April 14, 2007

 NYSRS HEALTH INSURANCE, COMPENSATION & CAC REPORT 

MEDICARE UPDATE

Arthur J. Segal, M.D., F.A.C.R., Chairman, Medical Insurance and Compensation Committee / NYSRS CAC Representative

The ‘Stark’ Reality*:

Organizational Change for NYS Medicare Carrier

  The newly formed National Government Services is bringing together all the Medicare operations from all of the legacy contractors which are part of the WellPoint family.  National Government Services is hoping to maintain its position as one of the biggest contractors administering Medicare Part A, Part B and Regional Home Health and the DMERC contractor requirements in the United States.  National Government Services will be in about 40 locations throughout the United States and it is their hope that this organization will achieve additional efficiencies to better serve patients and health care providers.  However, National Government Services says that you will be dealing with the same local people.  When you go onto the Empire Medicare website, http://www.empiremedicare.com/ , you will note a portal page restating the mission of National Government Services and a link to all legacy contracts. 

Pay for Performance (P4P)

On December 20, 2006 the President signed the Tax Relief and Health Care Act of 2006 (TRHCA). Section 101 under Title I authorizes the establishment of a physician quality reporting system by CMS. CMS has titled the statutory program the Physician Quality Reporting Initiative (PQRI).  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% of total allowed charges for covered Medicare physician fee schedule services.

A detailed overview of ACR’s P4P activities, including quality measures ACR is developing, as well as the PQRI, can be found at: http://www.acr.org/s_acr/sec.asp?CID=3835&DID=24313

With 130 public and private P4P programs already in existence, including Medicare’s new bonus payments for reporting quality measures (see “Medicare Physician Quality Reporting Initiative, below), the ACR believes P4P represents a golden opportunity for radiologists to receive the full recognition—and long overdue value added compensation—for the superior services they provide.

CMS has set up a PQRI website, which lists all 74 current quality measures (including #10 and #11—which are related to stroke imaging) at:  http://www.cms.hhs.gov/pqri.  Please be aware that CMS still has many policy and technical issues to resolve, so you will need to monitor its website for updates. It expects to have the reporting coding specifications for the 74 measures soon.

The ACR is planning to post a Frequently Asked Questions section to the above ACR website in the very near future.  These will include specific requirements about how to report quality measures to CMS, and how CMS will determine eligibility for and the amount of bonuses paid.

The ACR welcomes all member questions by clicking on:  P4Pquestions@acr.org

Addl reference: (Part B News, Volume 21, No. 11, March 12, 2007, pp. 3-4)

NPI

        Despite the current May 23, 2007 deadline for including NPI (National Provider Identifier) on Medicare claims, this effective date remains questionable; however, suggest careful attention to the announced final deadline so as not to have claims rejected unnecessarily.

(Part B News, Volume 21, No. 11, March 12, 2007, p.6-7)

Bone Densitometry*

2006             2007               Descriptor

76075            77080              Dual-energy, 1 or more sites (axial skeleton)

76076            77081              Appendicular skeleton (peripheral)

76077            77082              Vertebral body assessment

(Radiology Coding Alert, Volume 9, No. 4, April 2007, p. 25)

*For more detailed information, recommend review of the source information, cited above.

Revised Form CMS-1500

In July 2006, the Form CMS-1500 (12-90) was revised by the National Uniform Claim Committee (NUCC) predominantly for the purpose of accommodating the National Provider Identifier.  In September 2006, Medicare announced that it would implement the revised From CMS-1500 (08-05) on January 1, 2007 with dual acceptability of both versions until March 31, 2007.  Medicare furthermore announced that beginning April 1, 2007, the only acceptable version of the form would be the Form CMS-1500 (08-05) and that the prior version, Form CMS-1500 (12-90) would be rejected.  PLEASE NOTE THAT THERE ARE INCORRECTLY FORMATTED VERSION OF THE REVISED FORM BEING SOLD BY PRINT VENDORS, specifically the Government Printing Office (GPO).  Currently, a new date has been established, ? June 1^st. Reference: http://search.cms.hhs.gov/search?q=form+cms-1500+%2812-90%29&btnG.x=18&btnG.y=4&site=default_collection&output=xml_no_dtd&client=my_frontend&proxystylesheet=my_frontend&oe=UTF-8  

& (Part B News, Volume 21, No. 12, March 19, 2007, p.1)

AAA SCREENING PAYMENT AFTER 1/1/07* -- REPEAT

CMS has authorized payment for screening abdominal aortic aneurysms with ultrasound for NEW MEDICARE PATIENTS IF the examining physician recommends this test on the basis of risk factors (e.g. family history, a 65-75 year old male who has smoked “at least 100 cigarettes in his life”), has several additional criteria and this recommendation is the result of this “Welcome to Medicare” exam and only for a limited period of time following this exam.  Recommended fee is $87 (not finalized).  Use a new “G” code for this.  See references for more detail.

(Part B News, Volume 20, No. 34, September 4, 2006, pp. 5-6)

(Interventional Procedure Coder’s Pink Sheet, Volume 2, No. 10, p 6, October, 2006)

(Radiology Coding Alert, Volume 9, No. 1, January 2007, p. 3)

Home Page Information:

http://www.ghimedicare.com/

http://www.umd.nycpic.com/

http://www.gao.gov

Coding 

Upstate Medicare –

http://www.umd.nycpic.com/billtips.html#ICD-9-CM   and then select, ICD-9-CM Coding for Diagnostic Tests

Respectfully submitted,

Arthur J. Segal, M.D., F.A.C.R.

Chairman, Medical Insurance and Compensation Committee / NYSRS CAC Representative