http://www.texmed.org/Deadlines Deadlines For Doctors Can Keep You Compliant! Are You Ready for These Deadlines? http://www.texmed.org/Deadlines/Detail.aspx?ID=27189 Texas Medical Association Federal Agency: Physicians Can Begin to Register on CMS Open Payments Website Federal Agency http://www.texmed.org/Deadlines/Detail.aspx?ID=27186 Texas Medical Association In February 2013, the Centers for Medicare & Medicaid Services (CMS) issued a final rule that implements the Physician Payments Sunshine Act, a provision of the Patient Protection and Affordable Care Act (PPACA). CMS requires manufacturers and group purchase organizations (GPOs) to start collecting data that must be reported to CMS by March 31, 2014. Federal Agency http://www.texmed.org/Deadlines/Detail.aspx?ID=27055 Texas Medical Association Physician practices that are structured as a limited liability partnership, professional association, or any other corporate form must file a Texas franchise tax return or request an extension annually by May 15. Practice Operations http://www.texmed.org/Deadlines/Detail.aspx?ID=27022 Texas Medical Association The Medicare Improvements for Patients and Providers Act of 2008 (MIPPA) created an e-prescribing reporting incentive that pays successful e-prescribers a percent of Medicare billing. E-Prescribing http://www.texmed.org/Deadlines/Detail.aspx?ID=27021 Texas Medical Association Medicare is paying physicians to meaningfully use an electronic health record. Once physicians meet the criteria, they must attest to meeting the criteria. Medicare http://www.texmed.org/Deadlines/Detail.aspx?ID=27008 Texas Medical Association Novitas has received documentation from physicians that does not include a copy of the approved Novitas forms. Medicare http://www.texmed.org/Deadlines/Detail.aspx?ID=27007 Texas Medical Association The enrollment requirement for ordering/referring physicians is part of the Patient Protection and Affordable Care Act (PPACA). The provision was included in the PPACA to address multiple issues including combating fraud and abuse by making sure only those physicians who are appropriately enrolled in Medicare are providing services to Medicare beneficiaries, making sure that nonphysician providers were not ordering/referring services that they’re not allowed to order under the Medicare rules, and making sure that physicians maintain updated enrollment records with Medicare. Since January 1992, physicians have been required to list the ordering/referring physician on a claim if the service provided was the result of an order/referral. Medicare http://www.texmed.org/Deadlines/Detail.aspx?ID=27005 Texas Medical Association Physicians must submit the G-Code, G8553, on at least 10 Medicare claims for encounters taking place by June 30, 2013, to prevent a 2-percent penalty in 2014. The claims for those encounters must be submitted and accepted by July 26, 2013. Collections http://www.texmed.org/Deadlines/Detail.aspx?ID=27004 Texas Medical Association Aetna has made changes to their National Precertification List. Private Payer http://www.texmed.org/Deadlines/Detail.aspx?ID=27003 Texas Medical Association Aetna regularly updates their clinical, payment, and coding policy positions. Private Payer http://www.texmed.org/Deadlines/Detail.aspx?ID=27002 Texas Medical Association Aetna regularly reviews and makes changes to their Pharmacy programs. Private Payer http://www.texmed.org/Deadlines/Detail.aspx?ID=27001 Texas Medical Association The ClaimsXten tool offers flexible, rules-based claims management with the capability of creating customized rules, as well as the ability to read historical claims data. Private Payer http://www.texmed.org/Deadlines/Detail.aspx?ID=27000 Texas Medical Association For certain business units and types of appeals, Cigna historically has offered second-level appeals to health care professionals who were not satisfied with the resolution of a first-level review. Beginning July 1, 2013, Cigna will no longer offer second-level appeals. All appeals will follow a thorough single appeal review process and will be completed within 60 days. Private Payer http://www.texmed.org/Deadlines/Detail.aspx?ID=26992 Texas Medical Association Cigna routinely reviews its clinical, reimbursement, and administrative policies, as well as coverage positions and precertification requirements. Private Payter http://www.texmed.org/Deadlines/Detail.aspx?ID=26990 Texas Medical Association The Centers for Medicare & Medicaid Services (CMS) developed the National Correct Coding Initiative (NCCI) to promote national correct coding methodologies and to control improper coding that leads to inappropriate payment in Part B claims. CMS updates NCCI quarterly. Practice Operations http://www.texmed.org/Deadlines/Detail.aspx?ID=26937 Texas Medical Association Physicians who do not successfully e-prescribe 10 times and report each time with a G-Code on the claim form for Medicare patients by June 30, 2013, will be penalized 2 percent in 2014. *Exceptions: If you are participating in the EHR Incentive Program, or you have applied for one of the exemptions as defined by the Centers for Medicare & Medicaid Services, you don't need to do this. E-Prescribing http://www.texmed.org/Deadlines/Detail.aspx?ID=26713 Texas Medical Association Section 6401 (a) of the Patient Protection and Affordable Care Act established a requirement for all enrolled physicians and suppliers to revalidate their enrollment information under new enrollment screening criteria. This revalidation effort applies to those physicians and suppliers who were enrolled before March 25, 2011. Medicare http://www.texmed.org/Deadlines/Detail.aspx?ID=26712 Texas Medical Association Section 6401 (a) of the Patient Protection and Affordable Care Act established a requirement for all enrolled physicians and suppliers to revalidate their enrollment information under new enrollment screening criteria. This revalidation effort applies to those physicians and suppliers who were enrolled before March 25, 2011. Medicare http://www.texmed.org/Deadlines/Detail.aspx?ID=26711 Texas Medical Association The Centers for Medicare & Medicaid Services (CMS) issued revised and clarified Place of Service (POS) coding instructions. The instructions establish that for all services – with two (2) exceptions – paid under the Medicare Physician Fee Schedule, the POS code that the physician and other suppliers need to use is the same code used for the setting in which the patient received the face-to-face service. Medicare http://www.texmed.org/Deadlines/Detail.aspx?ID=26707 Texas Medical Association The Centers for Medicare & Medicaid Services (CMS) has created a new process to identify and perform retroactive adjustments on any previously paid claims that may have been paid erroneously during periods when the beneficiary data in Medicare’s files did not reflect the fact that the beneficiary was unlawfully present in the United States. Medicare http://www.texmed.org/Deadlines/Detail.aspx?ID=26646 Texas Medical Association UHC provides a monthly notice of recently approved and/or revised medical policies, drug policies, and coverage determination guidelines (CDGs) for your review. You may view new and/or revised medical policies, drug policies, and CDGs, in their entirety, along with an overview or summary of changes, on the UHC website. Private Payer http://www.texmed.org/Deadlines/Detail.aspx?ID=26645 Texas Medical Association On March 1, 2013, UnitedHealthcare is introducing Provisor, an interactive new iPhone®/iPad® app to help make prescribing easier and more effective for UHC-contracted physicians. It will include access to current UHC base formularies (prescription drug lists, UHC members' personal health records, and drug reference information.) HIT http://www.texmed.org/Deadlines/Detail.aspx?ID=26643 Texas Medical Association The new 2013 UnitedHealthcare Physician, Health Care Professional, Facility, and Ancillary Provider Administrative Guide is now posted on UnitedHealthcareOnline.com. The guide is effective April 1, 2013, for currently contracted physicians and immediately for physicians newly contracted on or after Jan. 1, 2013. http://www.texmed.org/Deadlines/Detail.aspx?ID=26642 Texas Medical Association Aetna is requiring all participating providers who perform in-office surgical pathology testing to be accredited by CLIA and at least one other accrediting entity. Dermatologists are exempt from this requirement. Private Payer http://www.texmed.org/Deadlines/Detail.aspx?ID=26641 Texas Medical Association Section 6401 (a) of the Patient Protection and Affordable Care Act established a requirement for all enrolled physicians and suppliers to revalidate their enrollment information under new enrollment screening criteria. This revalidation effort applies to those physicians and suppliers who were enrolled before March 25, 2011. Medicare http://www.texmed.org/Deadlines/Detail.aspx?ID=26589 Texas Medical Association Medicare payments to physicians will drop 2 percent because Congress and President Obama failed to avoid the sequestration budget cuts. Although the sequestration takes effect March 1, an American Medical Association advisory says the Medicare fee reductions will not begin until April 1. Medicare http://www.texmed.org/Deadlines/Detail.aspx?ID=26586 Texas Medical Association TRICARE will have the authority to sanction third-party billing agents by invoking the administrative remedy of exclusion or suspension from the TRICARE program. Such sanctions may be invoked in situations involving fraud or abuse on the part of third-party billing agents that prepare or submit claims presented to TRICARE for payment. Practice Operations http://www.texmed.org/Deadlines/Detail.aspx?ID=26236 Texas Medical Association On Jan. 25, 2013, the U.S. Department of Health and Human Services released an update to the earlier HIPAA rules that further expands the requirements of physicians. Federal Agency http://www.texmed.org/Deadlines/Detail.aspx?ID=26234 Texas Medical Association Physicians participating in the e-prescribing incentive program must have claims turned in for encounters happening on or before 12/31/2012. Be sure to report G-code G8553 for the Medicare patient encounters where a prescription was sent electronically. Must submit 25 for eligibility for 1 percent Medicare bonus. Medicare http://www.texmed.org/Deadlines/Detail.aspx?ID=26233 Texas Medical Association Physicians participating in the Medicaid EHR incentive program are eligible for $63,750 in incentive payments over six years of program participation. Physicians must attest every year. HIT http://www.texmed.org/Deadlines/Detail.aspx?ID=26232 Texas Medical Association Medicare is paying physicians to meaningfully use an electronic health record. Once physicians meet the criteria, they must attest to meeting the criteria. Medicare http://www.texmed.org/Deadlines/Detail.aspx?ID=26231 Texas Medical Association The deadline to select your Medicare participation status ends 12/31/2012 Medicare http://www.texmed.org/Deadlines/Detail.aspx?ID=26230 Texas Medical Association CMS extended the deadline for physicians to determine their 2013 Medicare Participation status after a last minute deal was signed to stop the 28.5 percent cut to Medicare for 2013. Medicare http://www.texmed.org/Deadlines/Detail.aspx?ID=25813 Texas Medical Association Physicians who qualify for any one of four e-prescribing hardship exemptions must file with the Centers for Medicare & Medicaid Services (CMS) between Nov. 1, 2012, and Jan. 31, 2013. The four exemptions are: -You cannot electronically prescribe due to local, state, or federal law or regulation (e.g., you prescribe controlled substances). -You prescribe infrequently (e.g., fewer than 100 prescriptions between Jan. 1 and June 30). -Your practice is in a rural area without high-speed Internet access. -Your practice is in an area that lacks sufficient pharmacies for e-prescribing. E-Prescribing http://www.texmed.org/Deadlines/Detail.aspx?ID=25281 Texas Medical Association The Texas Legislature passed House Bill 300 (HB 300) during its 82nd regular session to amend the Texas Medical Privacy Act (TMPA) and other state privacy/security laws. HB 300 offers more stringent protections for protected health information (PHI) than its federal counterparts, HIPAA and the HITECH Act. Among other things, HB 300 mandates employee training on state and federal laws regarding PHI that is tailored to each employee’s scope of employment. It also puts in place new requirements for notices to patients regarding electronic disclosure of PHI. HIPAA http://www.texmed.org/Deadlines/Detail.aspx?ID=25280 Texas Medical Association The multiple Centers for Medicare & Medicaid Services (CMS) contractors who perform various audit programs in Medicare can be confusing. Medicare http://www.texmed.org/Deadlines/Detail.aspx?ID=25076 Texas Medical Association In June, Cigna sent a letter to primary care physicians and other specialists in 19 specialties about the availability of their results for the 2013 Cigna Care designation and physician quality and cost-efficiency displays. Physicians have until Aug. 2, 2012, to submit a reconsideration request for the correct information to be posted in the online provider directory. Private Payer http://www.texmed.org/Deadlines/Detail.aspx?ID=25075 Texas Medical Association Blue Cross and Blue Shield of Texas (BCBSTX) will implement changes in the maximum allowable fee schedule used for BlueChoice®, HMO Blue® Texas (Independent Provider Network and THE Limited Network only), and ParPlan effective Nov. 1, 2012. Private Payer http://www.texmed.org/Deadlines/Detail.aspx?ID=25074 Texas Medical Association Aetna will enroll eligible TRS-Care participants in an Aetna Medicare Advantage plan. Participants have to opt-out if they want to continue to stay in traditional Medicare Private Payer http://www.texmed.org/Deadlines/Detail.aspx?ID=25073 Texas Medical Association Effective Sept. 1, 2012, Blue Cross and Blue Shield of Texas (BCBSTX) will no longer serve as the third-party administrator for HealthSelect of Texas, the state’s health care plan managed by the Employees Retirement System of Texas (ERS). UnitedHealthcare (UHC) will take over as third-party administrator. Private Payer http://www.texmed.org/Deadlines/Detail.aspx?ID=24699 Texas Medical Association If you are currently enrolled for Electronic Funds Transfer (EFT) with TrailBlazer Health Enterprises (TrailBlazer), be on the lookout for a letter from Novitas Solutions, Inc. (Novitas) requesting a CMS-588 EFT Authorization Agreement (Agreement). Medicare http://www.texmed.org/Deadlines/Detail.aspx?ID=24604 Texas Medical Association UnitedHealthcare (UHC) has several medical policies that have been revised, and the effective date for the revisions is 06/01/2012. Private Payer http://www.texmed.org/Deadlines/Detail.aspx?ID=24568 Texas Medical Association UnitedHealthcare (UHC) has several medical policies that have been revised, and the effective date for the revisions is 06/01/2012. Private Payer http://www.texmed.org/Deadlines/Detail.aspx?ID=24204 Texas Medical Association Division of Workers' Compensation regulations will require that workers' compensation patients currently on prescription drugs listed on the "N" list as established by the Official Disability Guidelines (ODG) be prescribed drugs that are not on the "N" list as of September 1, 2013, unless preauthorization has been obtained. Practice Operations http://www.texmed.org/Deadlines/Detail.aspx?ID=24071 Texas Medical Association The Centers for Medicare & Medicaid Services awarded the JH contract to Novitas Solutions, Inc., in March 2012. The previous contractor was TrailBlazer. Medicare http://www.texmed.org/Deadlines/Detail.aspx?ID=24046 Texas Medical Association The annual registration fee has been increased for physicians (and others) to $244. However, for administrative convenience for both the collection and the payment, physicians will pay a combined registration fee of $731 every three years. Under the Controlled Substances Act, the Drug Enforcement Agency (DEA) is authorized to charge reasonable fees relating to the registration and control of the manufacture, distribution, dispensing, import, and export of controlled substances and listed chemicals. DEA must set fees at a level that ensures the recovery of the full costs of operating the various aspects of its Diversion Control Program. Each year, DEA is required by statute to transfer the first $15 million of fee revenues into the general fund of the Treasury, and the remainder of the fee revenues is deposited into a separate fund of the Treasury called the Diversion Control Fee Account (DCFA). It has been more than five years since the last fee adjustment. DEA proposed a new fee schedule by publication of an NPRM on July 6, 2011. The government adopted the proposed change on March 15, 2012. (Source, 77 Fed. Reg. 15234). Federal Agency http://www.texmed.org/Deadlines/Detail.aspx?ID=23982 Texas Medical Association The Centers for Medicare & Medicaid Services' Office of E-Health Standards and Services (OESS), has announced that it would not initiate enforcement action with respect to any HIPAA covered entity non-compliant with the ASC X12 Version 5010 (Version 5010) standards until June 30, 2012. This extends a previous enforcement delay that was to be end March 31, 2012 (See the March 31 entry for details on the previous HIPAA 5010 Electronic Transactiion Standards Enforcement Discretion Period delay). Please note, January 1, 2012 remains the compliance date for implementation for these updated standards. Federal Agency http://www.texmed.org/Deadlines/Detail.aspx?ID=23614 Texas Medical Association Comparative billing reports (CBRs), produced by SafeGuard Services under contract with CMS, contain actual data-driven tables and graphs with an explanation of findings that compare a practitioners' billing and payment patterns with those of their peers located in their state and across the nation. These reports are not available to anyone except the practitioners who receive them. These reports are an example of a tool that helps practitioners better understand applicable Medicare billing rules and improve the level of care they furnish to their Medicare patients. For more information and to review a sample of the Advanced Diagnostic Imaging CBR, visit the CBR Services website at www.CBRservices.com, or call the SafeGuard Services’ Provider Help Desk, CBR Support Team, at (530) 896-7080. Medicare http://www.texmed.org/Deadlines/Detail.aspx?ID=23372 Texas Medical Association Physicians who do not successfully e-prescribe 10 times and report each time with a G-Code on the claim form for Medicare patients will be penalized 1.5 percent in 2013. HIT http://www.texmed.org/Deadlines/Detail.aspx?ID=23240 Texas Medical Association BCBS of Texas has posted 4 Medical Policies currently undergoing review. Physicians have until 12/31/2011 to comment on the changes. Private Payor