The Centers for Medicare & Medicaid Services (CMS) has made available a file that contains the National Provider Identifier (NPI) and the name (last name, first name) of all physicians and non-physician practitioners who are of a type/specialty that is eligible to order and refer in the Medicare program and who have current enrollment records in Medicare (i.e., they have enrollment records in the Provider Enrollment, Chain and Ownership System (PECOS) that contain an NPI). Read more »

The Centers for Medicare & Medicaid Services (CMS) is revising certain Medicare policy which may affect physicians and suppliers who submit claims for diagnostic tests to Medicare.

Revisions to Publication 100-04, Medicare Claims Processing Manual, chapter 1, sections 30.2.9 and 30.2.9.1 (as codified in 42 CFR § 414.50) include two alternative methods for determining when to apply the anti-markup payment limitation, and changes to certain terminology.

These policy revisions, which go into effect March 15, were provisions of the 2008 Physician Fee Schedule (PFS) final rule (72 FR 66222) but were not finalized until the 2009 PFS final rule (73 FR 69799).

CMS Transmittal 1892, Change Request (CR) 6733 and Medicare Learning Network (MLN) Matters article MM6733 provide instructions for determining when the anti-markup payment limitation may apply to a physician/supplier submitting claims for diagnostic tests (other than clinical diagnostic laboratory tests) to Medicare.

Note that CMS also is replacing all references to the terms “purchased diagnostic test” and “purchased test interpretation” with “anti-markup test” or “diagnostic tests subject to the anti-markup payment limitation.”

As is usually the case in a recession, people are looking for ways to scrimp and save. Fortunately, chronic wound care is not one of those areas where people are willing to do without.

Renee Skinner, program director at six-hospital system UNC Healthcare’s Wound Healing Center, tells HealthLeaders Media, “When you have this type of issue, people will cut back on the things that are basic healthcare, but when they have an open wound that’s painful, that’s infective, they can’t ignore that. You can see the impact in the individual patients’ lives [due to layoffs], but the medical need doesn’t change with the economic climate of a nation.”

Hospitals are finding that wound healing centers are revenue drivers partly because of this high demand.

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Come Jan. 1, 2012, a provision in the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA) requires all suppliers of the technical component (TC) of advanced diagnostic imaging services suppliers to be accredited by an accreditation organization designated by the Secretary of Health and Human Services (HHS). To that end, the Centers for Medicare & Medicaid Services (CMS) has named three national accreditation organizations—The American College of Radiology (ACR), the Intersocietal Accreditation Commission (IAC) and The Joint Commission for the Accreditation of Healthcare Organizations (JCAHO)—for the job.

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Get out your CPT® 2010 book and a pencil — it’s time to make a few more corrections. The American Medical Association (AMA) issued an updated corrections document on Jan. 21.

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Two months ahead of schedule, the Medicare Payment Advisory Commission (MedPAC)—an independent congressional agency charged with advising Congress on a wide range of Medicare issues—voted Jan. 15 on recommendations for 2011 Medicare provider payment updates.

Here is a summary of MedPac’s recommendations to Congress:

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As we reported in a previous article, President Obama signed the Department of Defense appropriations bill into law on Dec. 19, 2009, delaying a 21.2 percent reduction in physician fees until March 1. In response, just days later, the Centers for Medicare & Medicaid Services (CMS) released the January 2010 Physician Fee Schedule (PFS) file that contains the 2010 relative value units (RVUs) and temporary conversion factor.

The amount of time it will take payers to update their systems with the new rates is much greater.

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Idaho and Illinois residents have been granted the legal right to externally appeal health insurance benefit denials. This brings the number of states without such a law down to just five: Mississippi, Nebraska, North Dakota, South Dakota, and Wyoming. The law, however, varies from state to state.

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The American Academy of Family Physicians (AAFP) believes the proposed Meaningful Use rules will be hard on small- and medium-sized practices, and wants changes made.

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On April 19, some providers currently serviced by Wisconsin Physician Service (WPS) will transition to jurisdiction 1 (J1), administered by Part A and Part B Medicare Administrative Contractor (A/B MAC) Palmetto GBA.

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