MGMA Study Reveals ICD-10 Concerns

According to a new study by the Medical Group Management Association (MGMA), only 4.8% of more than 1,200 responding medical groups indicated they had made significant progress in ICD-10 implementation. Additionally, more than 55% of respondents said they were concerned about the costs related to the ICD-10 conversion, while 70% were concerned about loss of clinician productivity following the switch.

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Physicians Hesitant To Participate In Medicare

According to a Medical Group Management Association (MGMA) survey of physicians, 82% of practices would be likely to participate in accountable care organizations, patient-centered medical homes,or bundled payment and shared savings pilots if Congress passed legislation to override mandated sustainable growth rate (SGR) reductions for the next five years. The following survey results indicate what would happen if the scheduled 27% reduction in Medicare reimbursement takes place on January 1, 2013:

  • 45% of practices say they are very likely to reduce the number of appointments for new Medicare patients
  • 27% say they probably would reduce the number of appointments available for their current Medicare patients
  • 31% are very likely to stop accepting new Medicare patients completely
  • 75% say they would reduce employee salaries or benefits

In addition, 60% of practices reported reducing staff salaries, benefits, or delaying buying new clinical equipment or facilities over the past five years.

MGMA Seeks Extension To eRx Deadlines

Earlier this week, the Medical Group Management Association (MGMA) urged the Centers for Medicare & Medicaid Services (CMS) to extend the June 30 deadline for reporting e-prescribing instances and submitting a hardship exemption request to avoid the 2013 e-prescribing program penalty.

In a letter to CMS, MGMA asks for these changes to give practices and providers more time to meet the program criteria to avoid next year’s penalty.  MGMA also asked the agency to harmonize and simplify duplicate quality reporting programs to improve efficiency and reduce administrative burdens on practices.

Currently, providers who were not successful e-prescribers in 2011 have until June 30 to either report at least 10 instances of e-prescribing on claims to CMS, or apply for a hardship exemption to avoid a 1.5% reduction on all Medicare claims in 2013.

House Passes Legislation To Repeal IPAB

HMS Healthcare Management SolutionsThe House Energy and Commerce Committee passed legislation to repeal the Independent Payment Advisory Board (IPAB). The legislation was approved by voice vote earlier this week.

Many organizations, including the Medical Group Management Association (MGMA), have  supported repeal of the IPAB because it undermines congressional authority over the Medicare program and may subject physicians to additional arbitrary Medicare payment reductions on top of projected Sustainable Growth Rate (SGR) cuts.

The House Ways and Means Committee is scheduled to markup the IPAB repeal legislation today. If approved, the bill will move to the House floor. Despite current House activity, Senate passage of similar legislation is seen as challenging.

Physician practices interested in contacting members of Congress to support the repeal can do so by clicking here.

The Trouble With 5010

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 Demonstrations Aimed At Improper Payments

The Centers for Medicare & Medicaid Services (CMS) announced two three-year demonstrations originally scheduled for January 1, 2012 will now begin on or after June 1. Both projects are aimed at reducing improper Medicare payments and eliminating fraud, waste and abuse from the system.

The first program will allow Medicare recovery audit contractors (RACs) to perform prepayment review in 11 states – seven with high levels of fraud or error (FL, CA, MI, TX, NY, LA and IL) and four with the highest number of short hospital stays (PA, OH, NC and MO). When CMS originally announced this program, it indicated that the prepayment review would begin by looking at claims for short inpatient hospital stays.

The second demonstration program will require prior authorization for power mobility devices for beneficiaries with addresses in seven states (CA, FL, IL, MI, NY, NC and TX). CMS made a number of changes to this demonstration in response to concerns, including eliminating an initial prepayment review phase of the demonstration.

HMS will continue to follow developments regarding the implementation of these demonstrations.  The Medical Group Management Association (MGMA) has expressed concern over their development and implementation without careful consideration of their effect on physicians, group practices and the patients they serve.

CMS’ statement of support for these programs can be viewed by clicking here.

MGMA Protests 5010 Payment Delays

The Medical Group Management Association (MGMA) sent the Centers for Medicare & Medicaid Services (CMS) a letter complaining that physician practices are having trouble getting paid because of the transition to the HIPAA 5010 electronic transaction set, which went into effect on January 1, 2012.  MGMA demanded that CMS take action to prevent further disruptions to physicians’ cash flow.

“Should the government not take the necessary steps, many practices face significantly delayed revenue, operational difficulties, a reduced ability to treat patients, staff layoffs, or even the prospect of closing their practice,” MGMA wrote. “As the transition to Version 5010 is a mandatory step toward ICD-10 implementation, this raises even more concerns, understanding the magnitude of ICD-10 is exponentially greater than Version 5010.”

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