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As Deadline Nears, ACA and FCA Provide Resources on PQRS

The ACA recently provided an important reminder to DCs on the Physician Quality Reporting System (PQRS).   Centers for Medicare and Medicaid Services’ (CMS) gave providers five years (2008-12) to learn how to properly participate in this system.  Beginning in January 2012, physicians and other providers who reported certain quality measures may be eligible for a 0.5% payment incentive, to be paid in the third quarter of 2013.  However, the ACA reminded, “CMS recently ruled that providers not successfully/satisfactorily participating in PQRS by the 2013 reporting period (Jan. 1 - Dec. 31, 2013), will have their Medicare reimbursement decreased by 1.5 percent beginning in 2015, and 2 percent in 2016. Therefore, the 2012 reporting period is the last opportunity providers have to voluntarily participate in PQRS and learn how to report successfully/satisfactorily while incentives are still offered and their Medicare reimbursement is not subject to penalties.”

Medicare Physician Quality Reporting for 2013: Changes from 2012

The 2013 PQRS measures and codes are different from 2012.  If you bill an obsolete code, your bill will be rejected in its entirety.  

Please NOTE:  The Electronic Health Record measure was retired.  Do not include any G codes for that measure on 2013 Dates of Service.  The Pain Assessment and Functional Outcome Assessment measures now have six (6) possible reporting G codes.
 

First Coast Service Option Medicare Denials for Missing Modifier

The FCA has recently learned from our members that First Coast Service Options (FCSO) has begun denying Physical Medicine modality and therapy codes due to a missing modifier. We await further official confirmation from our FCSO liaison, which will be forwarded immediately to you, our member.

Here We Go Again on Medicaid

The Governor released his proposed budget late last week and, once again, as it has been for virtually every year since FCA successfully lobbied to include chiropractic in Florida Medicaid, the bureaucracy and Governor are recommending it be eliminated (along with podiatry, another “optional service” per the federal law).  The Governor’s staff gave a courtesy call to the FCA (and the Florida Podiatric Association) late last week to report the position.   If you have been attuned to FCA legislative reporting over the last 20 years, you know that we have been successful each time, thus far, in having it reinstated in the legislative budgetary process.  We do not take this lightly, however.  What this means is that the FCA will need to fight this issue once again in the 2013 legislative session.   We cherish your continued support.

Sequestration and Medicare Fees: Fee Schedule Change 4/1/2013

In response to member calls about the effect of sequestration on Medicare fees. According to First Coast Service Options, the physician fee schedule for 2013 will change April 1, 2013:

Medicare Payment Reductions April 1st

Although the Medicare Allowable Fee Schedule will not change April 1st, payments for services will be reduced by 2%.  The 2% will be applied after all co-payments and deductibles are applied and will be reflected on the remittance advice or EOB.  It appears this will affect the provider on assigned claims and the patient on the unassigned claims.  

Florida Medicaid Issues Its Provider Alerts Messages for May

The Medicaid Division of the Florida Agency for Health Care Administration (AHCA) has issued its “Provider Alerts Message” for this month.  The message highlights upcoming July 1 changes in access to some services used by providers, including Recipient Eligibility Verification, Remittance Advices and Online Provider Enrollment.   

Members Achieve Success with Medicare Enrollment, Thanks to FCA Webinar

 The FCA is receiving reports of members completing their Medicare enrollment successfully and more quickly when they follow the steps outlined in the FCA webinar, “Medicare Enrollment and Validation.” (see link below)  

Happy with Your Medicare Claims Contractor? Let Your Voice be Heard!

(From the ACA “Week In Review” of August 1, 2013) The Centers for Medicare and Medicaid Services (CMS) is launching a new instrument called the Medicare Administrative Contractors (MAC) Satisfaction Indicator (MSI). This tool will be used to measure your satisfaction with the MAC(s) that serve you. Your input will help your MAC improve the level of service offered to all Medicare Fee-for-Service (FFS) providers. CMS is developing a registry of Medicare providers for participation in the MSI. 

First reports received: OIG Medicare audit activity has begun

Throughout 2013, there have been warnings of increased audit activity in Medicare. It has now been reported to the FCA that seven chiropractic physicians in one state received a letter from the OIG requesting records from 2012.

 
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