Updates and News from the Centers of Medicare and Medicaid Services

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. To enroll in Medicare on line

CMS Final Rule on Medicare Physician Payment Changes Effective Jan. 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. Learn more.

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. Learn more.

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. More.

Tamper Proof Rx Pads Rule

• Consultation Guidelines
  
  
  •  Revised Consultation Guidelines
    
• Medicare/Medicaid Prescription Drug Coverage
  
• • Toolkit for Healthcare Professionals
    

  • CMS TO REQUIRE TAMPER-RESISTANT PRESCRIPTIONS for MEDICAID