I also am new to the RVU process but have a fairly good understanding of what needs to be done. However, I have been unable to find any information on what a Transitioned Non-Facility verses a Fully Implemented non- Facility is. I noticed the PE RVU is higher for the Fully Implemented non-facility. Someone told me it represents where you are at in your implementation of EHR???? I am waiting for a callback from CMS but if anyone has an answer it would be appreciated. Pat Carlson Open Cities Health Center
Video: Medicare Provider Enrollment 3.wmv
AARP Urges Congress to Address Medicare Physician Payments
“As you know, physicians and other health care providers are scheduled to receive a 27 percent cut on January 1, 2013, as a result of the flawed sustainable growth rate (SGR) formula. This is in addition to the 2 percent reduction included in the planned sequestration. Failure to adopt legislation to address the “doc fix” would create considerable instability in the Medicare program. Such a significant reduction in reimbursement could cause providers to stop seeing Medicare beneficiaries or prevent them from accepting new ones. We are disappointed that Congress has thus far been unable to develop a long-term solution to this perpetual problem. However, even in the absence of a longer-term solution, the SGR cuts must not be allowed to occur. Under current law, the Centers for Medicare and Medicaid Services may begin issuing the reduced payments on January 1. A reduction for even a short time in reimbursement rates could disrupt access to care, as providers may delay seeing Medicare patients until updated rates go into effect.
Pitts Kicks Off 113th Congress with Hearing on Reforming the Medicare Physician Payment System
In response to a question from the Health Subcommittee’s Vice Chairman, Michael C. Burgess, M.D. (R-TX), Chairman Glenn Hackbarth cited positive examples from Medicare Advantage that could be applied. Hackbarth said, “Some Medicare Advantage plans, as you know, perform extremely well on both quality of care measures and costs. Among the plans that perform well are a variety of different models. Some are pre-paid group practice model like Kaiser Permanente, but there are other plans that contract with individual independent practices and don’t rest entirely on large, multi-specialty groups.” Burgess added, “It’s not just satisfaction of the agencies and the people who measure those things, but it’s also satisfaction of patients and satisfaction of physicians. Certainly my experience with a group like Scott and White in Temple, Texas, this has worked reasonably well and we certainly want to be careful that we don’t damage with whatever we do going forward.”
Medicare PQRS Requirements for Physical Therapy
Finally, I’ve heard considerable confusion about relationship of PQRS, the new functional limitation reporting and g-codes. PQRS and Functional Limitation Reporting have nothing to do with each other. They share only one thing, they both use G-Codes to report information to CMS. G-codes are just a set of 5 digit codes that can be submitted like CPT codes but CMS uses them to cover additional requirements. Most people are familiar with G0283 being CMS’ own code for E-stim, but now they’ve branched out and used the series for both PQRS and Functional Limitations.
Bundled payments, DMEPOS, regulatory reform, and ESRD
We also announced a major expansion of the Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Competitive Bidding Program. In its first year of operation, competitive bidding, where prices are based on suppliers’ bids, saved the Medicare program, and taxpayers, over $202 million, while maintaining access to quality products for Medicare beneficiaries in the nine areas of the country where the program launched. It’s a great example of the Administration’s determination to put the brakes on runaway healthcare costs. With this expansion in the program, Medicare beneficiaries in 91 major metropolitan areas will save an average of 45 percent on certain DMEPOS items beginning in July. Between 2013 and 2022, we estimate that the expansion of the DMEPOS program will save Medicare $25.7 billion, while saving beneficiaries, who pay a percentage for medical equipment and supplies, $17.1 billion through lower prices.
WCH Service Bureau, Inc: Medicare provider payments
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St. Joseph receives new Medicare provider agreement
Medicare certification is transferred to the new owners in most hospital acquisitions, but the University of Maryland was likely trying to protect itself from liability. The university is not responsible for any previous lawsuits under its agreement with Catholic Health. It could have been responsible for previous Medicare fraud issues if it had kept the Medicare certification.
Medicare Cuts and Hospice Closures
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New Postings on the Reed Smith Health Industry Washington Watch Blog : Health Industry Washington Watch
GAO & OIG Developments. Recent OIG reports address DME infusion drugs, long-term care hospital reporting of co-location status, conflict-of-interest oversight for Medicare Part D pharmacy and therapeutics committees, Part B drug pricing, and skilled nursing facility care planning/discharge planning. GAO reports have focused on pharmacy services administrative organizations, risk adjustment for Medicare Advantage plans, and the Medicare low-volume payment adjustment for dialysis facilities.
Central Florida Republican News: Feds let Medicare provider give away $20 grocery cards to lure patients
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CMS to Cut Physicians’ Medicare Payments 26.5% in 2013 Unless SGR Bypassed
CMS has issued its final rule on the Medicare physician fee schedule (pdf) for 2013, saying Medicare reimbursement rates for physicians will be slashed by 26.5 percent on Jan. 1, 2013, unless Congress bypasses the sustainable growth rate. Here are six primary points from CMS’ final rule, many of which carried over from the proposed rule in July. • Sustainable growth rate. The SGR, which is the formula used to adjust Medicare physician payment rates, is currently expected to cut physician rates by 26.5 percent. However, every year since 2003, Congress has temporarily bypassed the SGR to ensure there would be no cuts to physician Medicare payments, and another temporary “doc-fix” is likely this year during a lame duck session. • Primary care emphasis will stand. Primary care physicians and extenders will see increased payments next year, assuming there is an SGR fix, as the final rule solidified new policies in total allowed charges. Family practice physicians will see the largest Medicare payment increases at 7 percent, and several other primary care providers — such as internal medicine physicians, pediatricians, and nurse practitioners — will see payment boosts ranging from 3 to 5 percent. The total allowed charges figures are similar to those that were in the proposed rule. As stated in the proposed rule, CMS also said a new policy will pay a patient’s physician or practitioner to coordinate care in the 30 days following a hospital or skilled nursing facility stay. • Specialists will still see reduced charge rates. The proposed rule stated that many specialty physicians will see their Medicare rates decrease, and that carried forward in the final rule as well. Here are some of following specialties that will see the biggest decreases in Medicare total charge rates/payments: independent laboratory providers (14 percent), neurologists (7 percent), radiation oncologists (7 percent), pathologists (6 percent), interventional radiologists (3 percent) and cardiologists (2 percent). • Physician value-based payment modifier and Physician Quality Reporting System. CMS said it will apply the value-based payment modifier — which is a tool that provides different Medicare payments to physicians based on quality of care and cost of care comparisons — to groups that have 100 or more physicians in 2015 instead of groups of 25 or more in the proposed rule. • Information technology. The final rule also expanded Medicare telehealth services and simplified reporting within the Medicare Electronic Health Records Incentive Pilot Program for physicians. • Certified registered nurse anesthetists. Medicare will now pay CRNAs for providing all services that are allowable under state law and within the full extent of their state’s scope of practice.