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Check out the latest updates on Medicare fee schedule , proposed rule includes key points for RD Medicare providers, & CMS extends Pecos enrollment deadline.
Medicare fee schedule update: A drastic 21% cut to providers has been avoided with Congress reaching agreement on legislation to temporarily patch the Medicare payment problem for the next six months. The new legislation delays the 21% cut to payments until Nov. 30, and increases payments by 2.2% retroactive to June 1. Despite the fix, Medicare provider payments will decrease 23% on Dec. 1, unless Congress can act before then. To prepare for the 2.2 % update, CMS directed Medicare administrative contractors (MACs) to discontinue processing claims at the negative update rates and to temporarily hold all claims submitted June 1 and later. CMS expects to begin processing claims at the new rates no later than July 1. According to CMS, claims paid at the negative update rates will be reprocessed as soon as possible. Check with your MAC for local guidance. A list of MACs can be found in the Medicare MNT page on ADA’s Web site (in Become a Provider) or directly at http://www.eatright.org/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=4294967924
Proposed rule includes key points for RD Medicare providers.
The Centers for Medicare & Medicaid (CMS) just released the Medicare Program; Payment Policies Under the Physician Fee Schedule and Other Revisions to Part B for CY 2011 notice which includes important points for registered dietitians (RDs). The federal register notice allows the public a 60-day comment period before CMS finalizes the rule and it becomes effective January 1, 2011. A few of the key proposed changes that impact RDs:
· CMS is developing regulations for a new annual wellness visit which includes a health risk assessment (HRA) and creates a personalized prevention plan for beneficiaries. RDs are listed as one of the eligible medical professionals who may screen and counsel Medicare beneficiaries.
· CMS will waive the deductible and copayments for medical nutrition therapy (MNT) services, as well as other preventive services with an A or B rating from the U.S. Preventative Services Task Force (USPSTF). Since diabetes self management training (DSMT) services are not currently rated by the USPSTF, beneficiaries receiving DSMT must still pay the Medicare deductible, if applicable, and the copayment at each visit;
· The deductible and copayment is also waived for preventive services provided at Federally Qualified Health Centers;
· CMS will expand Medicare Part B telehealth services to include group MNT, DSMT for individual and group sessions (note there are some special considerations for DSMT) and individual and group kidney disease education;
· The DSMT code values, or the payment for the service, are updated;
· Throughout 2011, RDs and other eligible providers will receive a 1% incentive payment for qualifying claims submitted under the Physician Quality Reporting Initiative (PQRI). The incentive payment decreases to 0.5% in 2012 - 2014, and beginning in 2015, a penalty will apply for eligible providers who do not satisfactorily submit quality data.
Other items in the proposed rule include changes in the monthly capitation payment for end-stage renal disease (ESRD) related services for home dialysis and other ESRD provisions, durable medical equipment and supplies bidding issues, and more. The proposed rule is accessible at http://www.federalregister.gov/OFRUpload/OFRData/2010-15900_PI.pdf.
Look for ongoing coverage and guidance from ADA.
CMS extends Pecos enrollment deadline: For those who were concerned about the July 6th deadline to get updated information into Medicare’s online provider enrollment system (PECOS), you have more time. The Centers for Medicare & Medicaid Services (CMS) is working with providers to address concerns about enrollment in the Internet-based PECOS to ensure that Medicare beneficiaries continue to receive the health care services and items they need. As a result, CMS will not implement changes that would automatically reject claims based on orders, certifications and referrals made by providers who 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. Until the automatic rejections are operational (date still unknown), providers should not see any change in the processing of submitted claims; they will continue to be reviewed and paid as they have been historically.
Bottom line: If you need to submit or update your Medicare enrollment, do so as soon as possible. As a reminder, RDs who have not submitted a Medicare application since 2003 must submit an updated application. For information and to submit an online application, go to http://www.cms.gov/MedicareProviderSupEnroll/04_InternetbasedPECOS.asp#TopOfPage
The July MNT Provider is now available for all ADA members. |
