The Affordable Care Act, Section 6405, “Physicians Who Order Items or Services are Required to be Medicare Enrolled Physicians or Eligible Professionals,” requires physicians or other eligible professionals to be enrolled in the Medicare Program to order or refer items or services for Medicare beneficiaries. Some physicians or other eligible professionals do not and will not send claims to a Medicare contractor for the services they furnish and therefore may not be enrolled in the Medicare program. Also, effective January 1, 1992, a physician or supplier that bills Medicare for a service or item must show the name and unique identifier of the attending physician on the claim if that service or item was the result of an order or referral. Effective May 23, 2008, the unique identifier was determined to be the National Provider Identifier (NPI). The Centers for Medicare & Medicaid Services (CMS) has implemented edits on ordering and referring providers when they are required to be identified in Part B, DME, and Part A HHA claims from Medicare providers or suppliers who furnished items or services as a result of orders or referrals.
Video: Medicare Provider Enrollment 3.wmv
Implementation of Medicare Ordering/Referring Provider Edits (March 20 Call) : Health Industry Washington Watch
Effective May 1, 2013, Medicare contractors will activate edits that will deny claims for Medicare Part B (including imaging and lab services), DME, and Part A home health agency (HHA) services if the ordering/referring physician or other professional is not identified, is not in Medicare’s enrollment records, or is not of a specialty type that may order/refer the service/item being billed. Concerns have been raised by physicians and suppliers that they could experience claims denials and delays after May 1 based on discrepancies between the names of the ordering physician on the 1500 claim form and in Medicare’s enrollment records. CMS is holding a March 20, 2013 National Provider Call to discuss these new requirements.
Health Insurers Launch TV Campaign Opposing Medicare Advantage Cuts
The Medicare NewsGroup: Medicare’s Middlemen Await Word From CMS To Put In Play Sequesration Cuts Medicare’s middlemen, the companies that will carry out the administrative work of the automatic budget cuts set to hit Medicare providers on April 1, are waiting for directions from the Centers for Medicare & Medicaid Services (CMS) to put in play provider payment reductions. The updates to the payment systems will ultimately lead to $11 billion in reduced payments to hospitals, doctors and other health care providers for the remainder of fiscal year 2013. These middlemen are Medicare Administrative Contractors (MACs), the private companies that handle the bulk of the entitlement program’s administrative claims processes. They will implement the 2 percent across-the-board payment reductions, mandated by sequestration, which is the result of the federal government’s inability to reach a deficit-reduction deal totaling $1.2 trillion. This means a .02 cent cut for every $1 paid to health care services providers, such as doctors, hospitals, skilled nursing facilities, insurers, medical device suppliers and home health companies (Sjoerdsma, 3/6).
Lawmakers Might Have Time To Avert Medicare Payment Cuts
Call me American citizen. I first want to address Medicare I believe it is disrespectful that we would even consider cutting payments Doctors do not take plain Medicare patients due to payments being so low. We should never take our parents Social Security, Medicare, or the right to have quality medical care away. We should never have our Social Security or health care taken away or deceased.
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SAI Global Compliance Survey Of Healthcare Providers Identifies Audit Awareness Compliance Effectiveness And Training As Top GRC Priorities For 2013
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Why does an MRI cost more with No Fault than Blue Cross or Medicaid?
Auto insurance providers also claim that they pay more for medical services than other providers such as Blue Cross and Medicare and further claim that they should pay the same rate. Some simple facts are that Blue Cross and Medicaid represent a larger scale of business to the medical industry than auto insurance. Also, Blue Cross and Medicare provide pre-approval for medical services, allow for electronic medical billing and provide payment within several days by direct deposit. This gives the medical providers’ confidence that they will be paid in a timely manner and reduces the cost of doing business.
Health Care Authority Prepares to Start Paying Medicaid Providers at Higher Rates Under Health Reform
The website includes an explanation of the current situation, the higher rates, a list of all the eligible codes involved in the rate changes and a Frequently-Asked Questions document to address other concerns. That FAQ and the Attestation Form have been recently updated to address “how to bill” issues as well as provider questions related to mid-level providers receiving the enhanced rates. The updated FAQ explains that eligible physicians who supervise mid-level practitioners and who have submitted the form will need to fill out and submit the second page of the form only.
CMS Issues Final Rules on Medicaid, Medicare Provider Payment Rates
The payment increase applies to physicians practicing in family medicine, general internal medicine, pediatric medicine and related subspecialties, such as board certified pediatric cardiologists. The rule clarifies that primary care services delivered by medical professionals working under the personal supervision of a qualifying physician, such as nurse practitioners, also are eligible for the higher payment rate (Reichard,