Wednesday, June 20, 2012
Important June Deadlines.....
HIPAA 5010 Deadline is June 30
Medicare Fee-For-Service Will Reject 4010 Transactions After June 29th
After June 29, any Medicare Fee-for-service claims submitted in version 4010 format will be rejected back to the submitter with the following message: "MSG-117 ON JUL 1, 2012, C LMS MUST BE ASC X12 V5010". All claims received after normal close of business cutoff times on June 29, 2012 must be sent as ASC X12 ver. 5010 or NCPDP D.0. Providers that are still conducting one or more of the Version 4010 transactions electronically, such as submitting a claim or checking claim status, or rely on a software vendor, billing service or clearinghouse to do this on their behalf, are affected.
In addition, beginning July 1, 2012, the Coordination of Benefits (outbound ASC X12 837) and Health Care Claim Status Response (ASC X12 277) transactions will be sent in version 5010 only.
Medicare FFS will be allowing an additional 30 days to complete the transition to the ASC X12 Health Care Claim Payment/Advice (835), also called the Remittance Advice. Therefore, as of August 1, 2012, Medicare FFS will be generating only the 5010 version of the 835 Remittance Advice for all trading partners. For more help with Version 5010 upgrades and Medicare claims, contact your MAC (Medicare Administrative Contractor). If you have difficulty reaching a MAC, send an email describing your issue, with "5010 Extension" in the subject line, to ProviderFeedback@cms.hhs.gov.
Medicare E-Prescribing Deadline June 30
Medicare providers must file at least 10 electronic prescriptions by June 30 to avoid penalties under Medicare's e-prescribing program. The Medicare e-Rx Incentive Program requires filing at least 10 G-8553 codes by June 30th in order to avoid a 1.5% Medicare deduction in 2013. Note: if you were not a successful e-prescriber in 2011 you must file via claims. From calendar year (CY) 2012 through 2014, a payment adjustment that increases each calendar year will be applied to an eligible professional's Medicare Part B Physician Fee Schedule (PFS) covered professional services for not becoming a successful electronic prescriber. The payment adjustment of 1.0% in 2012, 1.5% in 2013, and 2.0% in 2014 will result in an eligible professional or group practice participating in the eRx Group Practice Reporting Option (eRx GPRO) receiving 99.0%, 98.5%, and 98.0% respectively of their Medicare Part B PFS amount for covered professional services. The penalty is a 1.5 percent payment reduction for all Medicare claims filed in 2013. Physicians can apply for a hardship exemption but it must be done before June 30 deadline. You can file for a hardship exemption through the Quality Reporting Communication Support Pageor by submitting one claim with the 'G' hardship codes by June 30, 2012. For more details you can review this MLN Matters.
CMS Accepting Applications for Next Round of Advanced Payment ACOs
Notices of intent to apply to the Medicare Shared Savings Program are due June 29. Applications to Advance Payment Model are due Sept. 19.
As of Aug. 1, the CMS will begin accepting applications for a new round of Advance Payment ACOs, which offers upfront and monthly payments to health care providers who have come together to share responsibility and provide coordinated high quality care to their Medicare patients. Under the Medicare Shared Savings program the selected participants can use the payments to make important investments in their care coordination infrastructure. The program is designed to help smaller ACOs, with less capital, participate in the Shared Savings Program. Additional information can be found in a CMS fact sheet.