Thursday, April 3, 2014
Health Plan Certification of Compliance Comment Period Extended to April 3
The Department of Health and Human Services (HHS) has extended the comment period for the proposed rule, “Administrative Simplification: Health Plan Certification of Compliance.” HHS is specifically looking to receive additional comments from third party administrators (TPAs) and self-insured plans.
HHS is now accepting public comments on the proposed rule through April 3, 2014.
The Certification of Compliance for Health Plans proposed rule is different from previous Health Insurance Portability and Accountability Act (HIPAA) Administrative Simplification regulations because it affects more and different types of entities.
For example, many third party administrators, self-funded health plans, and group health plans that have not been impacted by previous HIPAA Administrative Simplification requirements will be affected by this rule, even if they do not directly conduct HIPAA covered transactions.
The proposed rule would require controlling health plans to submit documentation on or before December 31, 2015. It would also establish penalty fees for a controlling health plan that fails to comply with the Certification of Compliance requirements.
The goal of the extension of the comment period is to provide these entities with time to understand and offer feedback on the business impacts of the Certification of Compliance proposed rule. HHS encourages these entities to submit feedback so that their comments and suggestions can be considered during the policy-making process.
Road to 10: The Small Physician Practice's Route to ICD-10
The Centers for Medicare & Medicaid Services (CMS) is pleased to announce the release of the Road to 10, a free online resource built with the help of physicians in small practices. Available on the Provider Resources page at cms.gov/ICD10, this tool is intended to help small medical practices jumpstart their ICD-10 transition.
The Road to 10 gives providers the capability to build ICD-10 action plans tailored for their practice needs. The customized action plans break down the transition into concrete steps:
- Plan Your Journey – Look at the codes you use, prepare a budget, and build a team;
- Train Your Team – Find options and resources to help your team get ready for the transition;
- Update Your Processes – Check your clinical documentation and update policies, procedures, systems, and forms;
- Engage Your Partners – Talk to your software vendors, clearinghouses, and billing services; and
- Test Your Systems and Processes – Test within your practice and with your partners.
The tool is designed for use by small practices in primary care as well as all specialties. The Road to 10’s resources include common ICD-9 and ICD-10 codes, clinical documentation primers, and clinical scenarios for:
- Family practice
- Internal medicine
- Pediatrics
- OB/GYN
- Cardiology
- Orthopedics
Keep Up to Date on ICD-10
Visit the CMS ICD-10 website for the latest news and resources to help you prepare for the October 1, 2014, compliance date. Sign up for CMS ICD-10 Industry Email Updates and follow us on Twitter.
Wednesday, April 2, 2014
Register for Group Practice Reporting Option for 2014 PQRS Participation
Group Practices Can Now Register for Group Practice Reporting Option for 2014 PQRS Participation
Eligible professionals (EPs) who wish to participate in the 2014 PQRS program as a group practice can now register for the group practice reporting option (GPRO).
When your group is ready to register, you can access the PV-PQRS Registration System at https://portal.cms.gov. You will need to use a valid IACS User ID and password to choose your group’s reporting mechanism. The registration system will be open from April 1 to September 30 for the 2014 PQRS program.
Additional information about the 2014 GPRO registration is available on the CMS website.
Participating as a Group Practice
Group practices participating in the GPRO that satisfactorily report data on PQRS measures during the 2014 reporting period (January 1- December 31) are eligible to earn the 0.5% incentive payment and will avoid the -2% 2016 PQRS payment adjustment.
To earn an incentive for the 2014 PQRS program year and avoid the 2016 PQRS payment adjustment, group practices with 2 or more eligible professionals may register to participate in GPRO via:
If your group has 25 or more eligible professionals, you can also participate in GPRO via:
Value Modifier
Groups of physicians with 10 or more EPs that want to participate in PQRS as a group must register for a PQRS group reporting mechanism in the PV-PQRS Registration System. Please note that in order to avoid the -2% Value Modifier payment adjustment in 2016, the group must meet the criteria to avoid the 2016 PQRS negative payment adjustment.
Additional Resources
Join CMS on April 10 for a National Provider Call on registering for the PQRS GPRO in 2014. For additional information on how to register in the PV- PQRS Registration System, please visit the Self Nomination/Registration page on the Physician Feedback/Value Modifier website. For more information about how to participate in the 2014 PQRS program through the GPRO, review the 2014 PQRS GPRO Requirements document.
For questions about how to register, contact the Quality Net Help Desk at 1-866-288-8912 (TTY: 1-877-715-6222), or by email: Qnetsupport@sdps.org.
Eligible professionals (EPs) who wish to participate in the 2014 PQRS program as a group practice can now register for the group practice reporting option (GPRO).
When your group is ready to register, you can access the PV-PQRS Registration System at https://portal.cms.gov. You will need to use a valid IACS User ID and password to choose your group’s reporting mechanism. The registration system will be open from April 1 to September 30 for the 2014 PQRS program.
Additional information about the 2014 GPRO registration is available on the CMS website.
Participating as a Group Practice
Group practices participating in the GPRO that satisfactorily report data on PQRS measures during the 2014 reporting period (January 1- December 31) are eligible to earn the 0.5% incentive payment and will avoid the -2% 2016 PQRS payment adjustment.
To earn an incentive for the 2014 PQRS program year and avoid the 2016 PQRS payment adjustment, group practices with 2 or more eligible professionals may register to participate in GPRO via:
- Qualified PQRS registry
- Directly from EHR using certified EHR technology (CEHRT)
- CEHRT via data submission vendor
If your group has 25 or more eligible professionals, you can also participate in GPRO via:
- Web interface (reporting CG CAHPs also required for groups of 100+)
- CG CAHPS via CMS-certified survey vendor (supplement to other PQRS reporting mechanisms)
Value Modifier
Groups of physicians with 10 or more EPs that want to participate in PQRS as a group must register for a PQRS group reporting mechanism in the PV-PQRS Registration System. Please note that in order to avoid the -2% Value Modifier payment adjustment in 2016, the group must meet the criteria to avoid the 2016 PQRS negative payment adjustment.
Additional Resources
Join CMS on April 10 for a National Provider Call on registering for the PQRS GPRO in 2014. For additional information on how to register in the PV- PQRS Registration System, please visit the Self Nomination/Registration page on the Physician Feedback/Value Modifier website. For more information about how to participate in the 2014 PQRS program through the GPRO, review the 2014 PQRS GPRO Requirements document.
For questions about how to register, contact the Quality Net Help Desk at 1-866-288-8912 (TTY: 1-877-715-6222), or by email: Qnetsupport@sdps.org.
Medicare Part A News-Jurisdiction H for April 1st, 2014
The following news is brought to you by Novitas Solutions.
Medicare News
2014 Medicare Symposiums
Dates and locations for upcoming 2014 Medicare Symposiums are now available! Register today for an event near you! Additional event locations and handout materials will be added when they become available. Stay tuned for updates!
2014 Open Meeting Dates and New Meeting Format Information is Now Posted
Dates for the remainder of the 2014 Open Meetings are now posted here.
Please note that starting in May of 2014 the Novitas Solutions Open Meeting will be a combined meeting for both Medicare Administrative Contractor (MAC) Jurisdiction H (JH) and MAC Jurisdiction L (JL) contract areas.
Open Meetings are for the purpose of discussing draft Local Coverage Determinations (LCDs). Anyone is welcome to present information related to the policies that are in the 45-day draft comment period. Interested participants may request to present scientific, evidence-based information; professional consensus opinions; or any other information that is relevant to any of the LCDs that are in draft. These in-person presentations are made to the Novitas Solutions’ Contractor Medical Directors. Interested parties may also request to attend as an observer.
NOTE: The Open Meeting is not a forum for discussing specific claims; or for the submission of new drugs, indications, or marketing of forthcoming drugs or medical devices. Information regarding new drugs, indications, or marketing information should be submitted according to Novitas guidelines. Specific claim questions, including billing, pricing and coding, should be directed to our Customer Service Center at 1-877-235-8073.
Medicare Learning Network (MLN) Matters Articles from CMS
Medicare News
2014 Medicare Symposiums
Dates and locations for upcoming 2014 Medicare Symposiums are now available! Register today for an event near you! Additional event locations and handout materials will be added when they become available. Stay tuned for updates!
2014 Open Meeting Dates and New Meeting Format Information is Now Posted
Dates for the remainder of the 2014 Open Meetings are now posted here.
Please note that starting in May of 2014 the Novitas Solutions Open Meeting will be a combined meeting for both Medicare Administrative Contractor (MAC) Jurisdiction H (JH) and MAC Jurisdiction L (JL) contract areas.
Open Meetings are for the purpose of discussing draft Local Coverage Determinations (LCDs). Anyone is welcome to present information related to the policies that are in the 45-day draft comment period. Interested participants may request to present scientific, evidence-based information; professional consensus opinions; or any other information that is relevant to any of the LCDs that are in draft. These in-person presentations are made to the Novitas Solutions’ Contractor Medical Directors. Interested parties may also request to attend as an observer.
NOTE: The Open Meeting is not a forum for discussing specific claims; or for the submission of new drugs, indications, or marketing of forthcoming drugs or medical devices. Information regarding new drugs, indications, or marketing information should be submitted according to Novitas guidelines. Specific claim questions, including billing, pricing and coding, should be directed to our Customer Service Center at 1-877-235-8073.
Medicare Learning Network (MLN) Matters Articles from CMS
New:
- MM8651 – Implement Operating Rules - Phase III ERA EFT: CORE 360 Uniform Use of Claim Adjustment Reason Codes (CARC) and Remittance Advice Remark Codes (RARC) Rule - Update from CAQH CORE - February 1, 2014 version 3.0.4
- MM8695 – Calendar Year (CY) 2014 Annual Update for Clinical Laboratory Fee Schedule and Laboratory Services Subject to Reasonable Charge Payment - REVISION
Medicare Part A News-Jurisdiction H for March 31st, 2014
The following news is brought to you by Novitas Solutions.
Medicare News
Protocol for Submission of Information relative to New Drugs, New or Revised Indications, or Marketing Information of Forthcoming Drugs or Devices is Now Available!
Please review Novitas Solutions’ protocol regarding Submission of Information relative to New Drugs, New or Revised Indications, or Marketing Information of Forthcoming Drugs or Devices. This information can be also be located by clicking Medical Policy Center, from the left menu. Look for it under the section “Need Help?”
JH Part A Webinar Handout: "Update - New Novitas Website"
How long do I have to submit a claim? Are there exceptions if I miss the deadline to file a claim? Find answers to these questions and more when you visit the Novitas Educational Tips and Tools - NETTs page and review the document titled "Timely Filing Requirements". Additional documents are available for your viewing pleasure. Visit this page often to see what has been added or join the Listserv and receive immediate notification when something is added or updated.
Medicare News
Protocol for Submission of Information relative to New Drugs, New or Revised Indications, or Marketing Information of Forthcoming Drugs or Devices is Now Available!
Please review Novitas Solutions’ protocol regarding Submission of Information relative to New Drugs, New or Revised Indications, or Marketing Information of Forthcoming Drugs or Devices. This information can be also be located by clicking Medical Policy Center, from the left menu. Look for it under the section “Need Help?”
JH Part A Webinar Handout: "Update - New Novitas Website"
April 2, 2014 (1:00pm-2:30pm CT, 2:00pm-3:30pm ET)
Join us for our webinar "Update - New Novitas Website" on April 2, 2014 (1:00pm CT/2:00pm ET).
We will demonstrate the improved Novitas Solutions website, how to navigate the site, inform you of the new available search tools, and provide tips to enhance your search results.
Register today for this informative event!
Novitas Educational Tips and Tools - NETTs: Timely Filing
We will demonstrate the improved Novitas Solutions website, how to navigate the site, inform you of the new available search tools, and provide tips to enhance your search results.
Register today for this informative event!
Novitas Educational Tips and Tools - NETTs: Timely Filing
How long do I have to submit a claim? Are there exceptions if I miss the deadline to file a claim? Find answers to these questions and more when you visit the Novitas Educational Tips and Tools - NETTs page and review the document titled "Timely Filing Requirements". Additional documents are available for your viewing pleasure. Visit this page often to see what has been added or join the Listserv and receive immediate notification when something is added or updated.
Medicare Part A News-Jurisdiction H for March 28th, 2014
The following announcements are brought to you by Novitas Solutions.
We have updated our online status tool to include the status of Phase 3 revalidation applications (i.e., requests issued after September 20, 2013). We apologize for the inconvenience and appreciate your patience as we worked through this issue. We request that you utilize the online tool as your source of information for application status so our Customer Service Representatives can be utilized for more complex inquiries.
JH Part A Top Inquiries (December 2013 - February 2014)
The JH Part A Top Inquiries Frequently Asked Questions (FAQs) have been updated. Please visit our FAQs for the answers to your questions.
Medical Policy Updates
The following JH MAC Local Coverage Determinations (LCDs) which were posted for notice on February 6, 2014 are now effective:
The JH MAC draft LCD L32687 Wound Care and Cellular and/or Tissue-Based Products for Wounds scheduled to become effective on 3/27/2014 has been placed on hold. Therefore, the LCD has been reverted back to the version effective prior to the 3/27/2014 revisions and has been revised for dates of service on and after 01/01/2014 to reflect the annual CPT/HCPCS code updates.
The following JH MAC Local Coverage Determination (LCD) which was posted for notice on February 6, 2014 is now effective. This LCD has also been revised:
The following JH MAC LCD has been retired effective March 26, 2014 for dates of service on and after March 27, 2014:
Enhanced Provider Enrollment Status Inquiry Tool
The following JH MAC Local Coverage Determinations (LCDs) which were posted for notice on February 6, 2014 are now effective:
- Bariatric Surgical Management of Morbid Obesity (L32619)
- Frequency of Dialysis (L32755)
- Glaucoma Treatment with Aqueous Drainage Device (L32733)
- Hemophilia Factor Products (L32735)
- Infrared Photocoagulation (IRC) of Hemorrhoids (L34350)
- Intraoperative Neurophysiological Testing (L32605)
- Lacrimal Punctum Plugs (L32607)
- Outpatient Sleep Studies (L32711)
- Qualitative Drug Testing (L34352)
- Surgery: Blepharoplasty (L32715)
- Vascular Access for Hemodialysis (L32708)
- Wireless Capsule Endoscopy (L32686)
The JH MAC draft LCD L32687 Wound Care and Cellular and/or Tissue-Based Products for Wounds scheduled to become effective on 3/27/2014 has been placed on hold. Therefore, the LCD has been reverted back to the version effective prior to the 3/27/2014 revisions and has been revised for dates of service on and after 01/01/2014 to reflect the annual CPT/HCPCS code updates.
The following JH MAC Local Coverage Determination (LCD) which was posted for notice on February 6, 2014 is now effective. This LCD has also been revised:
The following JH MAC LCD has been retired effective March 26, 2014 for dates of service on and after March 27, 2014:
Enhanced Provider Enrollment Status Inquiry Tool
We have updated our online status tool to include the status of Phase 3 revalidation applications (i.e., requests issued after September 20, 2013). We apologize for the inconvenience and appreciate your patience as we worked through this issue. We request that you utilize the online tool as your source of information for application status so our Customer Service Representatives can be utilized for more complex inquiries.
JH Part A Top Inquiries (December 2013 - February 2014)
The JH Part A Top Inquiries Frequently Asked Questions (FAQs) have been updated. Please visit our FAQs for the answers to your questions.
Medicare Part B News-Jurisdiction H for April 1st, 2014
The following updates are brought to you by Novitas Solutions.
Medicare News
2014 Medicare Symposiums
Dates and locations for upcoming 2014 Medicare Symposiums are now available! Register today for an event near you! Additional event locations and handout materials will be added when they become available. Stay tuned for updates! Information can be found here.
2014 Open Meeting Dates and New Meeting Format Information is Now Posted
Please note that starting in May of 2014 the Novitas Solutions Open Meeting will be a combined meeting for both Medicare Administrative Contractor (MAC) Jurisdiction H (JH) and MAC Jurisdiction L (JL) contract areas.
Open Meetings are for the purpose of discussing draft Local Coverage Determinations (LCDs). Anyone is welcome to present information related to the policies that are in the 45-day draft comment period. Interested participants may request to present scientific, evidence-based information; professional consensus opinions; or any other information that is relevant to any of the LCDs that are in draft. These in-person presentations are made to the Novitas Solutions’ Contractor Medical Directors. Interested parties may also request to attend as an observer.
NOTE: The Open Meeting is not a forum for discussing specific claims; or for the submission of new drugs, indications, or marketing of forthcoming drugs or medical devices. Information regarding new drugs, indications, or marketing information should be submitted according to Novitas guidelines. Specific claim questions, including billing, pricing and coding, should be directed to our Customer Service Center at 1-877-235-8073.
Medicare Learning Network (MLN) Matters Articles from CMS
Medicare News
2014 Medicare Symposiums
Dates and locations for upcoming 2014 Medicare Symposiums are now available! Register today for an event near you! Additional event locations and handout materials will be added when they become available. Stay tuned for updates! Information can be found here.
2014 Open Meeting Dates and New Meeting Format Information is Now Posted
Dates for the remainder of the 2014 Open Meetings are now posted here.
Please note that starting in May of 2014 the Novitas Solutions Open Meeting will be a combined meeting for both Medicare Administrative Contractor (MAC) Jurisdiction H (JH) and MAC Jurisdiction L (JL) contract areas.
Open Meetings are for the purpose of discussing draft Local Coverage Determinations (LCDs). Anyone is welcome to present information related to the policies that are in the 45-day draft comment period. Interested participants may request to present scientific, evidence-based information; professional consensus opinions; or any other information that is relevant to any of the LCDs that are in draft. These in-person presentations are made to the Novitas Solutions’ Contractor Medical Directors. Interested parties may also request to attend as an observer.
NOTE: The Open Meeting is not a forum for discussing specific claims; or for the submission of new drugs, indications, or marketing of forthcoming drugs or medical devices. Information regarding new drugs, indications, or marketing information should be submitted according to Novitas guidelines. Specific claim questions, including billing, pricing and coding, should be directed to our Customer Service Center at 1-877-235-8073.
Medicare Learning Network (MLN) Matters Articles from CMS
New:
- MM8651 – Implement Operating Rules - Phase III ERA EFT: CORE 360 Uniform Use of Claim Adjustment Reason Codes (CARC) and Remittance Advice Remark Codes (RARC) Rule - Update from CAQH CORE - February 1, 2014 version 3.0.4
- MM8695 – Calendar Year (CY) 2014 Annual Update for Clinical Laboratory Fee Schedule and Laboratory Services Subject to Reasonable Charge Payment - REVISION
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