Medicare Jurisdiction E Part B Updates

Payment Rules Notice

Although we are still assessing the impact of the partial government shutdown on completion of the calendar year 2014 Medicare fee for service payment regulations, we intend to issue the final rules on or before November 27, 2013, generally to be effective on January 1, 2014. The impacted regulations include:

• Medicare Program; End-Stage Renal Disease Prospective Payment System, Quality Incentive Program, and Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (CMS-1526-F)
• CY 2014 Changes to the Hospital Outpatient Prospective Payment System and Ambulatory Surgical Center Payment System (CMS-1601-FC)
• CY 2014 Home Health Prospective Payment System Final Rule (CMS-1450-F)
• Revisions to Payment Policies under the Physician Fee Schedule and Other Revisions to Part B for CY 2014 Final Rule with Comment Period (CMS-1600-FC)

Source: LEARNRESOURCE-L E-mail Update, National Institutes of Health, U.S. Department of Health and Human Services dated October 23, 2013

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2014 Medicare Physicians Fee Schedule (MPFS) Available Soon

2014 MPFS Available Soon Watch for the 2014 Medicare Physician Fee Schedule (MPFS). It will be published on the “Fee Schedules” webpage at med.noridianmedicare.com/web/jeb/fees-news/fee-schedules after its regulation is put on display.
Last Updated Nov 27, 2013

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Physicians Dropped by Health Plans for Overutilization

By Averel B. Snyder, MD from Physicians Practice

After United Healthcare dropped 15 percent of its provider panel, I was not surprised. I actually thought something like that would occur sooner. It is clear that for Medicare to survive and to decrease healthcare costs in this country, healthcare delivery needs to change. Most believe that fee-for-service reimbursement is no longer an option and there seems to be a shift toward pay for performance. Clearly, increasing quality, decreasing costs, and increasing patient satisfaction are goals both payer and provider would strive for.

There are certain services in place to help meet these goals. One such example is the Medicare Annual Wellness Visit (AWV). The AWV, by delivering evidence-based preventive services, helps keep patients healthier and prevents over-utilization of services. The visit also helps satisfy quality measures for PQRS reporting. Despite all these advantages only approximately 12 percent of Medicare beneficiaries have had their AWV.

Another way to increase quality and decrease costs is to identify those patients that are at increased risk of overutilization. The current methodology to identify risk is the CMS HCC method. In addition to identifying risk by assigning a risk score to each patient, the codes are necessary for Medicare Advantage (MA) plans to get paid from CMS. The majority of physicians do an incomplete job of coding, making it necessary for MA plans to use third-party providers for risk assessments and retrospective chart reviews. There are now automated software solutions that provide all the components of the AWV and calculate the CMS HCC risk score real time.

The point is that fee-for-service overutilization, no coding, and not providing quality measures will not be and should not be tolerated. Those plans with strong executive leadership will identify those top 15 percent physician over-utilizers and not allow them to participate in the MA plan. If I was one of those executives I would make the same decision. It is time to make the paradigm shift and provide the highest quality care as cost efficiently as possible. It is to the providers' advantage to provide wellness visits for all their Medicare patients, and to understand the nuances of HCC coding.

Article By Averel B. Snyder, MD from Physicians Practice

http://www.physicianspractice.com/blog/physicians-dropped-health-plans-overutilization?GUID=2E8F906E-CDE7-43B7-AC93-7066F83372C7&rememberme=1&ts=19112013

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2013-2014 Influenza (Flu) Resources for Health Care Professionals

MLN Matters® Number: SE1336
Provider Types Affected

This MLN Matters® Special Edition article is intended for all health care professionals who order, refer, or provide flu vaccines and vaccine administration to Medicare beneficiaries.
What You Need to Know

Keep this Special Edition MLN Matters® article and refer to it throughout the 2013 - 2014 flu season.

Take advantage of each office visit as an opportunity to encourage your patients to protect themselves from the flu and serious complications by getting a flu shot.
Continue to provide the flu shot as long as you have vaccine available, even after the new year.
Don't forget to immunize yourself and your staff.

Introduction

The Centers for Medicare & Medicaid Services (CMS) reminds health care professionals that Medicare Part B reimburses health care providers for flu vaccines and their administration. (Medicare provides coverage of the flu vaccine without any out-of-pocket costs to the Medicare patient. No deductible or copayment/coinsurance applies.)

You can help your Medicare patients reduce their risk for contracting seasonal flu and serious complications by using every office visit as an opportunity to recommend they take advantage of
Medicare's coverage of the annual flu shot.

As a reminder, please help prevent the spread of flu by immunizing yourself and your staff!

Know What to Do About the Flu!

Educational Products for Health Care Professionals
The Medicare Learning Network® (MLN) has developed a variety of educational resources to help you understand Medicare guidelines for seasonal flu vaccines and their administration.

1. MLN Influenza Related Products for Health Care Professionals

• MLN Matters® Article MM8433: Influenza Vaccine Payment Allowances – Annual Update for 2013-2014 Season – http://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/downloads/MM8433.pdf
• Quick Reference Information: Medicare Part B Immunization Billing chart - http://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/downloads/qr_immun_bill.pdf
• Quick Reference Information: Preventive Services chart - http://www.cms.gov/Medicare/Prevention/PrevntionGenInfo/Downloads/MPS_QuickReferenceChart_1.pdf
• Preventive Immunizations booklet – http://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/Downloads/Preventive-Immunizations-ICN907787.pdf
• MLN Preventive Services Educational Products Web Page  - http://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/PreventiveServices.html
• Preventive Services Educational Products PDF – http://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/downloads/education_products_prevserv.pdf

2. Other CMS Resources

• Seasonal Influenza Vaccines 2013 Pricing - http://www.cms.gov/Medicare/Medicare-Fee-for-Service-Part-B-Drugs/McrPartBDrugAvgSalesPrice/2013ASPFiles.html
• Immunizations web page is located at http://www.cms.gov/Medicare/Prevention/Immunizations/index.html
• Prevention General Information is located at http://www.cms.gov/Medicare/Prevention/PrevntionGenInfo/index.html
• CMS Frequently Asked Questions - http://questions.cms.gov/faq.php  
• Medicare Benefit Policy Manual - Chapter 15, Section 50.4.4.2 – Immunizations - http://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/downloads/bp102c15.pdf   
• Medicare Claims Processing Manual – Chapter 18, Preventive and Screening Services http://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/downloads/clm104c18.pdf

3. Other Resources

The following non-CMS resources are just a few of the many available where you may find useful information and tools for the 2013 – 2014 flu season:

• Advisory Committee on Immunization Practices -  http://www.cdc.gov/vaccines/acip/index.html  
• Flu Clinic Locator - http://www.flucliniclocator.org
• Other sites with helpful information include:
  • Centers for Disease Control and Prevention - http://www.cdc.gov/flu;
  • Flu.gov - http://www.flu.gov; 
  • Food and Drug Administration - http://www.fda.gov;
  • Immunization Action Coalition - http://www.immunize.org;  
  • Indian Health Services -  http://www.ihs.gov/;  
  • National Alliance for Hispanic Health - http://www.hispanichealth.org;  
  • National Foundation For Infectious Diseases - http://www.nfid.org/influenza;
  • National Library of Medicine and NIH Medline Plus - http://www.nlm.nih.gov/medlineplus/immunization.html;
  • National Network for Immunization Information - http:/www.immunizationinfo.org;
  • National Vaccine Program - http://www.hhs.gov/nvpo;
  • Office of Disease Prevention and Health Promotion - http://odphp.osophs.dhhs.gov;   
  • Partnership for Prevention - http://www.prevent.org; and
  • World Health Organization - http://www.who.int/en

Beneficiary Information
For information to share with your Medicare patients, please visit http://www.medicare.gov on the Internet.

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