2011 Physician Fee Schedule Rule - (PDF) released November 2, 2010Summary of the Medicare and Medicaid Extenders Act of 2010
Proposed Cuts Threaten Access to Care in North Carolina - Commentary by the AMA
Medicare Payment Rates v. Price to Practice - AMA data
Tell Your Legislator to Take Action!
NCMS Letters to the NC Congressional Delegation
Physician Quality Reporting System (PQRS)
Other Incentive Programs
NCMS PractEssentials Presentation on Incentive Programs
Dec. 31, 2010 - Deadline to file FFS claims for services rendered before January 1, 2010
Jan. 1, 2011 - 2011 Physician Fee Schedule Rule takes effect
Jan. 3, 2011 - Comment period on 2011 Physician Fee Schedule Rule ends
All CMS-Related Provisions in the Affordable Care Act
Implementing Medicare Cost Savings under the Affordable Care Act
Independent Payment Advisory Board- The ACA establishes the IPAB to monitor Mediare program spending and to recommend payment policy revisions to contain cost growth.
- The IPAB begins its work in 2012 and will be required to submit its recommendations to Congress annually.
- The IPAB's proposals on how to improve care and control program expenditures are binding when Medicare cost projections exceed certain targets, unless Congress acts to reduce expenditures in other ways.
Centers for Medicare and Medicaid Services
CIGNA Goverment Services
The Federal Register | 
As required by the Patient Protection and Affordable Care Act, all Medicare providers that were enrolled prior to March 25, 2011, must revalidate their enrollment. Upon receiving a revalidation request from Palmetto GBA, providers will have 60 days from the date of the letter to submit enrollment forms. Failure to revalidate enrollment can result in interruptions to your Medicare payments and deactivation of your Medicare billing privileges.
Click here to view Palmetto's Revalidation Initiative FAQs.
Medicare Part B Physician Fee Schedule (Excel file)
2011 Physician Fee Schedule - released November 2, 2010
Quarterly Provider Updates
Medicare Provider Enrollment, Chain, and Ownership System (PECOS)
NOTE: All physicians who refer or order for Medicare (unless opted out) are required by the Affordable Care Acto to enroll in PECOS.
Physicians have three options that govern their participation status in the Medicare program for an entire calendar year:
- Participating (PAR): Physician signs a participation agreement with Medicare agreeing to take assignment on all Medicare claims as payment in full for all covered services. PAR physicians are paid 100% of the Medicare fee schedule amount for covered services.
- Non-Participating (Non-PAR): Physicians can either accept assignment for Medicare patients or pursue payment from patients on unassigned claims. On assigned claims, non-PAR physicians are paid 95% of the Medicare fee schedule amount for covered services. However, on unassigned claims, non-PAR physicians may collect up to 109.25% of the Medicare fee schedule amount, assuming their patient pays.
- Private Contracting/Opting Out: This third option permits physicians to privately contract in writing with all patients to provide health care services outside the Medicare reimbursement system. People often confuse the two, but opting-out is different from being non-PAR. The amount agreed upon by the physician and patient might bear little relation to the Medicare fee schedule amounts. By law, this private contract between a physician and a patient must contain certain provisions.
FAQ on Medicare Participation/Opt-out Resources
Medicare Opt-Out Affidavit: J11 Part B
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