The Patient Protection and Affordable Care Act (PPACA) Section 6404 establishes a maximum period for submission of Medicare Claims of not more than 12 months. As a result of the PPACA, Medicare has announced that claims with dates of service on or after January 1, 2010, received later than 1 calendar year beyond the date of
Medicare & Reimbursement
Medicare HHA Pay for Performance Demonstration Yields $15 Million
By Michael Cassidy on
Posted in Medicare & Reimbursement
CMS announced that it is sharing more than $15 million in savings with 166 Home Health Agencies (HHAs) based on their performance during the first year of the 2-year Medicare Home Health Pay For Performance (HHP4P) demonstration. The demonstration project began in January, 2008 and ended December, 2009. The results for calendar year 2008 produced $15.4 million…
Medicare Physician Payment Cuts Delayed Through May 31, 2010
By Michael Cassidy on
Posted in Medicare & Reimbursement
“Medicare Physician Payment Cuts” “SGR” ” May 31, 2010″ “Medicare SGR Physician Pay Cut”…
Continue Reading Medicare Physician Payment Cuts Delayed Through May 31, 2010
Congressional Progress: Medicare Physician Fee SGR 21.3 % Cut
By Michael Cassidy on
Posted in Medicare & Reimbursement
Today the Senate passed an amended version of H.R. 4851, the act to extend SGR relief ( Continuing Extension Act of 2010 ) by continuing 2009 rates. Since an earlier but different version has already passed the House, this version must be approved again. The AMA predicts action by the end of the week.
Although…
Registration of Billing Agents, Clearinghouses and Alternate Payees
By Michael Cassidy on
Posted in Medicare & Reimbursement
Section 6503 of the Patient Protection and Affordable Care Act (PPACA) requires that all billing agents, alternate payees, and clearinghouses that submit claims on behalf of health care providers must register with the state and the Secretary in a form specified by the Secretary. This provision will be effective January 1, 2011.
Section 6505 also prohibits…
Medicare Self-Referral Disclosure Protocol
By Michael Cassidy on
Posted in Medicare & Reimbursement
Section 6409 of the Patient Protection and Affordable Care Act (PPACA) requires the Secretary of Health and Human Services to develop a Medicare self-referral disclosure protocol, which is intended to allow providers to disclose self-referral violations and negotiate reduced civil penalties. The protocol shall be developed no later than six months following the date of enactment…
Special Requirements for DME and Home Health Services
By Michael Cassidy on
Posted in Medicare & Reimbursement
The Patient Protection and Affordable Care Act (PPACA) contains several provisions aimed to reduce fraud and abuse in home health and Durable Medical Equipment (DME) programs, which CMS and OIG consider to be high risk programs. Effective July 1, 2010, physicians who order covered home health or DME services must be enrolled in Medicare (§ 6405). …
PPACA Reduces Medicare FFS Claim Filing Period to One Year
By Michael Cassidy on
Posted in Medicare & Reimbursement
Medicare Explains Timely Filing Requirements for Medicare Fee-For-Service Claims
On March 23, 2010, President Obama signed into law the Patient Protection and Affordable Care Act (PPACA), which amended the time period for filing Medicare fee-for-service (FFS) claims as one of many provisions aimed at curbing fraud, waste, and abuse in the Medicare program.
…
And Here’s The CMS 10 Day Hold Notice for Medicare Physician Claims
By Michael Cassidy on
Posted in Medicare & Reimbursement
Information Regarding the Holding of April Claims for Services Paid Under the
2010 Medicare Physician Fee Schedule (3-26-2010)
The Centers for Medicare & Medicaid Services (CMS) is working with Congress, health care providers, and the beneficiary community to avoid disruption in the delivery of health care services and payment of claims for physicians, non-physician…
Medicare Physician Fee Schedule SGR 21.3% Decrease April 1, 2010
By Michael Cassidy on
Posted in Medicare & Reimbursement
Senate failure to pass 30-day extension causes 21.3 percent cut to Medicare physician payments on April 1.
The Senate has adjourned for 2 weeks without postponing the Sustainable Growth Rate (SGR) Medicare Physician Fee Schedule reduction. For the past several months, since the problem arose 1/1/10, carriers have responded by advising physicians to …