hmsabc

The Trouble With 5010

hmsabc — Thu, 23 Feb 2012 21:29:44 +0000

As the Medical Group Management Association (MGMA) and the American Medical Association (AMA) continue to call on the Centers for Medicare & Medicaid Services (CMS) to further delay enforcement of the HIPAA 5010 electronic transaction standards scheduled for April 1, physician practices that already have started using the new standards have reported several problems, most commonly:

Issues with practice management and billing systems that had shown no problems during the testing.
Issues with billing secondary payers.
Claims rejections due to issues with billing and practice addresses.
Crosswalks for national provider identifiers that are not being recognized.
Claims lost by Medicare contractors.
Certain “not otherwise specified” claims being denied due to not having descriptions on the claims.
Sporadic payment of resubmitted claims.
Call hold times of one to two hours when attempting to contact contractors for further explanation of unpaid and rejected claims.
Unsuccessful claims processing, with no reasons cited for rejection, despite using submitters that were approved after successful 5010 testing.

HMS Healthcare Management Solutions information systems are currently compliant with the 5010 update to the HIPAA electronic transaction standards. Our systems are in place and have been tested to ensure you can continue to send claims and receive reimbursement without interruption.

Find out how we can assist you by contacting HMS today!

CMS Releases Stage 2 Meaningful Use Proposals

hmsabc — Thu, 23 Feb 2012 17:28:17 +0000

Officials with the Centers for Medicare & Medicaid Services (CMS) and the Office of the National Coordinator for Health IT (ONC) announced the proposed requirements for Stage 2 Meaningful Use and 2014 certification of electronic health records at the Healthcare Information and Management Systems Society’s annual conference in Las Vegas.

The Stage 2 Meaningful Use rules and EHR certification standards largely reflect the recommendations made last year by the Health IT Policy Committee and the Health IT Standards Committee. Notices of proposed rulemaking (NPRM) for the two sets of regulations should be published later this week in the Federal Register. Following a 60-day comment period, the final rule is scheduled for release this summer.

Click here to read more.

California Medicaid Case Heads Back To Lower Court

hmsabc — Thu, 23 Feb 2012 16:00:08 +0000

The Supreme Court sent back to a lower court a case on whether Medicaid recipients and medical providers can sue California for cutting reimbursement rates in the healthcare program for low-income Americans.

The high court said after it heard oral arguments in the case on October 3, federal government officials approved the state’s statutes as consistent with federal law.

Justice Stephen Breyer said in the majority opinion the case was sent back to a U.S. appeals court based in California to determine whether the recipients and providers may sue in light of the changed circumstances of the federal government’s approval. In sending the case back, the justices set aside a ruling by the appeals court that had blocked the cuts for violating federal law.

Click here to read more.

Medicare Program Deadlines Approaching

hmsabc — Thu, 23 Feb 2012 13:52:41 +0000

Practices and eligible professionals (EPs) must complete any 2011 reporting by the end of February for Medicare programs including meaningful use, e-prescribing and Physician Quality Reporting System (PQRS).

For meaningful use, February 29 is the last day for EPs to register and attest to receive an incentive payment for calendar year 2011. E-prescribing and PQRS do not require EPs to register, but an EP’s claims must be processed in the National Claims History no later than two months after the end of the reporting period to be counted for that program year. Practices are encouraged to submit any Medicare claims with PQRS or e-prescribing information as soon as possible. The February 29 deadline does not impact e-prescribing payment adjustments, which began this year and were based on the first six months of 2011.

Temporary Doc Fix Sets Up 32% Slash For 2013

hmsabc — Wed, 22 Feb 2012 17:00:30 +0000

Congress has deferred steep physician payment cuts under the Medicare program until 2013, but has left in place a pay formula that will slash physician rates by an estimated 32% next year.

The conference committee had debated allocating unspent overseas war funds to cover the more than $300 billion cost to repeal the Sustainable Growth Rate (SGR) altogether, but lawmakers could not find enough support for the idea.

The temporary payment patch will lead to deeper cuts next year. The Congressional Budget Office has projected that simply freezing Medicare pay rates in 2012 would cause the scheduled reduction to deepen to 32% in 2013. The American Medical Association (AMA) and other physician organizations opposed the temporary approach because it failed to replace the payment formula. The patch costs nearly $20 billion but would increase the future cost of a permanent fix by $25 billion.

Click here to read more.

CMS National Provider Call

hmsabc — Wed, 22 Feb 2012 15:30:58 +0000

The Centers for Medicare & Medicaid Services (CMS) is hosting a national provider conference call featuring hospital-specific performance reports that simulate the Hospital Value-Based Purchasing program. The call, scheduled for 1:30 ET on Tuesday, February 28, will include an overview of the program, the presentation of the hospital-specific reports and a question-and-answer session.

The simulated reports will use hospital data from prior years to construct each hospital’s performance scores. CMS will use a sample report to show what hospitals can expect when they receive their own reports.

Click here for more information.

Court Action Could Prolong Health Care Fight

hmsabc — Wed, 22 Feb 2012 13:58:17 +0000

Next month’s challenge to the Obama-sponsored health care law could affect the care available to most Americans, alter the balance of power between Washington and the states and remain a flash point through this presidential campaign. Yet there is a path the Supreme Court could take when it hears the case that could delay for years any resolution of a main point of contention.

The core of the law is a requirement that most people buy health insurance by 2014 or face a tax penalty. But looming over the case is a federal policy that restricts the timing of lawsuits connected to the assessment and collection of “any tax.”

On the first day of their historic session March 26-28, the justices will consider that policy and address whether people who challenge the insurance requirement must first pay the disputed tax and seek a refund before bringing a lawsuit. If the answer is yes, the legal fight over a key part of the law could be delayed, possibly until 2015.

Click here to read more.

New Electronic Billing Standards Causing Payment Woes

hmsabc — Tue, 21 Feb 2012 20:29:36 +0000

The switch to the new standards for electronic transactions under the Health Insurance Portability and Accountability Act, which impact how physicians bill payers for their services, has caused severe payment disruptions at some doctor practices.

Physician offices are seeing shortfalls on their balance sheets after the move to HIPAA Version 5010 on January 1. The Centers for Medicare & Medicaid Services, (CMS) the agency overseeing the transition, acknowledged initial processing delays and instances of missing claims with the new standards. But according to CMS, those problems have been resolved.

Click here to read more.

Waterbury Hospital Laying Off 75 Employees

hmsabc — Tue, 21 Feb 2012 17:48:02 +0000

Facing steep losses, Waterbury Hospital says it is laying off 75 staff, or 5% of its workforce. The staff cuts also include elimination of 20 open positions; and a reduction in hours for 15 employees, the hospital said Tuesday.

Waterbury Hospital says its last fiscal year ended with a nearly $10 million loss, and has suffered $34 million in losses over the past four years. In the first four months of the current fiscal year, the hospital has lost more than $2 million and could lose $6 million by year’s end.

Click here to read more.

Upfront Fees For Non-Urgent ER Care

hmsabc — Tue, 21 Feb 2012 16:00:27 +0000

Next time you go to an emergency room, you should be prepared for this: If your problem isn’t urgent, you may have to pay upfront.

Last year, about 80,000 emergency-room patients at hospitals owned by HCA, the nation’s largest for-profit hospital chain, left without treatment after being told they would have to first pay $150 because they did not have a true emergency. But emergency-room doctors and patient advocates blast the policy as potentially harmful to patients, and they say those with mild illnesses such as sore throats and ear infections do little to clog ERs and do not require CT scans or other pricey technologies.

Click here to read more.