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Medicare Update for Physician Services

Medicare Update for Physician Services is a free, monthly e-zine that delivers news and information to help physician practices keep pace with news from CMS and the OIG. Each issue presents news items are by category, including a brief description and links to the full government document.

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Medicare Update for Physician Services

Issue 12, December 1, 2011

• Note from Peggy: Highlights of the 2012 Medicare Physician Fee Schedule final rule

  The 2012 Medicare Physician Fee Schedule (MPFS) Final Rule was published in the November 28 Federal...

• Regulations: CMS publishes MPFS final rule, ACO final rule, and more

  On November 28, CMS published the Medicare Physician Fee Schedule final rule in the Federal...

• Transmittals/MLN Marrters articls: CMS changes policy on autologous cellular immunotherapy treatment and more

  On October 28, CMS released a transmittal announcing that for claims processed with dates of...

• Quarterly updates: CMS creates new influenza vaccine code

  On October 28, CMS released a transmittal announcing that for claims processed with dates of...

• Other developments: CMS posts new PCIP FAQs and updates RVU file

  CMS posted several FAQs about the Primary Care Incentive Payment (PCIP) program

• Events: December 13 Physician Open Door Forum

  The next Physicians, Nurses & Allied Health Professionals Open Door Forum is scheduled for...

Issue 11, November 3, 2011

• Note from Peggy: 2012 OIG Work Plan for Professional Services

  On October 5, the Department of Health and Human Services (HHS) released the Office of Inspector...

• Regulations: CMS extends Bundled Payments deadline and issues proposals for Medicare Advantage

  CMS extends Bundled Payments deadline and issues proposals for Medicare Advantage

• Transmittals/MLN Marrters articls: CMS publishes new interest rate, revises manual, and more

  CMS publishes new interest rate, revises manual, and more

• Quarterly updates: CMS updates the CCI edits

  On October 12, CMS published the quarterly updates to the correct coding initiative (CCI) edits.

• Other developments: CMS, DOJ, and FTC issue ACO information

  On October 20, CMS published several fact sheets about accountable care organizations (ACO) and the...

• CMS Public Events: None this week

  There are no public events this week.

Issue 10, October 6, 2011

• Regulations: CMS updates "amount in controversy," and more

  On September 23, CMS posted a notice in the Federal Register to announce the annual adjustment in...

• Note from Peggy: CMS clarification of evaluation and management policy

  Ever since January 1, 2010, when CMS decided to no longer recognize the CPT consult codes for...

• Transmittals/MLN Matters articles: CMS posts special article on balance billing, and more

  CMS has posted a special edition MLN Matters article on balance billing of qualified Medicare...

• Quarterly updates: CMS releases updated lab NCD edits, and more

  On September 2, CMS issued a transmittal to announce changes that will be included in the October...

• Events: September 20 Hospital Open Door Forum transcript available

  MedicareFind subscribers can now access the written transcript and audio recording of the...

Issue 9, September 1, 2011

• Note from Peggy: Wait to hear from your Medicare Administrative Contractor (MAC) before revalidating your provider enrollment information

  Several years ago, there was a discussion in the Federal Register about requiring all providers to...

• Transmittals/MLN Matters articles: CMS instructs on MRI coverage, MUEs, and RAC letters

  Effective for claims with dates of service on or after July 7, 2011, CMS believes that the...

• Quarterly updates: CMS posts HCPCS update, I/OCE changes, and more

  CMS has posted its regular update transmittal for HCPCS Level II codes.

• Events: August 9 Hospital Open Door Forum transcript available

  MedicareFind subscribers can now access the written transcript and audio recording of the...

Issue 8, August 4, 2011

• Peggy’s note: Medicare proposed rule regarding payment policies under the 2012 physician fee schedule for Medicare Part B

  On July 19, 2011, CMS published a proposed rule in the Federal Register regarding the payment...

• Regulations: CMS publishes MPFS proposal, proposes changes to lab signature requirements

  On July 19, CMS published in the Federal Register a proposed rule to modify the MPFS for calendar...

• Transmittals/MLN Matters articles: CMS instructs on imaging accreditation, eRx, and more

  CMS posted a special edition MLN Matters article to provide assistance to providers in meeting the...

• Quarterly updates: CMS updates CLIA list, lab NCDs, and more

  On July 22, CMS issued a transmittal to inform contractors of new HCPCS codes subject to the CLIA...

• Events: June 28 Physician Open Door Forum transcript available

  MedicareFind subscribers can now access a transcript and recording of the June 28 Physicians...

Issue 7, July 7, 2011

• Note from Peggy: Routine foot care coverage summary

  CMS released a special edition MLN Matters article regarding foot care coverage guidelines. ...

• Regulations: CMS issues MPFS proposal, RVU review, and more

  CMS has posted a display copy of the physician fee schedule proposed rule for 2012.

• Transmittals/MLN Matters articles: CMS instructs on foot care, preventive services, and more

  CMS has released a special edition MLN Matters article on foot care coverage guidelines. The...

• Quarterly updates: CMS updates waived tests and more

  CMS has released its regular update to inform contractors of new waived tests under CLIA.

• Other developments: CMS posts IPPE FAQs and more

  CMS has posted a new set of FAQs on the initial preventive physical examination (IPPE).

Issue 6, June 2, 2011

• Note from Peggy: Processing of laboratory services

  The Clinical Laboratory Improvement Amendments of 1988 (CLIA) regulate all laboratories working...

• Regulations: CMS clarifies three-day rule, posts vaccine proposal

  As part of its recently released proposed rule for the inpatient prospective payment system, CMS...

• Transmittals/MLN Matters articles: CMS posts new K codes and more

  On April 29, CMS issued a transmittal to create four new K codes for suction pumps and accompanying...

• Quarterly updates: CMS releases updated RVU file, MPFS update, and more

  CMS has posted the RVU quarterly update file under the MPFS.

• Other developments: OIG examines HIPAA enforcement

  On May 16, the OIG issued a report on CMS’ oversight and enforcement of HIPAA. The OIG...

• Events: May 17 Physician Open Door Forum transcript available

  MedicareFind subscribers can now access a transcript and recording of the April 5 Physicians...

Issue 5, May 5, 2011

• Note from Peggy: Savings on account of ACOs

  In the April 7 edition of the Federal Register, CMS released a proposed rule concerning Medicare...

• Regulations: CMS publishes ACO proposal in Federal Register, releases flu vaccine proposed rule, and more

  On April 7, CMS published in the Federal Register a proposed rule to set requirements for...

• Transmittals/MLN Matters articles: CMS instructs on face-to-fact requirement, issues MLN Matters articles, and more

  On April 22, CMS issued a transmittal to implement manual language related to the face-to-face...

• Quarterly update: CMS posts new waived tests, interest rate

  On April 22, CMS issued a transmittal to notify contractors of new waived tests approved by the...

• Other developments: CMS posts top RAC issues, OIG audits diagnostic radiology

  CMS has posted a summary document to outline the top audit issues for each RAC and provide...

• Events: April 5 Open Door Forum transcript available

  MedicareFind subscribers can now access a transcript of the April 5 Physicians, Nurses and Allied...

Issue 4, April 7, 2011

• Note from Peggy: Primary care practitioners get a raise!

  Primary care practitioners are getting a raise from Medicare in the form of the primary care...

• Regulations: HHS releases ACO rulemaking

  CMS and the OIG have released display copies of a proposed rule and notice regarding accountable...

• Transmittals/MLN Matters articles: CMS posts special article on PCIP, instructs on MRI coverage, and more

  CMS has posted a special edition MLN Matters article on the primary care incentive payment program...

• Quarterly updates: CMS updates RVU file, MUEs, lab fee schedule, and more

  CMS has posted an update to the clinical laboratory fee schedule (CLFS) file.

• Other developments: CMS issues drug billing FAQs, addresses eRx incentives

  CMS’ physician regulatory issues team (PRIT) recently addressed the question of whether a...

• Events: February 22 Open Door Forum transcript available

  MedicareFind subscribers can now access the transcript and audio of the Physicians, Nurses, and...

Issue 3, March 3, 2011

• Note from Peggy: ABNs and modifiers

  While advance beneficiary notices (ABN) have been simplified with the implementation of the...

• Regulations: CMS publishes screening requirements final rule

  On February 2, CMS published in the Federal Register a final rule to implement provisions of the...

• Transmittals/MLN Matters articles: CMS updates annual wellness visit transmittals, instructs on -GZ denials, and more

  On February 25, CMS issued a transmittal to instruct its auditing contractors (e.g., RAC, CERT...

• Quarterly update: CMS issues lab/drug updates and more

  On February 11, CMS issued a transmittal to inform contractors of new waived tests approved by the...

• Other developments: CMS announces reprocessing plan, introduces esMD, and more

  CMS has issued its second edition of its provider compliance newsletter. This issue features...

• Events: Physician Open Door Forum April 5

  The next Physician, Nurses and Allied Health Professionals Open Door Forum is scheduled for...

Issue 2, February 3, 2011

• Note from Peggy: The 2011 MPFS conversion factor

  A zero percent update to the Medicare Physician Fee Schedule (MPFS) reduces the 2011 conversion...

• Regulations: CMS withdraws advance care planning, publishes screening final rule, and more

  CMS has issued a display copy of a final rule to implement provisions of the Patient Protection...

• Transmittals/MLN Matters articles: CMS implements timely filing changes, establishes lab payment demonstration, and more

  On January 28, CMS issued two transmittals to put in place a demonstration project for certain...

• Quarterly updates: CMS updates interest rates, lab NCDs

  On January 14, CMS issued a transmittal to implement a quarterly update to the interest rate that...

• Other developments: CMS posts new RAC FAQ

  What happens if the recovery auditor does not meet the 60 day requirement?

Issue 1, January 6, 2011

• Note from Peggy: New benefit for annual wellness visit

  Happy new year and welcome to a new Medicare benefit in the form of an annual wellness visit...

• Regulations: CMS posts EHR corrections, asks for RAC comments, and more

  On December 29, CMS published in the Federal Register a document to correct typographical and...

• Transmittals/MLN Matters articles: CMS addresses ordering/referring providers, ABN validity assessments, and more

  On December 17, CMS issued a transmittal to incorporate a table of therapy CPT codes indicating...

• Quarterly updates: CMS implements 2011 MPFS, posts lab travel allowance

  On December 29, CMS issued a transmittal to post implement policy changes under the MPFS for 2011.

• Other developments: CMS implements statutory payment fix and more

  On December 15, President Obama signed into law the Medicare and Medicaid Extenders Act of 2010...

• Events: Physician Open Door Forum January 11

  The next Physician, Nurses and Allied Health Professionals Open Door Forum is scheduled for...

• Events: January 11 Physician Open Door Forum transcript available

  MedicareFind subscribers can now access the transcript and audio of the Physicians, Nurses and...