Medicare News Archive
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Audit & Enforcement
12.06.07 Georgia Medicare Part B Data Center Transition - Dark Day Planned
Cahaba GBA, in conjunction with the Infocrossing Data Center (ADC), Companion Data Services (CDS) the new Enterprise Data Center (EDC) and the Centers for Medicare and Medicaid Services (CMS), is in the process of transferring the Georgia Medicare Part B data center operations from Infocrossing to Companion Data Services. This transition is being done to accommodate the implementation of the Medicare Contractor Reform.
There will be a system “Dark Day” on Monday, January 28, 2008 in order to accommodate this data center transition. This means that the Georgia Part B claims system will not be available to Cahaba's Customer Service Representatives on this day. Electronic claims submissions will not be affected.
Georgia Part B claims processing and Cahaba's Provider Contact Center will resume normal operations beginning Tuesday, January 29, 2008. Our goal is to make this data center transition as seamless as possible for Georgia Part B providers, and there should be minimal if any impacts to providers or beneficiaries.
If you have any concerns or questions related to this transition, please contact Cahaba's Part B Provider Contact Center at 1.877.567.7271.
04.04.07 “Warning” Edits to Become “Live” Edits
Since March 19, 2007, Cahaba GBA has issued warning edits on the audit trail reports. This is to allow submitters who have claims that would ordinarily be rejected because of one of these edits to be notified that they need to correct the problem without having their claims suddenly start rejecting.
Edits 117 (“Invalid Provider Group”) and edit 429 (“Name of Facility Needed”) will become live edits on May 1.
- Edit 117: Invalid Provider Group, indicates that your practice has been assigned a group number and this group number is not being used. The provider number submitted in place of the group number will appear inside the text of the edit, along with the group number that should have been used.
- Edit 429: Name of Facility Needed, indicates that the claim had a place-of-service code other than 12 (patient’s home) and the name and address of the facility where the services were rendered was not included on the claim. The facility name and address should be submitted in the 2310D loop. Please contact your vendor if you are getting this message on your claims and need help entering this information.
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02.06.07 New Edits for Audit System
Effective March 1, 2007, Cahaba GBA, LLC, will be implementing new edits in the audit trail system.
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Coding
11.13.07 New Information Available on HH PPS Billing & Coding Web site
- Questions and Answers regarding transition episodes - This document describes special steps for Home Health Agencies (HHAs) to take in completing their Outcome and Assessment Information Set (OASIS) assessments at the transition to the refined HH PPS January 1, 2008. These steps will assure HHAs can create the proper payment group code for their claims.
- HH PPS Health Insurance Prospective Payment System (HIPPS) code weight tables - These spreadsheets map each of the 1,836 new HIPPS code for the refined HH PPS to its associated case-mix weight and supply payment amount.
- Presentation on HH PPS claims processing changes - An outline describing the principle changes to HHA coding and billing that result from the refined HH PPS.
View the Updates
11.07.07 Top 5 Reasons for Claims Rejections in October
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08.21.07 Cahaba GBA Consolidates Mailroom
Effective September 10, 2007, Cahaba Government Benefit Administrators, LLC, the Medicare Part B contractor for the states of Alabama, Georgia and Mississippi will consolidate their mailrooms to the Birmingham office. Cahaba GBA’s decision to consolidate the mailrooms was based on goals emphasizing its focus on the Medicare Administrative Contractor (MAC) procurements.
Georgia beneficiaries and providers should use the following addresses starting September 10:
Georgia Part B Claims
P.O. Box 12847
Birmingham, AL 35202
Georgia Medicare Part B (Mail Other Than Claims)
P.O. Box 12967
Birmingham, AL 35202
08.07.07 Top 5 Reasons for Claims Rejections in July
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07.05.07 Top 5 Reasons for Claims Rejections in June
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05.07.07 Top 5 Reasons for Claims Rejections in April
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04.01.07 Stop Rushing to Switch Over to the New CMS-1500
While Medicare began to accept the revised Form CMS-1500 (08-05) on January 1, 2007 and was positioned to completely cutover to the new form on April 1, 2007, it has recently come to Medicare's attention that there are incorrectly formatted versions of the revised form being sold by print vendors, specifically the Government Printing Office (GPO). However, not all of the new forms are in error.
Don't discard your old CMS-1500 forms just yet. The Centers for Medicare & Medicaid Services has granted a respite and will allow the old version (12-90) until around June 1, not April 1 as originally planned. Submitting incorrect versions of the revised form will delay your payments. Your carrier won't key in a claim using an incorrectly formatted version and will instead return it to you.
04.04.07 Top 5 Reasons for Claims Rejections in March
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03.26.07 Medicare Extends Date for Accepting Form CMS-1500 (12-90)
While Medicare began to accept the revised Form CMS-1500 (08-05) on January 1, 2007 and was positioned to completely cutover to the new form on April 1, 2007, it has recently come to Medicare's attention that there are incorrectly formatted versions of the revised form being sold by print vendors, specifically the Government Printing Office (GPO). However, not all of the new forms are in error.
Given the circumstances, CMS has decided to extend the acceptance period of the Form CMS-1500 (12-90) version beyond the original April 1, 2007 deadline while this situation is resolved. Medicare contractors will be directed to continue to accept the Form CMS-1500 (12-90) until notified by CMS to cease. At present, June 1 is the target date. In addition, during the interim contractors will be directed to return, not manually key, any Form CMS-1500 (08-05) forms received which are not printed to specification. By returning the incorrectly formatted claim forms back to providers, we are able to make them aware of the situation so they can begin communications with their form suppliers.
The old version of the form contains "Approved OMB-0938-0008 FORM CMS-1500 (12-90)" on the bottom of the form (typically on the lower right corner) signifying the version is the December 1990 version. The revised version contains "Approved OMB-0938-0999 FORM CMS-1500 (08-05)" on the bottom of the form signifying the version is the August 2005 version. Checking the information at the upper right hand corner of the form is the best way to identify if that particular version is correct. On properly formatted claim forms, there will be approximately a ¼" gap between the tip of the red arrow above the vertically stacked word "CARRIER" and the top edge of the paper. If the tip of the red arrow is touching or close to touching the top edge of the paper, then the form is not printed to specifications.
03.13.07 Clarification on Form CMS-1500
The CMS-1500 form is the standard claim form used by a non-institutional provider or supplier to bill Medicare carriers and durable medical equipment regional contractors (DMERCs) when a provider qualifies for a waiver from the Administrative Simplification Compliance Act (ASCA) requirement for electronic submission of claims. It also is used for billing of some Medicaid State Agencies.
The National Uniform Claim Committee (NUCC) is responsible for the maintenance of the CMS-1500 form. CMS does not provide the form to providers for claim submission.
CMS has discovered that there are incorrectly formatted versions of the revised form. Given the circumstances, CMS is extending the acceptance period of the Form CMS-1500-(12-90) version beyond the original April 1, 2007 deadline while the situation is resolved. Contractors will be directed to continue to accept the Form CMS-1500 (12-90) until notified by CMS to cease.
Read more on which form is which
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02.26.07 Clarification - New Edit for Electronic Claims
Effective March 1, 2007, Cahaba GBA will implement a new edit for Medicare Part B claims. This new edit will validate the Receiver ID in Loop 1000B on all electronic claims. This should contain 00510 for Alabama Part B claims, 00511 for Georgia Part B claims, and 00512 for Mississippi Part B claims. Many submitters are currently sending their submitter codes or other invalid values in this loop and element.
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02.12.07 Facility Name and Address Requirements
Effective March 1, 2007 for all Medicare Part B claims (both paper and electronic) received on or after April 1, 2004, the name and address of the facility where the service was rendered is required except for when the place-of-service is the patient’s home (Place of service code 12).
Electronic claims that are submitted without this information will be rejected. This is edit number 429L and the message will read, “NAME OF FACILITY NEEDED.”
For electronic claims the facility information should appear in the 2310D loop. The facility name along with the address should be submitted. A complete physical address includes the street address number, the street, avenue, parkway, boulevard, etc., city, state, and a valid zip code.
Read more (Page 15)
02.05.07 Top 5 Reasons for Claims Rejections in January
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02.05.07 Facility Name and Address Requirements
Effective March 1, 2007 for all Medicare Part B claims (both paper and electronic) received on or after April 1, 2004, the name and address of the facility where the service was rendered is required except for when the place-of-service is the patient’s home (Place of service code 12).
Electronic claims that are submitted without this information will be rejected. This is edit number 429L and the message will read, “NAME OF FACILITY NEEDED.”
01.26.07 CMS-1500 Claim Form Revision
Cahaba Government Benefit Administrators®, LLC has implemented the revision of the CMS-1500 claim form, effective January 2, 2007, to accommodate the reporting of the National Provider Identifier (NPI).
Read Instructions
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03.06 Georgia Medicare’s Reprocessing of 2006 Physician Claims Based on 4.4 Percent Fee Schedule Update
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01.06 Medicare Remit Easy Print (MREP) Version 1.6 is now available for download
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Payment
12.21.07 Reminder: NPI Requirement on Medicare Electronic and Paper Institutional Claims Begins January 1st!
Effective 01.01.08, NPIs will be required to identify the primary providers (the Billing and Pay-to Providers) in Medicare electronic and paper institutional claims (i.e. 837I and UB-04 claims). You may continue to use the legacy identifier in these fields as long as you also use the NPI in these fields. This means that 837I and UB-04 claims with ONLY legacy identifiers in the Billing and Pay-to Provider fields will be rejected starting on 01.01.08. (Pay-to Provider is identified only if it is different from the Billing Provider.)
You may continue to use only legacy identifiers for the secondary provider fields in the 837I and UB-04 claims, until 05.23.08, if you choose.
Urgent: Test Your Claims Now! After you have submitted claims containing both NPIs and legacy identifiers and those claims have been paid, Medicare urges you to send a small batch of claims now with only the NPI in the primary provider fields. If the results are positive, begin increasing the number of claims in the batch.
(Reminder: For institutional claims, the primary provider fields are the Billing and Pay-to Provider fields. For professional claims, the primary provider fields are the Billing, Pay-to, and Rendering Provider fields. If the Pay-to Provider is the same as the Billing Provider, the Pay-to Provider does not need to be identified.)
11.27.07 Important NPI Compliance Dates for Medicare Providers
As of Oct. 29, 2007, all Medicare contractors have lifted the bypass logic and are editing against the Medicare crosswalk. As a result, claims that include non-matching NPIs and legacy identifiers are now being rejected. The following table is a review of the next set of dates which are crucial for compliance with the NPI regulations.
Jan. 1, 2008
- 837I electronic claims and UB-04 paper claims without an NPI in fields identifying the primary provider (billing and pay-to) will be rejected.
- Legacy identifiers paired with NPIs in the primary provider fields on the claim will still be acceptable as will legacy-only numbers in secondary provider fields.
March 1, 2008
- Medicare FFS 837P and CMS-1500 claims must include an NPI in the primary fields on the claim (i.e., the billing, pay-to, and rendering fields).
- You may continue to submit NPI/legacy pairs in these fields or submit only your NPI on the claim. You may not submit claims containing only a legacy identifier in the primary fields.
- Failure to submit an NPI in the primary fields will result in your claim being rejected or returned as unprocessable.
- Until further notice, you may continue to include legacy identifiers only for the provider secondary fields.
May 1, 2008
- In keeping with the Contingency Guidance issued on April 3, 2007, CMS will lift its NPI contingency plan, meaning that only the NPI will be accepted and sent on all HIPAA electronic transactions (837I, 837P, NCPDP, 276/277, 270/271 and 835), paper claims and SPR remittance advice.
- This also includes all secondary provider fields on the 837P and 837I. The reporting of legacy identifiers will result in the rejection of the transaction.
- CMS also will stop sending legacy identifiers on COB crossover claims at this time.
11.27.07 CMS Warns SSNs Should Not Be Reported in FOIA-Disclosable NPPES Fields
Some health care providers have reported their Social Security Numbers (SSNs), or the SSNs of other health care providers, in their NPPES records in fields that the Freedom of Information Act (FOIA) requires that CMS make publicly available. For example, there are instances where SSNs are reported in the “Other Provider Identification Numbers,” “License Number,” and “Employer Identification Number (EIN)” fields in providers’ NPPES records. The information that providers report in these (and certain other) fields is fully disclosable by CMS to the public and, therefore, SSNs should never be reported in any of these fields.
Because SSNs are nine-digit numbers, CMS has been suppressing all nine-digit numbers found in any FOIA-disclosable field except for ZIP code and telephone/fax number fields. This means that these nine-digit numbers – whether they are SSNs – are not displayed in the NPI Registry and cannot be found in the monthly NPPES downloadable file. If these nine-digit numbers are legitimate EINs, “Other Provider Identification Numbers,” or “License Numbers,” health plans and others who are using the NPI Registry and the downloadable file are not able to see them, which means that they cannot see all of the NPPES data they may need in order to accurately match providers in NPPES to the providers in their own files, thus making it more difficult to link NPIs to legacy identifiers. In some cases, this may adversely affect payments to providers by health plans.
It is imperative that providers immediately look at their NPPES records to ensure that they did not inadvertently report their, or someone else’s, SSN in a FOIA-disclosable field; if they did, they need to delete that SSN immediately and, if appropriate, replace it with the correct information (e.g., an EIN). Providers must look in their NPPES records in order to view all of the information they reported. If they need assistance in deleting inappropriately reported SSNs, they may contact the NPI Enumerator at 1.800.465.3203. If they need assistance in knowing which NPPES fields are disclosable under FOIA, they should review the document entitled, “National Plan and Provider Enumeration System (NPPES) Data Elements Data Dissemination – Information for Providers,” dated June 20, 2007, and found on the CMS NPI Web page.
Providers cannot rely on the information disclosed in the NPI Registry or in the downloadable file in trying to determine if they inappropriately reported SSNs in FOIA-disclosable fields because CMS suppresses these numbers, as explained above; these numbers will not be seen in the NPI Registry or the downloadable file. In order to protect your personal information from public disclosure, please correct this information immediately if this situation pertains to you.
Click Here to Review Your NPPES Records
11.26.07 NPI Registry Now Available for Medicare Providers
The NPI Registry enables you to search for a provider's NPPES information. All information produced by the NPI Registry is provided in accordance with the NPPES Data Dissemination Notice. You may run simple queries to retrieve this read-only data. For example, users may search for a provider by the NPI or Legal Business Name. There is no charge to use the NPI Registry.
View NPI Registry
11.19.07 2008 Participation Enrollment & Medicare Part B Information (CD-ROM)
The 2008 Participation Enrollment & Medicare Part B Information (CD-ROM) was mailed Tuesday, November 13, 2007. The 2008 Medicare Physician Fee Schedule will not be included on the CD-ROM this year. The 2008 Medicare Physician Fee Schedule will be placed on the Carrier’s Web site at https://www.cahabagba.com/part_b/claims/Fee_schedule_allowances.htm once the final rule is put on display. Placing the fees on the carrier Web site assures that providers will have the most current and correct fees available.
View the 2008 Fee Schedule
11.13.07 Important NPI Information for Medicare Providers
As it gets closer to May 23, 2008, be sure to pay attention to information from Medicare and other health plans regarding NPI implementation timelines.
View Summary of Key NPI Dates
11.02.07 Medicare Final Rule Announces 2008 Physician Fees and Reforms for Accurate Payments and Quality
The Centers for Medicare & Medicaid Services (CMS) today issued a final physician payment rule designed to improve accuracy of Medicare payments and give physicians and health care professionals additional financial incentives to provide higher quality and value in the delivery of care.
Under the new rule, Medicare estimates that it will pay approximately $58.9 billion to about 900,000 physicians and other health care professionals. The revised payments, quality incentive rates and related policy changes, which will become effective January 1, 2008, are included in the Medicare Physician Fee Schedule (MPFS) final rule. The rule went on display today at the Federal Register.
View the Final Rule, Effective for Services On or After January 1, 2008
11.02.07 Requirement to Update Information in the National Plan and Provider Enumeration System (NPPES)
Health care providers who are covered entities under HIPAA are required by the National Provider Identifier (NPI) Final Rule to update their NPPES data. The Final Rule [at (162.410(a)(4)] states that covered health care providers must notify the NPPES of changes in their required NPPES data elements within 30 days of the changes. Failure to provide updated information may be considered an act of non-compliance with the NPI regulation, and a complaint may be filed against covered health care providers who do not comply with this provision, or any other provisions of the rule.
Read More NPI Updates
10.12.07 Important NPI and Enrollment Information for Physicians and Non-Physician Practitioners
By October 31, 2007, all Medicare carriers (and A/B MACs that service providers who formerly billed carriers) will be rejecting Part B claims if they are unable to "match" a NPI and a PIN combination submitted on a claim to an NPI/PIN combination in the Medicare NPI crosswalk. The NPI/PIN combination may be used to identify the Billing, Pay-to, or Rendering Provider (the Pay-to Provider is identified only if it is different from the Billing Provider). This applies to claims that are submitted by corporations that physicians and non-physician practitioners have formed, or by physicians and non-physician practitioners who bill Medicare directly.
10.12.07 What to Do if Claims Are Rejected
Read Cahaba GBA's Tips
10.12.07 Medicare Fee-For-Service (FFS) National Provider Identifier (NPI) Final Implementation
MM5728 –Medicare Fee-For-Service (FFS) National Provider Identifier (NPI) Final Implementation This article is based on CR5728, which describes the policy change brought about as a result of the Health Insurance Portability and Accountability Act (HIPAA) of 1996, that requires issuance of a unique national provider identifier (NPI) to each physician, supplier, and other provider of health care who conducts HIPAA standard electronic transactions. Once CMS ends its’ NPI contingency, the legacy number will NOT be permitted on any inbound electronic and outbound electronic transaction (there are exceptions to the 835 remittance advice (see CR5452)). Medicare contractors will begin rejecting claims, electronic, including direct data entry, that contain legacy provider numbers for any primary provider instead of or in addition to the NPI number.
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10.10.07 NPI Vs. Legacy IDs Editing Begins October 15
Since October 2, 2006, providers have been encouraged to submit both the NPI and Medicare legacy identifier (PIN) on their claims. During this timeframe providers were not penalized for invalid NPI/legacy ID combinations.
Effective October 15, Cahaba GBA Part B, will begin editing the NPI/legacy ID combinations for validity against the NPI crosswalk file. Where a match cannot be located on the crosswalk, claims will be rejected or returned to the provider.
When the claim is returned, a provider should first verify that the correct NPI was submitted. If correct, you will need to verify that your legacy identifier (PIN or NSC) number corresponds with the information on file with the National Plan and Provider Enumeration System (NPPES). NPPES data may be checked on line at https://nppes.cms.hhs.gov.
If your NPPES information is correct and you have included and matched ALL Medicare legacy identifiers with a corresponding NPI in NPPES, but you are experiencing provider identifier problems with your claims that contain an NPI, you may need to submit a Medicare enrollment application (i.e., the CMS-855). If you have any questions, please contact the Provider Contact Center for Georgia at: 1.877.567.7271.
Cahaba GBA suggests that submitters send a small batch of claims with an NPI only to validate the legacy selected to match with the NPI is correct. The CMS has been told that some submitters do not have this capability, but it would be a helpful tool to detect problems early without effecting cash flow.
09.14.07 Starting Oct. 1, Medicare Policy Allows for Missed Appointment Charges
Beginning October 1, the Center for Medicaid and Medicare Services policy is to allow physicians and suppliers to charge Medicare beneficiaries for missed appointments. Medicare itself does not pay for missed appointments, so charges should not be billed to Medicare.
Providers may not charge only Medicare patients for missed appointments; they must also charge non-Medicare patients. Additionally, the charge for missed appointments must be the same for all patients (Medicare and non-Medicare).
09.11.07 AMA and MGMA Wants CMS to Turn Off NPI Edits
As of September 4, Medicare has started to "turn on" the edits that previously allowed carriers to correct billing or pay-to provider information submitted on Medicare claims submitted by group practices, which may cause a significant administrative burden for the physician practice. The AMA along with MGMA is aggressively advocating for the Centers for Medicare and Medicaid Services to reverse this policy.
Read Letter Sent to CMS
09.04.07 National Plan and Provider Enumeration System FOIA-Disclosable Data Becomes Available
NPPES health care provider data that is disclosable under the Freedom of Information Act (FOIA) will now be disclosed to the public by the Centers for Medicare & Medicaid Services (CMS). In accordance with the e-FOIA Amendments, CMS is disclosing this data via the Internet. Data is available in two forms:
- A query-only database, known as the NPI Registry
- A downloadable file
The NPI Registry became operational on September 4 and the downloadable file will be ready approximately one week later. CMS has posted several documents to help providers understand what the downloadable file looks like, including a "Read Me" file, Header File, and Code Value document for the downloadable file.
View NPPES Downloadable File
09.07.07 AMA Alert: Medicare starting to reject claims with NPI discrepancies
The AMA is alerting physicians that Medicare must be able to match a physician's appropriate PIN to his or her correct National Provider Identifier (NPI)-and may reject claims if a match can't be made. Prior to Sept. 4, most Medicare carriers permitted claims to process through their computer systems even if an appropriate match between the physician's NPI number and their old legacy billing number(s) couldn't be made. However, as of Sept. 4, Medicare has started to "turn on" the edits that previously allowed these claims to process.
The AMA strongly encourages physicians to immediately check with their billing office to determine what, if any, error reason codes have been returned over the summer. These codes could indicate an NPI mismatch in the Medicare system. And, physicians who use a clearinghouse should check to ensure that the NPI or these reason codes are not being stripped off of their claims.
NOTE: Medicare must be able to match single, incorporated physicians-those who have an LLC or other incorporated business arrangement. These physicians must have two NPIs-one for themselves and one for their corporation. In some cases Medicare may have originally assigned these physicians one PIN rather than the two that are now needed to match a physician to his or her correct NPI number. In these cases, re-enrollment in Medicare is required. In addition, physicians in large group practices who may have multiple Medicare PINs could also experience claims interruptions if there are matching problems.
The AMA is aggressively advocating for the Centers for Medicare and Medicaid Services to alleviate the significant administrative burden these developments will place on physician practices. The AMA is also working to get physicians more time to re-enroll in Medicare so they can obtain the appropriate PIN and avert claims processing interruptions.
09.04.07 Invalid NPI/legacy Combinations will be Rejected Starting Oct. 15
Since October 2, 2006, providers have been encouraged to submit both the NPI and Medicare legacy identifier (PIN) on their claims. During this timeframe providers were not penalized for invalid NPI/legacy ID combinations.
Effective October 15, 2007, Cahaba GBA Part B, will begin editing the NPI/legacy ID combinations for validity against the NPI crosswalk file. Where a match cannot be located on the crosswalk, claims will be rejected or returned to the provider.
When the claim is returned, a provider should first verify that the correct NPI was submitted. If correct, you will need to verify that your legacy identifier (PIN or NSC) number corresponds with the information on file with the National Plan and Provider Enumeration System (NPPES).
If your NPPES information is correct and you have included and matched ALL Medicare legacy identifiers with a corresponding NPI in NPPES, but you are experiencing provider identifier problems with your claims that contain an NPI, you may need to submit a Medicare enrollment application (i.e., the CMS-855). If you have any questions, please contact the Provider Contact Center servicing your state at:
- Alabama: 866.539.5598
- Georgia: 877.567.7271
- Mississippi: 866.419.9454
Check Your NPPES Data Online
09.03.07 Systems will begin to reject claims with improper NPIs
Starting September 3, Medicare carriers and DME MACs will begin transitioning their systems to start rejecting claims when the NPI and Legacy Provider Identifier cannot be found on the Medicare Crosswalk.
Since May 29, Medicare Fiscal Intermediaries, as well as Part B CIGNA Idaho and Tennessee, have been validating NPIs and Legacy Provider Identifier pairs submitted on claims against the Medicare NPI Crosswalk. Between the period of September 3 and October 29, all other Part B carriers and DME MACS will begin to turn on edits to validate the NPI/Legacy pairs submitted on claims. If the pair is not found on the Medicare NPI crosswalk, the claim will reject. Contractors have been instructed to inform providers at a minimum of 7 days prior to turning on the edits to validate the NPI/Legacy pairs against the Crosswalk.
If you are receiving informational edits today, CMS strongly urges you to validate that the NPPES has ALL of the NPI and legacy numbers you intend to use on claims and for billing purposes. If NPPES is correct, and you continue to receive information edits, you should ask your contractor to validate the provider information in their system. If the contractor information is not correct, you may be instructed to submit an enrollment form or CMS-855. Please include ALL of your NPI/Legacy numbers in NPPES AND all of your NPIs that are to be used in place of your legacy on the CMS-855. If the information is different in the two systems, there is a very good chance your claim will reject.
Verify NPPES Data
08.01.07 NPI Registry Delayed Until September 4
The NPI Registry, a query-only database, which was expected to be operational starting August 1 has been delayed until September 4. In order to ensure edits are reflected in the NPI Registry when it first becomes operational and in the first downloadable file, health care providers need to submit their edits no later than Monday, August 20. Health care providers who submit edits on paper need to ensure that they are mailed in time for receipt by the NPI Enumerator by that date.
The NPI Registry will operate in a real-time environment. This means that FOIA-disclosable data for newly enumerated providers, as well as updates and changes to enumerated providers' FOIA-disclosable data, will be available in the NPI Registry as that information is applied to NPPES. The NPI Registry will enable a user to query by, for example, NPI or provider name, and will return a list of all NPPES records that meet the query specifications. The user selects from that list the NPPES records he/she wants to see. The NPI Registry will then display the FOIA-disclosable data for those records. About a week later, CMS will make available a file for downloading that will contain the FOIA-disclosable NPPES data of enumerated health care providers. Technical expertise will be required to download that file and to import that data into a relational database or to otherwise manipulate the data.
Click Here for Additional Information
07.24.07 Potential Issues Related to Clearinghouse Practices
CMS is warning that some Clearinghouses are stripping the National Provider Identifier (NPI) off the claim prior to its submission to Medicare. This could adversely affect Medicare providers in two ways. First, providers may be under the false impression that their claims are being successfully submitted to Medicare, through their clearinghouse, using an NPI. Second, without the NPI, these claims will not count toward PQRI participation for Eligible Professionals. Stripping of NPIs may also be occurring even though the NPI appears on remittance advice because some clearinghouses are adding the NPI to the remittance prior to sending to the provider. CMS urges Medicare providers that use clearinghouses to check with their clearinghouse to assure NPIs are not being stripped from claims. If the provider determines that their clearinghouse is stripping NPIs from the claim, the provider may wish to consider other billing options.
CMS has also become aware that some clearinghouses are not forwarding to providers NPI informational claim error messages being sent by Medicare carriers. Providers who use clearinghouses should make sure they are in fact receiving NPI informational claim error messages so that issues can be addressed timely.
07.17.07 NPI/Legacy Provider Mismatch Warning Edits
Cahaba GBA, LLC, is now issuing warning edits on audit trail reports when a legacy provider number is submitted on an electronic claim along with an NPI and the NPI used does not match the NPI Cahaba has in its system for that legacy provider number. While these claims are not being rejected it is important that you resolve these edits as quickly as possible. Due to the limitations of the warning editing system, you may not get this warning message on all of your claims.
View PDF
07.05.07 New NPI Application Form Goes into Effect July 11
If submitting the paper NPI Application/Update form, you may use the old version until July 10. Do not submit old versions of the CMS-10114 to the NPI Enumerator after that date. Submit the revised CMS-10114. The revised CMS-10114 is available from the NPI Enumerator by calling 800.465.3203.
Download the new CMS-10114
07.05.07 Please Review Provider Information for NPPES Soon
The Centers for Medicare & Medicaid Services (CMS) will be disseminating provider information contained in the National Plan and Provider Enumeration System (NPPES) that is required to be disclosed under the Freedom of Information Act (FOIA), in accordance with the NPPES Data Dissemination Notice (CMS-6060-N) that was published in the Federal Register on May 30, 2007. The Notice encouraged providers who have been assigned National Provider Identifiers (NPIs) to view their NPPES data and to update, change, or delete (where permitted) the data that will be disclosed under the FOIA. In order for providers' updates, changes, and deletions to be reflected in the initial downloadable file, providers must ensure that their updates, changes, and deletions are submitted to NPPES no later than July 16.
NPPES FOIA-disclosable data will be made available in an initial file that can be downloaded from the Internet, as well as in a query-only database known as the NPI Registry. There will be monthly update files that also will be downloadable from the Internet. CMS will begin disseminating data on August 1.
CMS has made available a document that will assist providers in making updates, changes, and deletions to the FOIA-disclosable NPPES provider data. We strongly recommend that providers read this document as soon as possible.
Read Full Announcement
View CMS Help Sheet
07.03.07 CMS Proposes Payment Cuts for Physicians Services in 2008
The Centers for Medicare & Medicaid Services (CMS) projects that it will pay approximately $58.9 billion to 900,000 physicians and other health care professionals in calendar year (CY) 2008, under a proposed rule released today that would revise payment rates and policies under the Medicare Physician Fee Schedule (MPFS). This proposed rule is a further step in Medicare's efforts to ensure that payment policies provide incentives to improve the quality of care.
According to an article in the July 2 Modern Physician Medicare payments to physicians in 2008 would drop nearly 10% under the CMS proposal. Physician groups have pleaded with Congress to replace the sustainable growth rate formula, or SGR, which is tied to the health of the economy and is used to calculate physician payments under the Medicare program. It has been estimated that payments will drop by more than 40% by 2015 if the SGR is not replaced. Congress in the past has adopted interim measures to stop previous payment reductions.
Comments on the proposal will be accepted until Aug. 31. For more information or for AMA's National Advocacy Efforts against the proposed pay cuts, please go to www.ama-assn.org.
View AMA's 2007 Medicare Physician Payment Action Kits
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06.06.07 NPI/Legacy Provider Mismatch Warning Edits
Cahaba GBA, LLC, is now issuing warning edits on audit trail reports when a legacy provider number is submitted on an electronic claim along with an NPI and the NPI used does not match the NPI we have in our system for that legacy provider number. While these claims are not being rejected it is important that you resolve these edits as quickly as possible.
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06.04.07 Stage 3 NPI Changes for Transaction 835 and Standard Paper Remittance Advice
Be aware that Stage 3 of the NPI implementation is nearing. Make sure you have your NPI, know how to use it, and are prepared to receive it back in your remittance advice processes. This article gives advice on how to make sure your staff is aware of how the NPI implementation impacts the remittance advice transactions you receive.
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06.04.07 Unique Physician Identification Number Discontinuance
This article is based on Change Request (CR) 5584 which announces that the Centers for Medicare & Medicaid Services (CMS) will discontinue assigning Unique Physician Identification Numbers (UPINs) on June 29, 2007. The National Provider Identifier (NPI) is a requirement of the Health Insurance Portability and Accountability Act of 1996 (HIPAA), and the NPI will replace the use of UPINs and other existing legacy identifiers.
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06.04.07 CMS-1500 Claim Form (8/05) New Submission Deadline
The Form CMS-1500 is the paper claim form that physicians and suppliers, who qualify for an exemption from the mandatory electronic claims submission requirements (as set forth in the Administrative Simplification Compliance Act, Public Law 107-105 (ASCA) and the implementing regulation at 42 CFR 424.32), use to submit claims. Therefore, CR 5616, from which this article is taken, announces, based on the information at hand, that beginning July 2, 2007, you will need to submit claims using the Form CMS-1500 (08-05).
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05.23.07 The NPI Compliance Deadline is Here!
At this point, any covered entity that is noncompliant, and has not implemented a contingency plan, is at risk for enforcement action. As this guidance pertains to claims transactions, it means that:
- Providers must have and use their NPI;
- Clearinghouses must accept and use NPIs; and
- Health plans must accept and send NPIs in claims transactions.
Providers should be:
- Aware of contingency plans for any health plans they bill. Contingency plans may differ by health plan.
- Aware that health plans may lift their contingency plans (and require an NPI on claims or other HIPAA transactions) any time before May 23, 2008.
- Working with vendors and clearinghouses with whom they contract, to make sure the NPI is being passed to health plans.
- Paying close attention to how and when health plans will be testing implementation of the NPI.
- Aware that, for those health plans that did not establish a contingency plan, providers are required to use their NPIs now. This means that if you are not using your NPI, your claim may be rejected or denied.
Read Tip Sheet
04.27.07 NPI Update
The Centers for Medicare & Medicaid Services (CMS) has posted its new compliance contingency guidance FAQs. Medicare providers should pay special attention to the Medicare information section in the document for important news on the Medicare FFS Contingency Plan.
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04.16.07 Reminder from the National Association of Chain Drug Stores
Georgia's community pharmacies have significant concerns about the potential disruption to patient care posed by state implementation of the National Provider Identifier (NPI) on May 23, 2007. CMS has authorized states to accept a legacy number for prescribers for up to 12 months. In states like Georgia that have not committed to allowing prescribers to use traditional identifiers in transition, many patients may be unable to obtain their prescriptions because pharmacies might not have on file valid, tested, prescriber NPIs.
Pharmacies without valid prescriber NPIs at point-of-sale could be forced to weigh the ongoing provision of uncompensated services against the continuing health care needs of the patient(s) before them. The NACDS urges physicians to obtain valid NPIs in time for use on May 23.
04.04.07 NPI Update
The Centers for Medicare & Medicaid Services (CMS) announced that it is implementing a contingency plan for covered entities (other than small health plans) who will not meet the May 23, 2007, deadline for compliance with the National Provider Identifier (NPI) regulations under the Health Insurance Portability and Accountability Act (HIPAA) of 1996.
Letter from AMA President
Read Compliance Rule
03.29.07 NPI Update
Provider Outreach and Education has scheduled three NPI educational events during the month of April.
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02.28.07 NPI Update
There are less than 90 days left between today and the NPI compliance date of May 23, 2007. It is estimated that it may take at least this much time to implement the NPI into your business practices. Failure to prepare could result in a disruption in cash flow. Will you be ready to use your NPI? Time is running out!
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01.29.07 Impact of U.S. Congress' HR 6111
Passage in December 2006 of HR 6111 prevented a 5 percent cut in Medicare payment rates for all physician services due to the Sustainable Growth Rate (SGR) formula, which was slated to be imposed January 1, 2007. HR 6111 also prevented a reduction in the geographic practice cost index (GPCI) for physician work that would have affected more than 50 payment localities. (Data compiled by the American Medical Association)
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01.11.07 Entering NPIs into PC-ACE
After upgrading to version 1.76 you may enter your NPI information into PC-ACE. To do so:
- Start PC-ACE
- Click on Reference File Maintenance (The button with the picture of the folder with the sheet of paper)
- Click on the “Provider” tab
- Double click on each provider number listed to bring up the provider information screen
- For each provider that has an NPI assigned enter the NPI in the field labeled “NPI”, on the right side of the screen between “Group Label” and “Tax ID/Type.” Enter the NPI for each provider who has been assigned one, including group numbers.
Call EDI Services at 866.582.3253 if you have any questions.
01.04.07 Medicare Fee for Service Implementation of the National Provider Identifier
On May 23, 2007, the NPI will replace health care provider identifiers that are in use today in HIPAA standard transactions. It is estimated that, once a provider obtains an NPI, it may take up to 120 days to implement the NPI in current business practices. Following the key points in this article will assist Medicare providers as they transition from the application stage to the implementation stage to ensure NPI readiness.
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01.02.07 Legislative Change to the Update Factor for the 2007 Medicare Physician Fee Schedule
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01.02.07 Medicare Coding Changes for 2007
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12.14.06 NPI Teleconference Questions & Answers
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11.21.06 Over 1.4M National Provider Identifiers (NPIs) have been issued. Do you have yours?
If you are a health care provider who bills for services, you probably do need an NPI. If you bill Medicare for services, you definitely do! If you don't have an NPI, get one. If you have one, start the testing process with your health plan and use it on your claims and other transactions.
Key NPI Facts
- Every covered health care provider must get and use the NPI; and even if a health care provider is an individual and is not conducting electronic transactions and is, therefore, not a covered provider, he or she may be required by health plans or employers to obtain an NPI.
- The NPI is not just a number. It affects internal and external business and systems operations and can affect the appropriate payment of claims in a timely manner.
- It is estimated that use of the NPI can require a transition period of no less than 120 days.
- Providers should begin to test and use their NPIs in electronic health care transactions no later than January 31, 2007.
- May 23, 2007 is not when the process starts, but when the process must be completed.
11.09.06 Medicare Part B Fee Schedule Allowances
The 2007 Cahaba GBA Medicare Part B Fee Schedule Allowances will not be included on the CD-ROM this year. The 2007 Medicare Physician Fee Schedule CD-ROM with bonus information was mailed November 9, 2006.
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08.06 CMS Proposes Policy, Payment Changes for Physicians' Services in 2007
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08.06 Deficit Reduction Act of 2006 9-Day Payment Hold
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06.06 CMS Announces Proposed Changes to Physician Fee Schedule Methodology
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05.06 Update: Federal Reimbursement of Emergency Health Services Furnished to Undocumented Aliens
Physicians, hospitals and ambulance services that provide emergency health services to undocumented aliens should be aware that the Medicare Prescription Drug Improvement and Modernization Act (MMA) (Section 1011) provides $250 million each year, for Fiscal Years (FY) 2005-2008, for payments to eligible providers for emergency health services given to undocumented and other specified aliens. You may not be receiving funds that are available to you for services you furnish to undocumented aliens.
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03.06 National Provider Identifier (NPI) Tip
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02.06 2006 Medicare Reimbursement Rates Frozen at 2005 Levels
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01.06 Emergency Update to the 2006 Medicare Physician Fee Schedule (MPFS)
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01.06 Status of 2006 Medicare Physician Payment Update
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11.05 CMS Announces Payment Update and Policy Changes for Medicare Physician Fee Schedule
Georgia Medicare has decided not to mail the 2006 fees on CD-ROM this year in order to have greater flexibility for making last minute changes to the 2006 payment rates.
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10.05 National Provider Identifier (NPI)
The Atlanta Regional Office of the Centers for Medicare & Medicaid Services (CMS) is asking physicians to apply for their National Provider Identifier (NPI). The NPI will replace health care provider identifiers in use today in standard health care transactions. Providers must have their NPI to bill the Medicare Fee-For-Service program beginning on May 23, 2007. Keep in mind that other health insurance payers may require the use of an NPI prior to the Medicare compliance deadline.
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05.05 Introducing National Provider Identifier (NPI)
CMS is pleased to announce the availability of a new identifier for use in the standard electronic health care transactions. The National Provider Identifier (NPI) will be the single provider identifier, replacing the different provider identifiers providers currently use for each health plan with which they do business. The NPI is one of the steps that CMS is taking to improve electronic transactions for health care. National standards for electronic health care transactions encourage electronic commerce in the health care industry and simplify the processes involved to reduce the administrative burdens on health care providers.
Physician Relations
Physician Relations
11.30.07 Make Your Voice Heard! Participate in the Third Annual Medicare Contractor Provider Satisfaction Survey
The Centers for Medicare & Medicaid Services (CMS) has begun its third annual Medicare Contractor Provider Satisfaction Survey (MCPSS) to a new sample of Medicare providers. The survey is designed to garner quantifiable data on provider satisfaction levels with key services performed by the Medicare fee-for-service contractors.
MCPSS offers providers to opportunity to contribute directly to CMS’ understanding of contractor performance, as well as aid future process improvement efforts at the contractor level. Specifically, the survey will be used by CMS as an additional measure to evaluate performance. In fact, all Medicare Administrative Contractors (MACs) will be required to achieve performance targets on the MCPSS as part of their contract requirements by 2009.
CMS will contact approximately 35,000 randomly selected providers, including physicians and other health care practitioners, suppliers and institutional facilities that serve Medicare beneficiaries across the country. If you are selected to participate in the survey, you will be notified by December 2007.
CMS urges all Medicare providers, who are selected to participate in the MCPSS, to complete and return their surveys upon receipt. CMS plans to make the survey results available in July 2008. The survey is designed so that it can be completed in about 15 minutes and providers can submit their responses via a secure Web site, mail, fax, or over the telephone.
View Final Survey Results and More Information
11.26 - 12.02 National Influenza Vaccination Week
The CDC has created podcasts, e-cards and other e-health activities to support this national effort to spread the word about getting annual flu shots. Click on the link below for their Web site.
11.19 Message from CDC for Health Care Professionals for National Influenza Vaccination Week
The Centers for Disease Control and Prevention (CDC) urges all health care professionals to get an influenza vaccination this flu season. While most people traditionally associate the "flu season" with the fall, the truth is that influenza disease activity most often peaks in January or later.
Read Dr. Julie L. Gerberding's Message
11.19.07 2008 PQRI Medicare Physician Fee Schedule Summary Document
The link to the 2008 PQRI Medicare Physician Fee Schedule summary document is now working.
View Summary of Provisions
11.13.07 Educate Patients About Importance of Getting Flu Shot
Flu season is here! Medicare patients give many reasons for not getting their annual flu shot, including—“It causes the flu"; "I don’t need it"; "It has side effects"; "It’s not effective"; "I didn’t think about it"; "I don’t like needles!” The fact is that every year in the United States, on average, about 36,000 people die from influenza. Greater than 90 percent of these deaths occur in individuals 65 years of age and older. You can help your Medicare patients overcome these odds and their personal barriers through patient education. Talk with your Medicare patients about the importance of getting their annual flu shot - and don’t forget to immunize yourself and your staff. Protect yourself, your patients, and your family and friends. Get Your Flu Shot – Not the Flu. Remember - Influenza vaccination is a covered Part B benefit but the influenza vaccine is NOT a Part D covered drug.
Read More Information about Medicare’s Coverage of Flu Vaccine
11.13.07 Medicare Part D: What to look for in 2008
Read an end-of-year message regarding Medicare Part D by William Rogers, M.D., FACEP, Director of the Centers for Medicare & Medicaid Services (CMS) Physician’s Regulatory Issues Team.
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11.09.07 2007 Physician Quality Reporting Initiative (PQRI) Update
PQRI participants must use their NPIs correctly for their quality-data submissions to count toward successful reporting.
In recent NPI related communications, CMS indicated that since October 15, 2007, Medicare is sending informational warnings that indicate there was no NPI shown in the primary provider fields on your claim(s). Medicare is including these informational warnings on your pre-pass reject reports provided to you directly or to your bulletin board.
Medicare informational warnings called "Provider Identification Code Qualifier Invalid Value" messages will be labeled M389, M390, M391, and/or M392, but, again, these are only reminders. If you receive one of these messages, your claim did not include an NPI as required for PQRI reporting. If you are certain that your claim was submitted with an NPI, you may want to contact your clearinghouse or billing agent to ascertain the reason behind the message. It is possible that the clearinghouse or billing agent removed the NPI prior to submitting the claim to Medicare. You may also want to call your carrier/MAC to ask about the message and how you can correct future claims.
PQRI Participation and Coding Tips
Other PQRI Resources on CMS Web site
11.01.07 November is American Diabetes Month!
The Centers for Medicare & Medicaid Services (CMS) reminds health care professionals that Medicare provides coverage of diabetes screening tests for beneficiaries at risk for diabetes or those diagnosed with pre-diabetes, as well as other covered services for people with diabetes. CMS has published a new provider brochure entitled Diabetes-Related Services. This tri-fold brochure provides health care professionals with an overview of Medicare’s coverage of diabetes screening tests, diabetes self-management training, medical nutrition therapy, and supplies and other services for Medicare beneficiaries with diabetes.
Download, View and Print Diabetes Brochure
Order Free Copies of Brochure
09.04.07 September is National Cholesterol Education Month!
The Centers for Medicare & Medicaid Services (CMS) reminds health care professionals that Medicare provides coverage of cardiovascular screening blood tests for the early detection of cardiovascular disease or abnormalities associated with an elevated risk of heart disease and stroke. This benefit presents an excellent opportunity for health care professionals to help their eligible Medicare patients check their cholesterol status, know their risk for heart disease and the steps they can take toward following a heart-healthy lifestyle that can lower their risk for heart disease and keep it down.
Medicare provides cardiovascular screening blood tests for all asymptomatic beneficiaries every 5 years. The beneficiary must have no apparent signs or symptoms of cardiovascular disease. Covered screening tests include:
- Total Cholesterol Test
- Cholesterol Test for High-density Lipoproteins
- Triglycerides Test
Coverage of cardiovascular screening blood tests is provided as a Medicare Part B benefit. The beneficiary will pay nothing for the blood tests (there is no coinsurance or copayment and no deductible for this benefit).
IMPORTANT NOTE: The cardiovascular screening benefit covered by Medicare is a stand alone billable service separate from the Initial Preventive Physical Examination also known as the "Welcome to Medicare" visit and does not have to be obtained within the first six months of a beneficiary's Medicare Part B coverage.
09.01.07 Cahaba Releases September Schedule for Outreach Events
During September, Medicare Part B will be hosting three outreach events.
View Information Form
Register for Events
08.02.07 Medicare Releases Positive Results on Provider Satisfaction with Medicare Fee-for-Service Contractors
The Centers for Medicare & Medicaid Services (CMS) reports that most Medicare health care providers continue to be satisfied with services provided by Medicare contractors.
The Medicare Contractor Provider Satisfaction Survey (MCPSS), distributed by CMS for the second year, is designed to garner objective, quantifiable data on provider satisfaction with the fee-for-service contractors that process and pay Medicare claims. Sixty-five percent of those who were surveyed responded. The survey revealed that for the second consecutive year, 85% of respondents rated their contractors between 4 and 6 on a 6-point scale.
View Survey Results
07.12.07 CMS says Physician Groups Improve Quality and Generate Savings Under Medicare Physician Pay-for-Performance Demonstration
The Centers for Medicare & Medicaid Services announced that all participating physician groups improved the clinical management of diabetes patients in the first year of the three-year Medicare Physician Group Practice (PGP) Demonstration. This demonstration rewards providers for coordinating and managing the overall health care needs of Medicare patients with chronic conditions.
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07.05.07 CMS to Hold Free Physician Quality Reporting Initiative Teleconferences
The Centers for Medicare & Medicaid Services - Atlanta Regional Office will host two Physician Quality Reporting Initiative (PQRI) educational sessions on July 18.
07.03.07 Updated 2007 Physician Quality Reporting Initiative (PQRI) Educational Resource
The Centers for Medicare & Medicaid Services (CMS) is pleased to announce that the updated version of the Measure Finder Tool (Version 1.1) and User Guide is now available as part of the 2007 PQRI Tool Kit ~ Six Steps to Success.
The Measure Finder Tool (Version 1.1) is a slightly modified version of the tool to address a technical problem in Measure Finder Tool (Version 1.0). Please delete the previous version of the tool from your computer.
The Measure Finder Tool (Version 1.1) is designed to help eligible professionals and their coding/billing staff to quickly search for applicable measures and their detailed specifications. This tool will allow users to search for applicable measures based on a single code or a combination of codes. The User Guide provides instruction on how to use the PQRI Measure Finder Tool (Version 1.1).
Download the Tool Kit
07.03.07 Rural Referral Center Fact Sheet Now Available
The Rural Referral Center Fact Sheet, which provides information about Rural Referral Center program requirements, is now available in print format from the Medicare Learning Network. To place your order for the fact sheet, visit www.cms.hhs.gov/mlngeninfo, scroll down to "Related Links Inside CMS," and select "MLN Product Ordering Page."
06.30.07 Testing Opportunity for the 2007 Physician Quality Reporting Initiative (PQRI) has Ended
Effective June 30, 2007, PQRI testing with the G8300 test code will end. The test code G8300 will no longer be accepted by Carriers and A/B MACs on claims for dates of service after this date.
Reminder: For dates of service beginning July 1, 2007, when 2007 PQRI line items are included on claims, the PQRI line item will be denied and Remittance Advice (RA) remark code message N365, "This procedure code is not payable. It is for reporting/information purposes only" will appear on the RA.
06.05.07 Final Specifications for the Physician Quality Reporting Initiative Now Available
The Centers for Medicare & Medicaid Services (CMS) is pleased to announce that the Final Specifications for 2007 Physician Quality Reporting Initiative (PQRI) are now available. CMS has also posted new frequently asked questions about the 2007 PQRI. PQRI reporting begins for dates of services on July 1, 2007 and will continue through December 31, 2007.
Visit the PQRI Web Page
03.07.07 Physician Quality Reporting Initiative Presentation Available
The Centers for Medicare & Medicaid Services (CMS) is pleased to announce that a PowerPoint Presentation on the 2007 Physician Quality Reporting Initiative (PQRI) is now available.
Access PowerPoint Presentation
03.01.07 March is National Colorectal Cancer Awareness Month
Please join with the Centers for Medicare & Medicaid Services (CMS) in promoting increased awareness of colorectal cancer and the colorectal cancer screening benefit covered by Medicare. Colorectal cancer is largely preventable through screening, which can find colon growths called polyps that can be removed before they turn into cancer. Screening also can detect cancer early when it is easier to treat and cure.
Screening for colorectal cancer is recommended for all adults ages 50 and older, although screening may start at younger ages for individuals who are at high risk for colon cancer. The frequency of screening is based on an individual's risk for colorectal cancer and the type of screening test that is used.
An individual is considered to be at high risk for colorectal cancer if he or she has had colorectal cancer before or has a history of polyps, has a family member who has had colorectal cancer or a history of polyps, or has a personal history of inflammatory bowel disease, including Crohn's Disease and ulcerative colitis.
In addition, risk for colorectal cancer increases with age. It is important to encourage patients who were screened before entering Medicare to continue with screening at clinically appropriate intervals.
Coverage Criteria and Billing Procedures
02.28.07 Physician Quality Reporting Initiative
The Centers for Medicare & Medicaid Services (CMS) is pleased to announce that the 2007 Physician Quality Reporting Initiative (PQRI) Web page is now available.
PQRI establishes a financial incentive for eligible professionals to participate in a voluntary quality reporting program. Eligible professionals who successfully report a designated set of quality measures on claims for dates of service from July 1 to December 31, 2007, may earn a bonus payment, subject to a cap, of 1.5 percent of total allowed charges for covered Medicare physician fee schedule services.
This newly established Web page will be updated regularly, so check it often for timely and reliable information from CMS.
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12.28.06 Implementation of the 2007 Medicare Contractor Provider Satisfaction Survey (MCPSS)
The 2007 implementation of the Medicare Contractor Provider Satisfaction Survey (MCPSS) is approaching. This confidential survey is conducted by the Centers for Medicare & Medicaid Services (CMS) and administered through Westat. During this survey, randomly selected providers who bill to Cahaba GBA will be surveyed in seven key areas. Providers who are selected for this survey will receive a letter in January. In July 2007, Westat will provide sanitized survey results to Cahaba GBA, LLC.
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05.06 Your Medicare Rights and Protections
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03.06 Announcing a New Name for Medicare's Provider Education Articles – MLN Matters
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02.06 Decision Memo for Bariatric Surgery for the Treatment of Morbid Obesity
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11.05 Medicare Participation Options
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04.04 What the New Medicare Law Means for You
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Prescription Drug Plan
04.27.07 Medicare Part D Competitive Acquisition Program
The Centers for Medicare & Medicaid Services will be conducting an "Ask-the-Contractor" teleconference to discuss the additional 2007 CAP physician election period. The call will be hosted by the CAP designated carrier, Noridian Administrative Services (NAS). All interested providers and contractor staff are invited to participate.
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04.13.07 Medicare Part D Internet Eligibility Pilot
CMS is seeking interested individual providers and suppliers who would like to participate in a pilot to receive beneficiary eligibility via the Internet. CMS continues to seek viable solutions to better serve the provider community through self-service options.
CMS has asked Cahaba GBA, LLC to identify providers who may be interested in using the CMS internet provider portal to obtain beneficiary eligibility information. The commitment to work with CMS will require minimal set-up time and is supported by the 270/271 transaction helpdesk.
There are a limited number of slots available for the pilot. If selected, you may be asked to provide feedback on the functionality of the application and the data returned.
To be eligible to participate you must have an e-mail address, a National Provider Identifier (NPI) and internet access. If you are interested in participating in this innovative project please fill out the information on the attached form and fax to:
Cahaba GBA, LLC
Internet Eligibility Pilot
Attention: Provider Outreach and Education
Fax number: 912.921.3066
View Form
01.09.07 No Medicare Part D Late Fee for Low-Income Enrollees
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06.06 Medicare Part B Drug CAP 2006 Physician Election Period Extension
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04.12.06 Medicare Part D Fact Sheet
The AMA has been working with several national medical specialty societies, pharmacist organizations, and beneficiary groups to troubleshoot problems with the implementation of the new Medicare prescription drug benefit. An agreement has been reached on a standardized form for physicians to obtain formulary exceptions and prior authorizations for their patients. For the vast majority of drugs, this standard one-page form would replace the array of different and often lengthy forms currently required by the various Part D plans.
View memo
View Form
04.06 Health Care Professional's Medicare Part D Fact Sheet
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03.06 Clarification of Plan Due Diligence in Prior Authorization of Part B vs. Part D Coverage Determinations
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02.06 Drug Payment Clarification Under Part B/Part D
View Letter to Long-Term Care Associations
View Letter to Subspecialty Groups
02.06 Part D Excluded Drugs
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01.06 Free Part D Formulary Information
CMS has partnered with Epocrates to provide free Part D formulary information which can be accessed at the treatment center by a handheld device.