NO MORE MAIL FROM MEDICAID - August 23rd is the day

August 23, 2010

US mail ends from

Medicaid

Effective August, 2010 - providers will no longer receive payments, informational letters or provider general letters vis US mail. All communications will be exclusively in electronic format.

Informational Letters: will cease on and after 8/23/10 and can be retrieved from their website:

http://www.ime.state.ia.us/Providers/Bulletins.html

General Letters (Manual Transmittals): will cease on and after 8/23/10 and can be received from the website:

http://www.ime.state.ia.us/policyanalysis/PolicyManualPages/medprovgl.htm

For both types of letters, an additional notification mechanism is being desiged for the Iowa Medicaid Portal Access (IMPA) website at:

https://secureapp.dhs.state.ia.us/impa/ (details of this new feature will be sent out as it's completed and tested.

Providers Payments: will only be transmitted via an electronic format effective with the August 23rd payment cycle with funds available the following Thursday, August 26, 2010. Paper checks will no longer be issued as of this date. Providers have until August 9, 2010 to sign up for EFT through Provider Services.

Of note, Medicaid suggests if you don't have a computer, you can always go to your local library to access this information - honest - it's in their letter - they really suggested this!

CMS NOW WANTS TO REVIEW THE ENROLLMENT PROCESS...

The ordering and referring providers listed are inaccurate....continuity of lists of those enrolled in PECOS and those NOT enrolled in PECOS differ...

I'm not sure what's going on with the information below from CMS, which was released on June 30th, from the Office of Public Affairs at CMS. I just received my copy today.

Feel free to read CMS's entire article below in blue - but bottom line - looks like CMS will NOT deny claims from ordering and referring providers and will send out information once they decide how they are going to tackle this problem

The information below is a bit confusing - when I inquired to CMS, the response was they are trying to address many issues with PECOS with regards to who's "in" and who's "not in" - there seems to be many problems with the PECOS list and the claims system with records to the providers who are supposed to be in PECOS and those who maybe or are in, but not on the "list". The "list" being the one published on the CMS website.

EVERYONE IS REMINDED AGAIN - DON'T WAIT!!!

MAKE SURE YOUR PROVIDERS ARE ENROLLED IN PECOS,

IF NOT, COMPLETE THE PAPERWORK NOW!!

CMS TO REVIEW PECOS ENROLLMENT PROCESS

Medicare working with ordering and referring provers and suppliers

to streamline enrollment process

The Centers for Medicare & Medicaid Services (CMS) is working with providers to address concerns about enrollment in the Provider Enrollment, Chair and Ownership System (PECOS) to ensure that Medicare beneficiaries continue to receive the health care services and items they need. PECOS is the electronic system used to enroll physicians and eligible professionals into the Medicare program.

As part of those efforts, CMS will, for the time being, not implement changes that would automatically reject claims based on orders, certifications, and referrals made by providers that have not yet had their applications approved by July 6, 2010. While more than 800,000 physicians and other health professionals have enrolled and have approved applications in the PECOS system, some providers have encountered problems. CMS is continuing to update and streamline the process, and more providers have been enrolled in the past few days.

CMS issued an interim final regulation on May 5, 2010 implementing provisions of the Affordable Care Act that permit only a Medicare enrolled physician or eligible professional to certify or order home health services, durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) , and certain items and services under Medicare Part B. The new law applies to orders, referrals and certifications made on or after July 1. The comment period for the regulation closes on July 6, after which the comments will be reviewed and considered before a final regulation is issued.

The Affordable Care Act provisions and the regulation were designed as steps to prevent fraud in Medicare by ensuring that only eligible and identifiable providers and suppliers can order and refer covered items and services to Medicare beneficiaries.

Many physicians and other providers and suppliers have continued to make good faith efforts to comply with the requirements of the law and regulation. These efforts will be a significant factor in determining the procedures and processes that will be incorporated in the final rule.


While the regulation will be effective July 6, 2010, CMS will not implement automatic rejections of claims submitted by providers that have attempted to enroll in PECOS. However, until the automatic rejections are operational, providers should not see any change in the processing of submitted claims, they will continue to be reviewed and paid as they have historically been reviewed and paid.

Additionally, though CMS is taking a more deliberative approach to using the PECOS enrollment system, the agency will employ a contingency plan to meet the ACA requirement that written orders and certifications are only issued by eligible professionals effective July 1.

CMS will continue to send informational notices to providers reminding them of the need to submit or update their enrollment and will work with the provider community to provide guidance on enrollment and will process all applications expeditiously.

Final Notice for PECOS

CMS SENDS FINAL REMINDER NOTICE FOR PECOS ENROLLMENT

CMS directed all Medicare carriers to send ONE notice to providers who are still NOT enrolled in PECOS. This letter was recently mailed from WPS within the last week. This will be your final and only reminder to providers who need to enroll in PECOS.

If you haven't checked your status, contact the Provider Enrollment Hotline at WPS to verify if your providers are enrolled in the PECOS system! Call 866-503-7664. Callers will have to provide one of the following: Provider PTAN, Social Security Number, or Federal Tax ID number.

21% Medicare cut averted!

Congress raises Medicare payments by 2.2% thru November 30th....21% cut averted.

The House voted late tonight (June 24th) to adopt a Senate-passed Medicare physician pay increase of 2.2% through November 30th, 2010, temporarily reversing the 21% cut Medicare contractors began applying to claims earlier this week.

It is unknown at this time how the unpaid claims will be processed until CMS provides carriers with direction. When this has been determined, it will be posted.

Unfortunately this fix is just until November 30,2010, which means on December 1st, we may see a 23% decrease in the fee schedule.

A note of interest is that the House voted 417-1 to pass the measure after the Senate confirmed it unanimously. The person voting against it was Democrat Congressman George Miller of California - hope you never get sick, George!

June Medicare Claims Released for Processing

Medicare claims for June previously being "held" by carriers have been released - fee schedule slashed! Be prepared for unnreasonable reductions in your payments.

On June 18th CMS directed contractors to lift the hold and begin processing June 1st and later claims under the law's negative update requirement. Held claims will be released and processed on a flow basis, first-in / first-out. These "held" claims will reflect the negative update requirement and providers should see payments at approximate 21% less they had been paid.

Please know that the negative fee schedule update will ONLY be applied with dates of service June 1st and later. Claims with a DOS prior to June 1st will be processed at the rate which was in effect as of January 1,2010.

Congress continues to debate the elimination of the negative update that took effect June 1st. CMS is "hopeful" that Congressional action will be taken to avert the negative update and will continue to monitor those actions.

If Congress changes the negative update currently in effect, CMS is prepared to act quickly to make the appropriate changes to the Medicare claims processing system.

June Medicare Claims - Still on Hold

CMS DIRECTS CARRIERS TO CONTINUE HOLDING JUNE CLAIMS

At this time, Congress is debating the elimination of the negative update that took effect June 1, 2010.

The Centers for Medicare & Medicaid Services (CMS) is hopeful that Congressional action will be taken within the next several days to avert the negative update.

To avoid disruption in the delivery of health care services to beneficiaries and payment of claims for physicians, non-physician practitioners, and other providers paid under the MPFS, CMS had instructed its contractors on May 27th to hold claims for services paid under the MPFS for the first 10 business days of June (i.e., through June 14, 2010). This hold only affects MPFS claims with dates of service of June 1, 2010, and later.

Given the possibility of Congressional action in the very near future, CMS is now directing its contractors to continue holding June 1 and later claims through Thursday, June 17, lifting the hold on Friday, June 18.

Part 2: HIGLAS to Effect Cash Flow - End of July - 1st of August

Medicare Payments to be received earlier

just for a short time.

As an earlier post indicates, WPS will install a new standardized accounting system called HIGLAS. In order to install the system, WPS must reduce the payment floor for both paper and electronic claims to zero. Payments will be released early for claims that have already been approved for payment. The payment floor reduction begins on July 28, 2010 and goes through July 30, 2010.

It's planned that on approximately August 6th, there should be no claims left in the system so that the transition can take place. On August 9, 2010, the payment floor will be reset to 29 days for paper and 14 days for electronic claims.

This is what you need to remember! This temporary reduction of the payment floor will result in payments being issued EARLY (both checks and EFT's). This may give the appearance that your cash revenues have increased, when in fact you have just received your payments early.

Providers are encouraged to monitor their payments and make necessary adjustments as necessary to prevent cash flow problems during the transition period. Since payments will be issued early - there will be a period of time after the early payments that you will not be receiving any payments.

E-Prescribing of Controlled Substances Not Allowed Yet in Iowa

E-prescribing of controlled substances

in Iowa

All providers who have a federal DEA number should have recently received a letter from the FDA regarding the ability to electronically prescribe controlled substances. The letter stipulates that under certain conditions this is allowable if your computer system meets certain criteria.

Please be aware that Iowa law currently does not authorize e-prescribing of controlled substances. Rule review and amendment to address this issue is forthcoming but the Pharmacy Board does not anticipate changes for at least 3 or 4 months.

Red Flag Rules Moved to 12/31/10

FTC Red Flag Rules pushed back again

New enforcement date is December 31, 2010

The American Osteopathic Association, American Medical Association and the Medical Society of the District of Columbia filed a lawsuit in federal court last week seeking to prevent the Federal Trade Commission (FTC) from extending identity theft regulations to physicians.

The complaint, prepared by the Litigation Center of the AMA and State Medical Societies, targets the contentious "Red Flags" Rule, which requires creditors to implement safeguards against identity theft. The medical societies charge that the FTC's rule exceeds the powers delegated to it by Congress and that its application to physicians is "arbitrary, capricious and contrary to the law."

At the request of Congress, the FTC has announced that it will delay the enforcement of the "Red Flags" Rule until Dec. 31, 2010. Prior to this announcement, the "Red Flags" Rule was scheduled to go into effect on June 1. For more information on the delay, visit the FTC website.

Medicare to hold payments....again!

Here we go again...Medicare will hold claims for DOS June 1, 2010.....

The Continuing Extension Act of 2010, enacted on April 15, 2010, extended the zero percent (0%) update to the 2010 Medicare Physician Fee Schedule (MPFS) through May 31, 2010. The Centers for Medicare & Medicaid Services (CMS) believes Congress is working to avert the negative update scheduled to take effect June 1, 2010. To avoid disruption in the delivery of health care services to beneficiaries and payment of claims for physicians, non-physician practitioners, and other providers of services paid under the MPFS, CMS has instructed its contractors to hold claims containing services paid under the MPFS (including anesthesia services) for the first 10 business days of June. This hold will only affect MPFS claims with dates of service June 1, 2010, and later.

CMS states that this hold should have minimum impact on provider cash flow because, under the current law, clean electronic claims are not paid any sooner than 14 calendar days (29 for paper claims) after the date of receipt. but we all know, there will be some cash flow issues.

PECOS - Are you Enrolled?

IMPORTANT NOTICE ABOUT MEDICARE ENROLLMENT AND PECOS:
PROVIDERS BE WARNED.....

Since last October, CMS has been recommending that offices check to make sure that their providers are enrolled in PECOS. The date for PECOS enrollment has been moved several times, with the last date, by printed document from CMS, being January 3, 2011.

I am writing to WARN Iowa Providers that there is rumbling going on at CMS indicating that the PECOS compliance date may be moved forward to July 6, 2010.

This information was presented on a CMS teleconference last week, however, the presenters were not quite clear about the new rules and kept referring those asking questions to consult the Federal Register....where clarity doesn’t necessarily prevail.

Bottom line.....if you have a provider that has no enrollment activity since November of 2003, address change, name change, change in work history, change in employment, etc. then that provider is most likely NOT in the PECOS system. If you have had activity, you should call and check just to be safe!

You can call the WPS enrollment hotline to verify if your provider is or isn’t in PECOS. The number is 866-503-7664. Callers will have to provide one of the following: Provider PTAN, Social Security Number, or Federal Tax ID number.

If your provider is enrolled in PECOS – perfect – you’re done.
If your provider is NOT enrolled in PECOS, ask the enrollment specialist what needs to be done. Keep in mind that enrollment takes a minimum of 30 and 60 days to process, so don’t delay.

PLEASE UNDERSTAND THAT THIS IS VERY IMPORTANT AND REGARDLESS OF THE NEW COMPLIANCE DATE – DO IT TODAY!

Medicare - New Timely Filing Requirements

Timely Filing Requirements shortened for Medicare...

Under the new law, claims for services furnished on or after January 1, 2010 must be filed within one calendar year after the date of service.

In addition, claims for services furnished before October 1, 2009 to January 1, 2010, must be filed no later than December 31, 2010.

The law does permit the Secretary of HHS to make certain exceptions to the one-year filing deadline, but at this time no exceptions have been established. However, proposals for exceptions will be specified in future proposed rulemaking.

Iowa Medicaid - No more paper checks, No more Informational Letters

Effective July 1st - the checks won't be in the mail!

Effective July 1, 2010, Medicaid will no longer be sending out paper checks, in fact they won't be sending out any kind of paper thru the mail. These changes were made to reduce costs to the State.

Providers are encouraged to sign up NOW for EFT (electronic funds transfer) to avoid any possible grid lock when July 1st comes around. (This does not effect CDAC providers). Providers must fill out an EFT authorization form (form 470-4202) to set up the EFT payments. The form is available online at: www.ime.state.ia.us/Providers/Forms.html or by calling 800-338-7909 or locally in Des Moines at 256-4609. These forms, once complete can be faxed to 515-725-1155 or e-mailed to the address on the form.

Paper remittances will also disappear as well and will have to be downloaded from the IME website. Contact provider service at the numbers above for more information.

The "Informational Letters" that notify providers about various programs and policy changes will also have to be retrieved online at: www.ime.state.ia..us/Providers/Bulletins.html You can also sign up for theirs list serve which is very helpful

IME is telling providers if they don't have computer access, they can go to their local public library to access the internet...

WPS to start allowing providers to fax in re-openings and

re-determinations...

I have been working with WPS and CMS since early last fall on fax capabilities.

I am pleased to announce that Iowa is the first state in the WPS J5 Mac that will be able to fax in re-openings and re-determinations instead of mailing them. There are some guidelines that must be followed:

1. You MUST use the approved WPS fax cover sheet which can be obtained from the "forms" section of the WPS website, or at:

http://www.wpsmedicare.com/j5macpartb/forms/_files/ia_appealsfaxform.pdf

2. You MUST also submit either the re-determination or re-opening submission form as well.

3. You MUST only submit ONE item per form. The fax number is listed on the fax cover sheet and differs by State.

This is up and running currently.

Medicare to begin releasing payments:

On Friday, CMS notified carriers to start making payments on claims held with DOS 4/1/10 that had met the floor payment criteria.

There were massive amounts of claims being held. Carrier systems are unable to process these all at once, so they will begin processing claims at the system capacity on a daily basis until all claims have been processed. It could take up to a week to clear our some of the held claims, but all carriers are processing claims to capacity as of Friday.