Updates and News from the Centers of Medicare and Medicaid Services

2010 Medicare Physician Fee Schedule (MPFS) Provisions

The Health Policy department has summarized the 2010 MPFS final rule and its impact on otolaryngology. Learn more.

Letter on the Definition of Meaningful Use of EHR  

The Academy in addition to other specialty societies sent a letter with recommendations for defining and demonstrating the meaningful use of Electronic Health Records (EHR). Learn more.

CMS Scam Alert

Be aware of perpetrators posing as the Medicare contractors and sending faxes to physician offices. The fax instructs physician staff to respond to a questionnaire and to provide an account information update within 48 hours in order to prevent a gap in Medicare payments.  The fax may have the CMS logo and/or the Medicare contractor’s logo to enhance the appearance of authenticity.  If you receive a request for information in the manner described above, please check with your contractor before submitting any information.  Medicare providers should only send information to a Medicare contractor using the address found in the download section of the CMS.gov website found at http://www.cms.hhs.gov/MLNGenInfo/ or http://www.cms.hhs.gov/MedicareProviderSupEnroll

Bundling of the Epley Maneuver into E&M Services

The Academy is aware of this issue, and strongly disagrees with the bundling of 95992 into an E&M service.  We were part of the group that applied for a CPT code to report this procedure, and worked with the AMA RUC to get it appropriately valued.  The Academy, along with the American Academy of Neurology, met with CMS representatives on Tuesday, May 5, 2009 to discuss this matter.  We explained the amount and intensity of the work involved, and that this was a therapeutic procedure not accounted for in E&M criteria.  CMS was responsive with questions. Unfortunately, due to CMS procedural requirements, they will not give us an answer on our comments until the 2010 Physician Payment Fee Schedule is published in November. The Academy will continue to advocate on this matter until CMS reaches a decision favorable to our position.

The National Correct Coding Initiative (NCCI) Deletes Edits

The NCCI plans to delete the current edits for code pairs 30520 with 30465 and those for 38720 or 38724 with 31525 because of the advocacy and expertise of the Academy and the Physician Payment Policy workgroup (3P) who presented logic and justified the necessity of separating payment for these code pairs. The NCCI will implement these changes on July 1, 2009 in version 15.2.

Advanced Beneficiary Notice (ABN) and Medically Unlikely Edits (MUE)

The Centers for Medicare and Medicaid Services has reiterated that physicians who receive a denial due to an MUE should not use an ABN to bill a patient for the excess units of services denied.
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Academy Offers Comments on the Durable Medical Equipment Medicare Administrative Contractors’ (DME MAC) Local Coverage Determination (LCD) on Positive Airway Pressure Devices

On December 22, 2008, the Academy with the help of the Sleep Disorders Committee sent comments to the DME MACs regarding their proposed LCD on the Positive Airway Pressure Devices (CPAP). For more details on our comments, contact the health policy department at (703) 535-3727

Academy Offers Comments on the CMS’ Proposed Decision Memo for Sleep Testing for Obstructive Sleep Apnea (OSA) (CAG-00450N)

On January 22, 2009, the Academy with the help of the Sleep Disorders Committee sent comments to CMS’ Coverage Analysis Group (CAG) regarding their proposed decision memo on the sleep testing for OSA. For more details on our comments, contact the health policy department at (703) 535-3727.

Academy Offers Comments on the CMS’ Proposal to create a National Coverage determination (NCD) on Reconstructive Treatment for Facial Lipodystrophy

On February 12, 2009, the Academy with the help of the Plastic and Reconstructive Surgery Committee sent comments to CMS regarding their proposal to create an NCD on Reconstructive Treatment for Facial Lipodystrophy. For more details on our comments, contact the health policy department at 1-703-535-3727. To read our letter and to view CMS National Coverage Analysis tracking sheet for the reconstructive treatments.

Medicare Physicians and Non-Physician Practitioners Internet Based Medicare Enrollment is Available in 34 States and the District of Columbia

Medicare has introduced the Internet-based Provider Enrollment, Chain and Ownership System (PECOS), which will allow physicians and non-physician practitioners to enroll, make changes in their Medicare enrollment, view their Medicare enrollment information on file with Medicare, and check the status of their Medicare enrollment applications via the Internet. PECOS will be available to physicians in 34 States including the District of Columbia.
Enroll in Medicare online for providers

CMS Final Rule on Medicare Physician Payment Changes Effective January 1, 2009

CMS issued the final 2009 Medicare physician payment rule that replaces a scheduled 15.1% cut with a  1.1% increase as required under the Medicare Improvement for Patients and Providers Act of 2008 (MIPPA). The rule also implements other MIPPA provisions, including a requirement that CMS revise the way it applies a budget neutrality adjustment related to the most recent five-year review of work RVUs.  The costs now will be offset through a reduction of about 6% in the conversion factor as had been requested by the RUC, the AMA and nearly all medical specialties. Despite the MIPPA-mandated 1.1% update, the conversion factor will actually fall from $38.09 in 2008 to $36.07 in 2009. However, work values will increase by nearly 12% so that average payments will reflect the 1.1% increase.

New Institutional NCCI Edits to be Applied to Claims

NCCI edits are updated quarterly and the institutional version is one calendar quarter behind the physician version. In the past, theOutpatient Code Editor (OCE) has not applied the NCCI edits for the following categories of services: anesthesiology, evaluation and management, and mental health services. Effective 1/1/09, these categorical exclusions will be removed and there will be a large number of new institutional NCCI edits applied to claims.
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Deadline for Audiologists to Obtain their National Provider Identifiers (NPI)

Effective October 1, 2008 CMS is requiring audiologists to obtain their NPI, to enroll in Medicare, and to start billing under their own name in order to receive reimbursement for the audiological tests they provide to Medicare beneficiaries.
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Medicare Publishes Billing Edits to Reduce Payment Errors

Beginning October 1, 2008, the Centers for Medicare & Medicaid Services will publish most of the edits used in its Medically Unlikely Edit (MUE) program to improve the accuracy of claims payments. CMS established the MUE program to reduce payment errors for Medicare Part B claims.  Claims processing contractors use these edits to assure that providers and suppliers do not report excessive services.  The edits are applied during the electronic processing of all claims.
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