Delays in Medicare Reimbursement
DATE: March 20, 2012 TO: AACE Members RE: Delays in Medicare Reimbursement AACE’s Socioeconomics & Member Advocacy Department has received several inquiries from the membership regarding delays they are experiencing in Medicare reimbursement. Three issues have been identified that may be impacting your office practice: 1) Electronic prescribing (eRx) Effective January 1, 2012, a one-percent penalty was assessed to eligible professionals that did not participate in CMS’ 2011 Electronic Prescribing Incentive Program. CMS’ required eligible professionals who did not meet the criteria to submit prescriptions electronically needed to request a hardship exemption. The request had to be submitted during the first, six-months of 2011 to avoid the 2012 penalty for eRx. One of the issues that has been identified regarding eRx is eligible professionals who submitted their hardship exemption requests may have been assessed the one-percent reduction in their Medicare payment. CMS indicated that it has not reviewed and approved all of the hardship exemption requests due to limited resources. If a physician did not receive approval from CMS, a reduction in Medicare payment may have occurred. Once CMS reviews the requests and determines that the eligible professional met the hardship exemption criteria, those claims will be reprocessed accordingly. The other issue related to the hardship exemption requests is that if the eligible professional’s information was incorrect or incomplete, the one-percent penalty would be assessed. During CMS’ National Provider Call, the CMS representatives emphasized that these requests must be correct and complete. CMS is not allowing eligible professionals to re-submit their request with updated information at this time. 2) Physician Quality Reporting System (PQRS) CMS has recently identified an error related to the submission of Measure #235 “Hypertension: Plan of Care” for the 2012 Physician Quality Reporting System. Hypertension: Plan of Care is a claims/registry measure with G-codes that are inactive due to an error found on the HCPCS tape. This has resulted in claims containing the G-codes associated with the measure being rejected by the carrier/Medicare Administrative Contractor (MAC) or denied. The HCPCs codes (G8675, G8676, G8677, G8678, G8679, G8680, 4050F) will be reactivated with the next update of the HCPCS tape in April 2012. For 2012 claims-based reporting, PQRS requires at least 3 measures to be reported at a 50% reporting rate. In the interim, eligible professionals who had intended to report this measure via claims for the 2012 PQRS reporting period may want to consider taking one of the following steps:
- Report the measure on more than 50% of eligible visits from April through December 2012 to increase the likelihood for successful reporting of the measure; or
- Consider reporting additional measures to substitute for Measure #235 "Hypertension: Plan of Care."
- Ask your clearinghouse/billing company to make sure that the linkage between the vendor and Medicare is valid. If the linkage is bad, you will receive an error message ‘Submitter not approved for electronic claim submissions on behalf of this entity.
- Ensure that your staff is submitting the correct NPI (rendering versus billing provider NPI). For example, billing Part B services for a provider associated with a group under his/her individual NPI instead of the group’s NPI would cause a billing error.