Business Operations & Finance - News Archive
UnitedHealth Group UCR Settlement Claim Forms Mailed, AMA Offers Filing Resources
The American Medical Association issued a press release on April 22 regarding the UnitedHealth Group UCR Settlement. The AMA Practice Management Center has launched a new online resource that will help physicians file claims in the record-breaking $350 million settlement.
Federation organizations are welcome to either link to the AMA’s Web site at www.ama-assn.org/go/ucrsettlement or co-brand the two key online resources, “UnitedHealth Group UCR Settlement: Frequently asked questions” and “Step-by-step guide to maximizing your recovery from the UnitedHealth Group UCR Settlement,” to share with their members. Please contact Cindy Penkala at cynthia.penkala@ama-assn.org if you are interested in co-branding these resources.
Health Care Reform Act Affects Medicare Filing Requirements
One of the lesser-known changes in the Patient Protection and Affordable Care Act has amended the time period for filing Medicare Part B claims. Claims for services furnished on or after Jan. 1 now must be filed within one calendar year of the date of service. Additionally, claims for services furnished this year must be filed no later than Dec. 31. Services provided from Oct. 1, 2009 to Dec. 31, 2009 must be filed by the end of this year or they will be denied. Claims from before October 2009 will follow the previous timeline that allowed a minimum of 15 months (sometimes up to 26 months) to submit claims. CMS indicates it will outline some exceptions to the filing deadlines in upcoming rulemaking.
CMS Moves PECOS Enrollment Deadline Up to July 6, 2010 - The Academy has joined more than 30 other groups protesting the extension reversal
Physicians should prepare to comply with the July 6 effective date to enroll in the electronic Provider Enrollment, Chain and Ownership System (PECOS), according to a May 19 CMS conference call. However, the agency acknowledged the timeline concerns raised by the Academy and most medical groups, as well as CMS’ own workload capacity. During the call, CMS clarified that Jan. 3, 2011, is still the date they will begin denying claims for ordering or referring providers who are not enrolled in PECOS. An interim final rule recently released by CMS moved up the original January deadline to July 6. The AMA has added a section to its website dedicated to Medicare enrollment issues. The Academy has joined more than 30 other groups protesting the extension reversal.
CMS indicates that it will send a reminder to all physicians to enroll in the new PECOS system if they enrolled in Medicare more than six years ago. More details about PECOS are on the CMS Web site. New information includes a database of all physicians currently enrolled in PECOS and instructions on how to access and use the information.
Practice Expense Update Phase-in
CMS has decided to phase-in implementation of the new Practicing Physician Information Survey (PPIS), which will rescale the practice expense (PE) payments for most specialties. Rather than fully implement the new data in 2010, CMS decided to phase in the updates due to the dramatic swing in payments and to pressure from specialties adversely impacted by the changes proposed in PE allocations. Ophthalmology will now see an increase in its PE values of 11 percent over the next four years. Three percent of ophthalmology’s increase comes in 2010. The compromise is not expected to satisfy specialties that are adversely impacted, and they are expected to continue their push to derail implementation of the PPIS data. Academy intelligence indicates the Senate is considering legislation that restores those specialties to their current rates, without penalizing specialties (including ophthalmology) that are due the PE payment increase. The one-year agreement, costing about $1 billion, is to allow specialties facing cuts to work out issues with CMS. The Academy will remain vigilant to ensure that further erosion in ophthalmology’s rates is not included in Medicare and health care reform legislation.
Academy Interprets Necessity of DMEPOS Surety Bond
Ophthalmologists who have optical shops within their practice should not need the bonds unless the shop is purely a dispensary and does not provide typical services for Medicare beneficiaries who come in for post-cataract glasses with an outside prescription. The Academy believes such patients are your patient for the provision of the DMEPOS item (post-cataract eyeglasses) if you treat them as your other surgical patients and provide the normal course of services, including:
- Reviewing the prescription;
- Fabricating the lenses and fit them into the selected frames;
- Fitting the frames to the patient; and
- Checking visual acuity.
Recently, the National Supplier Clearinghouse posted language on its Web site stating that it believes patients who are not given an “exam or test” are not the patients of your practice, thus necessitating a bond if such individuals are seen in your optical shop. Academy questions to CMS to clarify the meaning of “exam or test” have gone unanswered.
CMS Releases Final 2010 Medicare ASC Payment Rule
In addition to releasing its Final 2010 Physician Fee Schedule on Oct. 30, CMS also released its 2010 ASC payment rates and policies. Although Medicare continues to transition in its new payment methodology for 2010, and payments are migrating to a larger percentage of the new method, rates are variable due to several factors. ASCs, which have not seen an update in payments since 2004, will see a 1.1 percent increase in their conversion factor, with a 2010 factor set at $41.873 (a 50-cent increase from last year). CMS continues to base any update on the Consumer Price Index rather than the Academy-advocated hospital market basket. CMS is also still using two budget neutrality adjustments which the Academy, in coordination with the Outpatient Ophthalmic Surgery Society and the Ambulatory Surgery Center Association, has been opposing.
CMS continues to refuse to allow unlisted codes (including eye codes) to be added to the ASC list, despite a detailed explanation of why such eye procedures are safe and appropriate for ASCs. One eye procedure is being removed from the ASC list, 21256 Reconstruction of orbit with osteotomies (extracranial) and with bone grafts (includes obtaining autografts) (e.g., microophthalmia). Medicare has again delayed requiring ASCs to report quality data. Therefore, ASCs will not be required by Medicare to report quality data in 2010. Further, because CMS disagrees with Medicare Payment Advisory Commission recommendations.
The revised Ambulatory Surgical Center Fee Schedule Fact Sheet (January 2010), which provides general information about the Ambulatory Surgical Center (ASC) Fee Schedule, ASC payments, and how ASC payment amounts are determined, is now available in downloadable format from the Centers for Medicare & Medicaid Services Medicare Learning Network.
Ophthalmology Calls on FTC to Investigate Decorative Contact Lens Marketing.
The pervasive, illegal sale of decorative contact lenses was highlighted by Connecticut Attorney General Richard Blumenthal, who demanded at a press conference that the illegal distribution of such lenses be halted immediately. Academy member William Ehlers, MD, a Farmington, Conn., ophthalmologist, discovered illegal contact lenses near the register of his local convenience store and brought their presence and inherent danger to Blumenthal’s attention. The Academy filed a formal complaint with the Federal Trade Commission (FTC) against the distributors in Connecticut.
In 2003, Congress enacted the Fairness to Contact Lens Consumers Act, which imposed new prescription-release and verification requirements on prescribers and sellers of contact lenses. In 2004, the FTC issued the Contact Lens Rule to implement the act and in 2005, Congress amended the law to state that all contact lenses (including cosmetic or colored contacts) are restricted medical devices requiring a prescription from a medical professional for purchase.
CMS Rule Lifts Medicare Advantage Fraud-Training Requirement
On April 15 CMS published a rule about Medicare Advantage and Part D plans explaining that physicians and suppliers enrolled in the Medicare program do not need to obtain fraud, waste and abuse-compliance training from Medicare Advantage plans. Ophthalmologists around the country were besieged by such requests from a number of plans; complaints from the Academy to the AMA resulted in a sign-on letter addressing the issue.
TOP
