditions for coverage (CFC), corrective action plan, Department of Health and Human Services, First Coast Service Options (FCSO), hhs, Medicare administrative contractor (MAC), Medicare conditions of participation (COP), Medicare contractors, National Government Service (NGS), Palmetto Government Benefits Administration (Palmetto GBA), reconsideration request, revocation of Medicare number, revocation of Medicare provider contract, termination of Medicare billing privileges. Bookmark the permalink.
Incentive for Medicare Providers
One such organization is Mount Sinai Hospital in New York. In a statement from the Department of Health and Human Services, it was reported that about 2.4 million of Medicare’s 49 million participants receive care from this group. There are still several publicly traded hospital chains, such as Community Health Systems Inc, who are not accepting Medicare patients, in addition to some of the nation’s high-profile nonprofit systems, such as the Cleveland Clinic and Kaiser Permanente. According to the Congressional Budget Office, accountable-care groups will save Medicare nearly $5 billion through 2019, some of which will be given back to the organizations as incentive. Kathleen Sebelius, Health and Human Services Secretary, stated that “Better coordinated care is good for patients and it saves money.” It’s a win-win situation.
57% of Medicare Doctors Used EHR System in 2011, GAO Says
It also found that 22% of the sampled Medicare physicians first began using an EHR system to document evaluation and management services in 2011, the year that CMS started issuing meaningful use incentive payments. Under the 2009 federal economic stimulus package, health care providers who demonstrate meaningful use of certified EHR systems can qualify for Medicaid and Medicare incentive payments.
Medicare Provider Enrollment: Revalidation Required: Michigan Attorneys
Health care reform law requires that providers who enrolled in Medicare prior to March 25, 2011, submit enrollment revalidation information upon request by the Centers for Medicare and Medicaid Services ("CMS") or its contractors. Any provider that fails to submit the requested revalidation information within 60 days of receiving such a request risks interruption or deactivation of Medicare billing privileges. Revalidation for all providers who enrolled in Medicare prior to the above date will occur between now and March of 2015 on a steady basis. Providers can check the lists provided at CMS’s website to determine if they were already sent a revalidation notice that was perhaps overlooked in the mail.
Medicare fraud suspensions and collections not being strongly enforced
STERLING HEIGHTS wnj.com Medicare fraud suspensions and collections not being strongly enforced 25. October 2011 By Jeanne Long Regulators fighting Medicare fraud frequently suspend the licenses of Medicare providers, only to quickly reinstate them after a short and uninvolved appeals process. The AP recently reported that the government’s private contractors tasked with inspecting Medicare providers and collecting payments often communicate poorly with the federal agency that runs Medicare, leading to gaps in the system that prevent efficient shutdown of fraudulent activity. Medicare providers accused of fraudulent activity often even continue to receive Medicare payments while they are under investigation. The government and its contractors often fail to even attend the appeals hearings, allowing suspended Medicare providers to coast to a default victory. In one notable case, Medicare contractors revoked a medical equipment company’s license after inspecting it and finding that the company had no employees and no customers. The owner of the company appealed, was reinstated the same day, and resumed fraudulently billing Medicare. One of the owner’s companies continued to bill Medicare for months after the owner eventually was indicted. The report also stated that almost 40% of the Medicare providers examined by the AP in six key fraud hot spots – South Florida, Los Angeles, Baton Rouge, Houston, Brooklyn, and Detroit – eventually regained their licenses.
LeadingAge: The Online Community for Senior Care and Services Providers: Washington State Accountable Care Organization Named
The Centers for Medicare & Medicaid Services (CMS) announced today that Washington is among 40 states and Washington, D.C. where people with Medicare can receive health care from an Accountable Care Organization (ACO). ACOs are organizations formed by groups of doctors and other health care providers that have agreed to work together to coordinate care for people with Medicare. The ACO is Polyclinic Management Services Company in Seattle, Washington. It is comprised of ACO group practices, with 296 physicians. It will serve Medicare beneficiaries in Washington. The 89 new ACOs named today will be serving 1.2 million people with Medicare. All ACOs have entered into agreements with CMS, taking responsibility for the quality of care they provide to people with Medicare in return for the opportunity to share in savings realized through high-quality, well-coordinated care.
States Seek Medicare Data to Keep Fraudulent Providers Out of Medicaid
Glenn Prager used to be a Medicare fraud fighter for the federal government. Early this year he switched to Medicaid, taking a job as Arizona’s inspector general. His primary task is to keep crooked health-care providers out of the state’s $9 billion Medicaid system. If they slip in under the wire, he says, the goal is to catch them before any claims are paid. But six months into his new role, Prager is frustrated that he can’t get his hands on the Medicare data he used when he was a federal investigator. “The basic problem,” he says, “is a lack of coordination and communication between the two programs. There’s no other way to explain it.” Prager is not alone in his complaints. The National Association of Medicaid Directors released a report last month calling on the federal government to share Medicare data and improve collaboration with states in their mutual battle to reduce Medicaid fraud and abuse. Congress and the federal Government Accountability Office are also pushing the U.S. Department of Health and Human Services to provide better support for state fraud-busting efforts. The federal government says it has ambitious projects under way to make Medicare data more useful to states, and to help states share information about their respective Medicaid programs. The problem, federal officials say, is that Medicare, which provides health coverage for seniors, is organized very differently from Medicaid. And each state organizes its Medicaid program in a different way, making data matches difficult. The scale of the programs is also daunting. Medicaid covers 60 million low-income people and costs more than $400 billion a year. Already growing faster than any other item on states’ budgets, it is slated to expand by 16 million more people if the Affordable Care Act is upheld. Medicare covers 48 million people and costs more than $470 billion. While only a small number of the health-care providers who participate in either program break the rules for financial gain, the result of the fraud that does take place is a substantial drain on the money available to provide legitimate health-care services. A majority of providers serve both Medicaid and Medicare, and the dishonest ones often steal from both programs at the same time. The federal government alone lost $22 billion to what it calls “improper payments” in the Medicaid program last year. Although no uniform method of calculating state losses exists, a similar amount was likely lost by states since they pay for about half of the program. Medicare lost $43 billion, according to federal data.
Cantwell Highlights Need for Medicare Payment Reform to Expand Access to Care, Build WA Primary Care Workforce
“Frankly, people in our region are very frustrated that we deliver care that way and get less reimbursement and less people want to go practice there. And somebody can go practice somewhere else where they can run up the bill to the American taxpayer,” Cantwell continued. “But just to assume that they are healthier and that someplace else is sicker and we should just pay more is not going to work. …So if you have any comment on that Dr. Stream? …And [also on] what we need to do for graduate medical education to really get that workforce plugged in.”
Accountable care delivery and payment structures: Medicare Advantage with physicians at risk
Critical success factors: The key to Medicare Advantage success is the ability and willingness of physicians to serve as gatekeepers responsible for directing and coordinating patient care across the continuum. Primary care physicians and specialists alike will be successful in this role only if they thoroughly understand and support the care model, and have the tools and information necessary for informed decision-making. Additional success factors for Medicare Advantage include successful management of chronic conditions; coordination of care, particularly during high-risk transitions; and the ability to implement effective contracts, particularly with specialists, hospitals, and outpatient care facilities.
A hidden cost for Medicare Providers?
One of the problems with Medicare is the billions of dollars of fraud committed each year. Some estimate as much as $50 billion annually is wasted by paying fraudulent claims. The Affordable Care Act attempts to address this, and included provisions to deter the “bad guys” from becoming Medicare providers, and beginning March 25, 2011,