Reporting quality measures for the Centers for Medicare & Medicaid Services’ (CMS) Physician Quality Reporting System (PQRS) has been a reason to protest for many medical specialist societies. The good news is that Medicare listened and come Jan. 1, 2014 will allow them to determine quality measures for their specialty-specific physicians.
According to Modern Healthcare:
The rule represents a major victory for the specialty societies, which had protested a common set of quality measures that many said favored primary care and family physicians over specialists. CMS in 2015 will begin imposing penalties on physicians who fail to report to one of these new "qualified clinical directories,” which will satisfy requirements for participating in the agency’s Physician Quality Reporting System.
The new rule brings more incentives for physicians to participate. Arthur Lerner, M.D., of Technology Education Consulting in Healthcare said, “The rule change empowers societies, medical boards and healthcare organizations to create data registries for their members that would include their own CMS-approved quality measures,” according to Modern Healthcare. He added, “This would more closely address the quality of patient care that their members provide.”
In 2014, 400,000 are estimated to participate in PQRS and beginning in 2015, physicians who do not participate will be penalized 1.5 percent (based on part B charges in 2013).
For more information on the new rule and PQRS, go to the CMS website.
Source: Modern Healthcare
Telehealth services are becoming more mainstream and the Centers for Medicare & Medicaid Services (CMS) shows its continued support for remote services in the 2014 Medicare Physician Fee Schedule (MPFS) final rule, published in the Nov. 27 Federal Register.
Prior to 1999, Medicare coverage for services furnished by a telecommunications system was limited to things like X-ray interpretations, electroencephalogram tracing, and cardiac pacemaker analysis. The Medicare, Medicaid and SCHIP Benefits Improvement Protection Act of 2000 (BIPA) significantly expanded Medicare coverage for telehealth services. For example, one provision expanded the Social Security Act to require the Department of Health & Human Services (HHS) secretary to establish a process that provides for annual updates to the list of telehealth services. CMS established this policy in the 2003 MPFS final rule.
Medicare also provides payment of a facility fee to the originating site. Telehealth originating sites are those located in a designated rural health professional shortage area (HPSA) in a county that isn’t in a metropolitan statistical area (MSA), or an entity that participates in an approved federal telemedicine demonstration project.
The initial list of telehealth originating sites included the physician office, critical access hospitals, rural health clinics, federally qualified health centers, and hospitals. The Medicare Improvements for Patients and Providers Act of 2008 (MIPPA) expanded the list to include hospital-based renal dialysis centers, skilled nursing facilities, and community mental health centers.
In the 2014 MPFS final rule, CMS redefines rural HPSAs as those located in rural census tracts as determined by the Office of Rural Health Policy (ORHP), defining “rural” to include geographic areas located in rural census tracts within MSAs. CMS also finalizes its proposal to establish and maintain geographic eligibility for an originating site on an annual basis.
The telehealth originating site facility fee in 2014 is increased by the 2014 MEI increase of 0.8 percent, making the 2014 payment amount for HCPCS Level II code Q3014 Telehealth originating site facility fee 80 percent of the lesser of the actual charge, or $24.63—up 20 cents from 2013.
CMS has also greatly added to the list of approved telehealth services over the years. The 2014 MPFS final rule further expands the list of approved telehealth services by adding “transitional care management.”
CMS finalized a payment policy for CPT® transitional care management codes 99495 and 99496 in the 2013 MPFS final rule. These services are for a patient whose medical and/or psychosocial problems require moderate or high complexity medical decision-making during transitions in care from an inpatient hospital setting. Transitional care management is comprised of one face-to-face visit within the specified time frames following a discharge, in combination with non-face-to-face services that may be performed by the physician or other qualified healthcare professional and/or licensed clinical staff under his/her direction.
Continue to append modifier GT Interactive audio and video telecommunications systems or GQ Asynchronous telecommunications system to the procedure code to receive payment equal to the amount the physician would have been paid if the service had been furnished without the use of a telecommunications system.
CMS is soliciting public requests to add services to the list of Medicare telehealth services. The deadline to submit requests is Dec. 31 to be considered for the next rulemaking cycle. For instructions on how to submit a request, go to www.cms.gov/telehealth.
The AMA has raised the alarm about insurers who pay providers using credits cards. When redeemed, the cards incur transaction costs of up to 5 percent, which must be borne by the provider and effectively lower reimbursement.
James L. Madara, MD, Executive Vice President and CEO of the AMA, wrote of the issue in a letter to Centers for Medicare & Medicaid Services (CMS) administer Marilyn B. Tavenner. The letter additionally noted, “that some credit card companies offer incentives of up to 1.75 percent of the claim amount to payers or their claims administrators when reimbursement is made using a commercial credit card.”
Put another way, using credit cards for payment not only shifts the costs of transferring money electronically from the payer to the practice, but also allows payers to recoup money for themselves while simultaneously shortchanging providers.
To fight against the transaction costs eroding provider reimbursement, the AMA recommended that CMS “prohibit payers from reimbursing physicians anything less than the contracted rate on their fee schedules when they pay physicians electronically,” as well as “ encourage payers to accept the newly adopted EFT [electronic funds transfer] standard prior to the January 1, 2014, implementation date if a physician requests this standard sooner than the effective date.”
You don’t have to wait for government action to counter insurers’ credit card payments, however. First, be sure you don’t agree to credit card payments from the payer as part of any new contract. Better still, insist that payments be made by check or electronic funds transfer without additional transaction costs. Also be aware of your office’s merchant credit card agreement and its associated fees. You can negotiate these contracts, as well.
If you’re already receiving credit card payments, call the insurer(s) and insist they reinstate payments via check or EFT. The healthcare electronic funds transfer standard known as ACH CCD+ is approved the Health Insurance Portability and Accountability Act (HIPAA) and costs less than credit card transactions.
When you report a CPT® “unlisted procedure” code, or one of the new technology (Category III) codes, you may be required to enclose a special report with your claim. Additionally, the CPT® manual provides instruction regarding special reports in the Radiology Guidelines, which specify, “A service that is rarely provided, unusual, variable, or new may require a special report. Pertinent information should include an adequate definition or description of the nature extent, and need for the procedure; and the time effort, and equipment necessary to provide the service.”
The special report should also provide information about the time, effort, and equipment necessary to provide the service. Additional information that may be helpful to the carrier includes: The complexity of symptoms, final diagnosis, pertinent physical findings, diagnostic and therapeutic procedures performed, concurrent problems, and planned follow-up care. This data gives the payer a better understanding of what the procedure is, what was required to perform it, and how it should be reimbursed.