The Senate voted 78-19 late Tuesday evening to pass H.R. 4691, the Temporary Extension Act of 2010, which included provisions to extend 2009 Medicare physician payment rates through the end of the month. As a result, the 21% payment cut that took effect on March 1 has been postponed until April 1.
As Congress was preparing to act on 4691, NCMS President Douglas Sheets, MD, and CEO, EVP Robert Seligson were in Washington, DC lobbying members of the N.C. Congressional Delegation to support a permanment fix of the sustainable growth rate (SGR), the formula used to establish Medicare physician reimbursement rates. Also attending the 2010 National Advocacy Conference were Ophelia Garmon-Brown, MD, MDiv, President, Mecklenburg County Medical Society (MCMS); Robert “Bob” Schafermeyer, MD, President-Elect, MCMS; Carolyn Scruggs, Executive Director, MCMS; and William W. Truslow, MD, President-Elect, Greater Greensboro Society of Medicine.
After the President signed the bill, the AMA reported that discussions were underway in the House and Senate on the next steps that will be taken to address the Medicare payment crisis. Proposals are being circulated that would implement still another short-term patch to the sustainable growth rate (SGR) formula, including proposals that would postpone cuts for 90 days, 7 months, or through the end of 2010.
Yesterday, AMA President J. James Rohack, MD, sent a letter to all members of the Senate, urging them to use the 31-day reprieve from the 2010 Medicare physician payment cut to delovop a legislative pathway toward a permanent repeal of the SGR formula. The NCMS and the AMA continue to press for the repeal rather than repeating the pattern of short-term remedies that serve to make future payment cuts more severe and increase the cost of permanent Medicare reform.
This week US Representatives Bob Etheridge (D-NC Dist. 2) and Walter B. Jones (R-Dist. 3) responded to letters sent by the NCMS urging them to support HR 3961, the Medicare Physician Payment Reform Act.
Physicians are urged to keep up the pressure, especially in the Senate, for enacting legislation to permanently resolve the Medicare physician payment crisis. Use the AMA’s Grassroots Hotline: 1-800-833-6354 or go to the NCMS Legislative Action Center to contact your Senators or Representatives.
After President Obama signed into law the Temporary Extension Act of 2010 on Tuesday, CMS announced it would stop its ten-day hold on physicians’ Medicare claims. In an announcement released on March 3, CMS stated:
“Among other things, this law extends through March 31, 2010, the zero percent update to the Medicare Physician Fee Schedule that was in effect for claims with dates of service January 1, 2010, through February 28, 2010. Consequently, effective immediately, claims with dates of service March 1 and later which were being held by Medicare contractors will be released for processing and payment. Please keep in mind that the statutory payment floors still apply and, therefore, clean electronic claims cannot be paid before 14 calendar days after the date they are received by Medicare contractors (29 calendar days for clean paper claims). In addition, the new law extends through March 31, 2010, the exception process for therapy claims reaching the annual cap, retroactive to January 1, 2010. Affected providers may submit claims for exceptions to the annual therapy caps, with dates of service January 1 through March 31, 2010, using the KX modifier, following the pre-January 1, 2010, requirements for therapy cap exception. Please watch your listserv and contractors website for more information about the new legislation.”
Blue Cross and Blue Shield of North Carolina (BCBSNC) is launching a Physician Hotline for physicians and their practices to call when faced with ongoing problems related to billing, claims, coverage determinations, credentialing, and other issues that aren’t getting resolved. The Hotline is designed to offer physicians an additional option when the usual troubleshooting resources have not yielded results. Susan Menendez, Director of Network Management for BCBSNC, will staff the Hotline and serve as a physician advocate.
This new service is a product of the ongoing work of the BCBSNC Joint Advisory Group (JAG), which was established by the 2009 Thomas/Love Settlement “to facilitate communication and cooperation between physicians and BCBSNC.” Physician-members of the JAG voiced the need for a central point person at BCBSNC who could communicate with and assist physicians who wish to express their concerns and problems.
BCBSNC’s agreement to provide the Hotline service is an important development in efforts to improve relations between BCBSNC and physicians and their practices. Calls to the Hotline may not always generate a different end result for physicians. However, physicians can call the Hotline to get a fresh look of their issue from BCBSNC.
Access the Hotline by calling (919) 765-4035, faxing (919) 765-7109, or emailing susan.menendez@bcbsnc.com.
In late December, BCBSNC announced that it had revised its medical policies for Intensity Modulated Radiation Therapy (IMRT), and that the new policies would take effect April 1, 2010. The changes prompted concerns from members of the radiation oncology community. In response, NCMS coordinated and hosted a meeting between representatives of BCBSNC and six radiation oncologists from around the state and two representatives of the NC Medical Group Managers Association. Led by Kevin Roof, MD, of Charlotte, the group also included the chairs of the Departments of Radiation Oncology from Duke, UNC, and Wake Forest Medical Schools. During the meeting, which took place on Wednesday, March 3rd, Genie Komives, MD, VP, senior medical director, healthcare quality, for BCBSNC, explained the rationale for the policy changes and the process for obtaining expedited appeals when the procedure is denied as investigational. The group provided significant information about the efficacy of IMRT for cancers that the policies indicate are investigational and therefore not covered (as of 4/1/10, IMRT will be covered only for prostate and head and neck cancers, although IMRT denials for other cancers can be appealed on an expedited basis if necessary). At the request of Dr. Komives, one month after the policy has been in effect, the group will reconvene to review the cases that were initially denied and subsequently overturned to see if a change in the policies are warranted.
The President signed HR 4691 into law late Tuesday, March 2, which contained a one-month stopgap provision to override the 21% Medicare rate cut called for by the flawed Sustainable Growth Rate (SGR) formula. Under this bill, the Medicare conversion factor update is set at 0% through March 31, 2010. Your NCMS President, Doug Sheets, MD, and Executive Vice President/CEO Bob Seligson have been in Washington, DC this week lobbying for a permanent solution to the perennial SGR problem. Organized medicine supports legislation to permanently replace SGR with a more realistic approach to Medicare payment updates.
On Thursday the U.S. House passed HR 4691, legislation that extends a number of expiring programs for 30 days, including current Medicare physician payment rates. The Senate unsuccessfully attempted to pass similar legislation by unanimous consent on Friday morning. The Senate has now adjourned for the weekend, so the 21% Medicare physician payment cut will be effective on Monday, March 1st. We have been notified that CMS is notifying their contractors to hold Medicare physician claims for 10 business days, starting Monday.
Delaying a permanent fix through a series of temporary patches in the past has sky-rocketed the cost of a permanent solution, and has fueled this partisan standoff. The NCMS encourages you to contact Senators Burr and Hagan to let them know that this cut threatens patient access and will irreparably destabilize Medicare. Congress has neglected to address this issue for nearly half a decade. Now is the time to permanently fix the SGR so that the elderly and needy do not go without medical treatment.
NCMS leadership and staff will be in Washington, D.C. next week meeting with the North Carolina Congressional Delegation on this very serious issue.
With a 21.2% decrease in Medicare physician reimbursement looming, the NCMS Resource Center has received numerous calls about the options available to physicians regarding Medicare participation. To learn more about the current situation and the three options (participation; nonparticipation; and opt-out), click here for a statement and materials from the AMA on this issue.
The North Carolina Department of Health and Human Services (DHHS) and Computer Science Corporation (CSC) have developed a working draft for a new Remittance and Status Report for Medicaid claims. They are now seeking feedback from you and your medical practice personnel who are familiar with the Reports. Access the draft Report here. Please direct any comments or questions to Conor Brockett (cbrockett@ncmedsoc.org) by Friday, March 5, 2010.
The finalized version of the Remittance Report will be used when CSC takes over the state’s Medicaid Management Information System (MMIS) in August 2011. The name of the new MMIS system is NCTracks. CSC already handles provider enrollment, verification, and credentialing for N.C. Medicaid.
DHHS cites the following features as improvements over the current Reports:
1) Distinct formats by provider type;
2) Inclusion of other types of payments such as health insurance premium payments, financial transactions, accounts receivable, management fees, and Health Check fees;
3) Multi-payer in nature by reporting for Medicaid, NC Health Choice, Division of Mental Health, Division of Public Health, and Office of Rural Health & Community Care services.
The Centers for Medicare and Medicaid Services (CMS) has announced a proposed plan for realignment. Pending plan approval by the Secretary of Health and Human Services, the Administration anticipates the changes to take effect in approximately 60 days.
CMS proposes to create the position of Principal Deputy Administrator, an Office of External Affairs and Beneficiary Services (which combines the Office of Beneficiary Information Services with the Office of External Affairs), and four Centers led by Deputy Administrators.
Center for Medicare (fee-for-service, managed care and the prescription drug benefit)
Center for Medicaid, CHIP and Survey & Certification
Center for Program Integrity (combines Medicare Program Integrity Group and the Medicaid Integrity Group)
Center for Strategic Planning (realigns the Office of Research, Development, and Information and the Office of Policy)
Five Divisions will remain in place: Office of Equal Opportunity and Civil Rights; Office of Legislation; Office of the Actuary; Office of Clinical Standards and Quality; and Office of Strategic Operations and Regulatory Affairs.
US Senator Kay Hagan (D-NC) announced this week that North Carolina will receive $9, 277, 361 to improve the quality of care for children enrolled in Medicaid and the Children’s Health Insurance Program (CHIP). The funds will be distributed over a five-year period, with $2, 201, 712 going to North Carolina in the first year. The money will be used to implement and evaluate provider performance measures and use health information technologies, such as pediatric electronic health records. The NCMS will be providing updates in the Bulletin and on the NCMS web site about the performance measures and health information technologies that will be developed through the program.
