To date, over $149 million in incentive payments have been made under the Medicare Incentive Program, and over $248 million has been paid under the Medicaid Incentive Program across the nation.

Registration Reminder

Registration for the EHR Incentive Programs is open and CMS is encouraging Medicare providers to register early to avoid potential payment delays. In order to register, providers will need their:

• National Provider Identifier (NPI).
• National Plan and Provider Enumeration System (NPPES) User ID and Password.
• Payee Tax Identification Number (if you are reassigning your benefits).
• Payee National Provider Identifier (NPI), if you are reassigning your benefits.

To register, please go to www.cms.gov/EHRIncentivePrograms/20_RegistrationandAttestation.asp. If you have problems with the registration process, you can contact our EHR Information Center from 7:30 am to 6:30 pm (Central Time) Monday through Friday, except federal holidays, at (888) 734-6433. Target Audience:  Medical coders, physician office staff, provider billing staff, health records staff, vendors, and all Medicare FFS providers. Registration Information: In order to receive the call-in information, you must register for the call. Registration will close at 1:30pm on August 26 or when available space has been filled; no exceptions will be made. For more details, including instructions on registering for the call, please visit http://www.eventsvc.com/palmettogba/082911.

Deadline for Eligible Professionals to Begin Reporting Period for 2011

A reminder that October 3, 2011 is the last day for eligible professionals to begin their 90-day reporting period for calendar year 2011. Eligible professionals have until February 29, 2012 to register and attest to receive an Incentive Payment for the 2011 calendar year, but the reporting period for which they are attesting needs to be 90 consecutive days within the 2011 calendar year. If a provider does not participate in the Medicare Incentive Program in CY 2011, they can still begin participation in CY 2012 and receive $18,000 for their first year’s incentive payment. Remember, for demonstrating meaningful use through both the Medicare and Medicaid EHR Incentive Programs, the EHR reporting period for an EP's first year is any continuous 90-day period within the calendar year. In subsequent years, the EHR reporting period for EPs is the entire calendar year. Under the Medicaid program, there is also an incentive for the adoption, implementation, or upgrade of certified EHR technology, which does not have a reporting period.

Meaningful Use Specification Sheets

A reminder that specification sheets on meaningful use, for both hospitals and professionals, are available at www.cms.gov/EHRIncentivePrograms/30_Meaningful_Use.asp in the Downloads section.  These sheets provide detailed information on each of the meaningful use measures, including specifics on how to calculate numerators and denominators, what qualifies for exclusions, and more.

EHR Assistance

Regional Extension Centers (RECs) are federally funded organizations under the Office of the National Coordinator (ONC) and cover every geographic region of the United States. They support and serve health care providers to help them quickly become adept and meaningful users of EHRs. The target audience of RECs is primary care clinicians, but many RECs offer assistance to specialists, as well. If you need assistance as you look into transitioning to EHRs and participating in the CMS EHR Incentive Programs, consider contacting:

California Health Information Partnership and Services Organization (CalHIPSO)

www.calhipso.org (888) 589-4897

 

Lumetra, San Francisco Local Extension Center

www.lumetrasolutions.com     

(415) 677-2081

All providers and suppliers who enrolled in the Medicare program prior to March 25, 2011, will be required to revalidate their enrollment by March 25, 2012 under new risk screening criteria required by the Affordable Care Act (section 6401a). Newly-enrolling and revalidating providers and suppliers are placed in one of three screening categories representing the level of risk to the Medicare program. The three categories, limited, moderate, or high, determine the degree of screening to be performed by the Medicare Administrative Contractor (MAC) processing the enrollment application. Palmetto GBA will begin notifying physicians and entities to revalidate in September.  Their plan is to start with those physicians and other organizations who are enrolled in Medicare, but do not yet have complete profiles in PECOS (Provider Enrollment, Chain, and Ownership System). They will also send revalidation letters to all Independent Diagnostic Testing Facilities (IDTF). The remainder of the physicians and providers will receive letters over the next 19 months, in an order still to be determined. Upon receipt of the revalidation letter, physicians and organizations will have 60 days to respond. Here are a few items to remember during the initial start-up of this effort:

• Yes, this applies to any individual or organization that enrolled or revalidated prior to March 25, 2011.
• Do not do anything until you get a letter instructing you to revalidate. (This is very important in order to ensure an orderly enrollment process.)
• CMS is working on simplifying this process on the Internet-based PECOS system, hopefully for January 2012.
• Palmetto is working with CMS to establish a schedule that will accomplish the regulatory requirement and avoid any disruption in payment to physicians.
• Physicians who are making changes (moving, closing practice, etc.) should continue to submit their changes as usual.

CMS has published a Special Edition Article #SE1126 to further explain this revalidation requirement.

The deadline for transitioning electronic transactions to the updated 5010 version of the Health Insurance Portability and Accountability Act (HIPAA) transactions standards is January 1, 2012.  Physicians will be required to conduct electronic transactions such as claims submissions, eligibility verification, claims status, remittance advice, and referral authorizations using the updated transaction standards.  If physicians’ practice management systems are not up to new standards, they will risk not receiving electronic payments from private insurers and Medicare.  The new HIPAA 5010 regulations impact all health care providers who:

• Send or receive electronic administrative transactions directly to payers—both private and public; and,
• Send electronic data to a billing service or clearinghouse that submits transactions on your practice’s behalf.

What is 5010? The new data standards come out of the Health Insurance and Accountability Act of 1996.  It demands for more specificity in what data must be entered and transmitted, with the hope that the claims process will be more efficient and more details will be available about the patient visit. For example, physicians must submit a nine-digit, rather than a five-digit, ZIP code on all claims submissions and submit a street address rather than a post office box.  5010 also allows physicians to distinguish between principal diagnosis, admitting diagnosis, external cause of injury, and patient reason for visit codes. Guidelines for Claims Submission Using HIPAA 5010 Standards Step 1:      Impact analysis – Conduct an internal analysis to determine the impact the change to 5010 will have on your practice. Step 2:      Vendor, payer, billing service, and clearinghouse connections – Contact your practice management and electronic medical record vendor for details on the installation of upgrades to your system.  Contact your clearinghouses, billing service, and payers to find out when upgrades will be completed and when they can accept 5010 transactions. Step 3:      Installation of vendor upgrades Step 4:      Internal testing and staff training – Once the upgrades are completed, conduct internal testing of your systems to ensure you can generate the 5010 transactions.  You will need to train staff during the process of implementing and testing your system. Step 5:      External testing with clearinghouses, billing service, and payers Step 6:      Making the switch to 5010 – After you have completed external testing with some or all of your trading partners, you may switch to using only the 5010 transactions.  You are permitted to begin using the 5010 transaction before the compliance date as long as you and the other organizations agree to the early switch. Step 7:      Backup plans – In case transaction is rejected after the switch, make a plan for an interruption in cash flow.  Some suggestions: Submit as many transactions as possible before January 1, 2012; decrease expenses before January 1, 2012, to increase cash reserves; establish a line of credit with a financial institution. Source: “5010 Implementation Steps: Getting the Work Done in Time for the Deadline,” AMA. Where Can I Find More Information?

• GetReady5010.org
• www.cms.gov/Versions5010andD0/
• HIPAA 5010 Guide