CMS To Delay Rate Cuts To Physicians

CMS has said that it will hold physician claims for 14 calendar days and delay the 21% rate cuts that are otherwise set to take effect Wednesday. Last week, the Senate recessed without acting on H.R. 2, which has been approved by the House already. Senate officials want to reassure everyone that the two-week delay will not impact doctors. The Senate will have only two days to act on the bill before the rate cuts take chunks out of payments sent to doctors. The Senate reconvenes on April 13.

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Providers Should Encourage Patients To Seek Second Opinions

According to new research, providers and consumers both benefit when patients get a second opinion about treatment. In 1,000 cases from 2012-2014, approximately 77 percent of “medical interventions” where a healthcare advisory company helped patients obtain a second opinion after initial diagnosis, led to changes in diagnosis and treatment or treatment physician. About 3 percent of patients seeking a second opinion ended up with a change of diagnosis and almost 21 percent decided to change their treatment plans. Another 41 percent of patients transferred their care to another provider. Experts say second opinions are crucial for patients, especially those diagnosed with complex condition, because “medicine is an art as much as a science.” Medical errors, such as misdiagnoses are an acute problem in the healthcare industry today. One report indicates that hospital mistakes may be the third-leading cause of death in the United States.

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Study: Medicaid Pay Bump Helps Beneficiaries Get Appointments

According to a new study published in the New England Journal of Medicine, increasing Medicaid reimbursement for primary care services to match Medicare rates have led to increases in appointments for Medicaid patients. However, care access gains may be completely “wiped out” this year because the ACA’s provision authorizing the increase in Medicaid rates has expired. Researchers noticed an increase from 58.7% to 66.4% in the availability of primary care appointments for Medicaid beneficiaries in the surveyed areas. The increases in appointment availability were similar in states that expanded Medicaid coverage and in states that did not. With this newly available data, physicians hope the Medicaid pay bump will be extended. Average national Medicaid reimbursement to primary care physicians is expected to drop between 43% and 47% as a result of the provision ending.

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Holding Of 2015 Date-Of-Service Claims For Services Paid Under 2015 Medicare Physician Fee Schedule

The CY 2015 Medicare Physician Fee Schedule (MPFS) final rule was published in the Federal Register on November 13, 2014. Medicare Administrative Contractors will hold claims containing 2015 services paid under the MPFS for the first 14 calendar days of January 2015 in an effort to implement corrections to technical errors discovered after the publication of the MPFS rule. Please note, this hold will have a minimal impact on provider cash flow as, under current law, clean electronic claims are not paid sooner than 14 days (29 days for paper claims) after the date of receipt. MPFS claims for services provided on or before Wednesday, December 31, 2014 are unaffected by the 2015 claims hold and will be processed and paid under the normal procedures and time frames.

Click here to see the Final Rule.

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ICD-10 Implementation Is Less Than A Year Away: What You Need To Do To Be Ready Part IV

In this installment of the ICD-10 Implementation Is Less Than A Year Away: What You Need To Do To Be Ready series, we’ll take a look at other key steps providers should take before the go-live date.

A few months before you go-live, confirm with system vendors that changes and upgrades have been completed. Determine the level of support you’ll need for go-live and who the main point of contact will be if issues arise. Also, finalize other changes that have not yet been completed. At this point, you should also conduct ICD-10 transaction testing and make modifications in response to the results of the systems testing.

Right before you go-live, provide intensive ICD-10 education to coding staff. Training should be conducted by an individual who has already become ICD-10 certified. Training can include classroom training, self-directed learning using printed or electronic materials, and audio or web-based programs. Remember not all coding staff will require the same type or amount of ICD-10 education. For example, coding staff working for a physician practice medical specialty area should focus on code categories most applicable to their particular patient mix. During this time, you should also continue assessing the quality of medical record documentation and implement document improvement strategies as needed.

Lastly, get ready to go live with ICD-10 for dates of service on or after October 1, 2015. Claims for services provided on or after this date must use ICD-10 for diagnoses. CMS has advised that there will be no extension or grace period and that noncompliant claims will be rejected.

We’ll post our final installment of our ICD-10 series tomorrow. Stay tuned!


HUSKY Health Primary Care Increased Payments Policy

Under the ACA, Medicaid has increased its payments to equal the 2013 and 2014 Medicare fee for certain primary codes when billed by an eligible primary care provider, who has submitted a valid attestation to the Department of Social Services. However, the ACA requirement ends with dates of service January 1, 2015 and forward. 

The Connecticut General Assembly has appropriated funding within the Medicaid biennial in order to continue increased primary care payments for dates of service beyond December 31, 2014. The Department is establishing a policy for primary care increased payments; this policy will be referred to as the HUSKY Health Primary Care Increased Payments Policy. The Department is also revising the list of codes eligible for an increased payment.

Click here for more information from the Connecticut Department of Social Services regarding the HUSKY Health Primary Care Increased Payments Policy.

Report: Florida Has Worst Physician Shortage In Country

According to a new report by the Kaiser Family Foundation, Florida has the worst physician shortage in the country. Areas and population groups with a population-to-provider ratio of 3,500-to-one (or 3,000-to-one in areas of high need) are designed health professional shortage areas (HPSAs), according to experts. The Kaiser Family Foundation report found approximately 6,100 HPSAs nationwide. Florida has more than 252 primary care HPSA designations and meets less than 45 percent of the state’s overall need. Other states with high HPSAs include California, New York, Texas and Illinois. Is it important to note, however, that the report does not account for additional primary care that physician assistants or nurse practitioners could provide-two groups that are often suggested as a way to offset the shortage.

Click here to see the report.

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