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Simply Healthcare plans may go out of business in few counties


As of January 1st 2015, Simply healthcare plans will no longer be available for Medicare beneficiaries residing in Broward, Palm Beach, Duval, Clay, Brevard, Hillsborough, Hernando, Pasco and Pinellas Counties in Florida.
 
Medicare patients will be receiving a formal notice from Simply Healthcare dated October 2, 2014. The CMS approved letter will be sent to the affected members which will provide information to help them make informed decisions about their Medicare coverage options for 2015. These members will also no longer receive instructions about their eligibility to enroll in another Medicare health plan. If Medicare patients do not sign up for a new plan by the end of 2014, their current coverage will end on December 31, 2014 and patients would be covered through original Medicare from January 1, 2015.

Please contact your Provider relations team for more information.

Florida Blue - Type 2 NPI is Required for Providers Billing with EIN


For individual providers who submit electronic claims with their Employee Identification Number (EIN) rather than their Social Security Number (SSN), a new policy from Florida Blue applies immediately. The policy, which strengthens alignment with the Centers for Medicare & Medicaid Services (CMS), requires such providers to have a valid Type 2 National Provider Identification (NPI) on file with us. For providers who continue to use their Social Security Number and not an EIN, a Type 1 NPI can continue to be used. 

For more information please refer to the Frequently Asked Questions or contact Florida Blue at 800-727-2227, Mon. through Fri., 8 a.m. – 8 p.m. ET.

Review New and Updated FAQs for the EHR Incentive Programs


To keep you updated with information on the Medicare and Medicaid EHR Incentive Programs, CMS has recently added one new FAQ and updated seven FAQs to the CMS FAQ system. We encourage you to stay informed by taking a few minutes to review the new information below.

New FAQ:

  1. For Measure 2 of the Stage 2 Summary of Care objective for the EHR Incentive Programs, may an eligible professional,  eligible hospital, or critical access hospital count a transition of care or referral in its numerator for the measure if they electronically create and send a summary of care document using their CEHRT to a third party organization that plays a role in determining the next provider of care and ultimately delivers the summary of care document? Read the answer.

Updated FAQs: 

  1. If my practice does not typically collect information on any of the core, alternate core, and additional clinical quality measures (CQMs) listed in the Final Rule on the Medicare and Medicaid EHR Incentive Programs, do I need to report on CQMs for which I do not have any data? Read the answer.
  2. Can eligible professionals use CQMs from the alternate core set to meet the requirement of reporting three additional measures for the Medicare and Medicaid EHR Incentive Programs? Read the answer.
  3. If one of the measures for the core set of CQMs for eligible professionals is not applicable for my patient population, am I excluded from reporting that measure for the Medicare or Medicaid EHR Incentive Programs? Read the answer.
  4. If none of the core, alternate core, or additional clinical quality measures adopted for the Medicare and Medicaid EHR incentive programs apply, am I exempt from reporting on all CQMs? Read the answer.
  5. If the denominators for all three of the core CQM are zero, do I have to report on the additional CQMs for eligible professionals under the Medicare and Medicaid EHR Incentive Programs? Read the answer.
  6. For the Medicare and Medicaid EHR Incentive Programs, if the certified EHR technology possessed by an eligible professional generates zero denominators for all CQMs in the additional set that it can calculate, is the eligible professional responsible for determining whether they have zero denominators or data for any remaining CQMs in the additional set that their certified EHR technology is not capable of calculating? Read the answer.
  7. I am an eligible professional who has successfully attested for the Medicare EHR Incentive Program, so why haven't I received my incentive payment yet? Read the answer.

Providers and Suppliers to Comply with MAC Request for Fingerprints within 30 Days


CMS implemented the fingerprint-based background requirement on August 6, 2014, as discussed in the rule published on February 2, 2011. Fingerprint-based background checks are required for all individuals with a 5 percent or greater ownership interest in a provider or supplier that falls into the high risk category and is currently enrolled in Medicare or has submitted an initial enrollment application. Medicare Administrative Contractors (MACs) have begun sending letters to these providers and suppliers, listing all owners who are required to be fingerprinted. The letters are being mailed to the provider or supplier’s correspondence address and the special payments address on file with Medicare. 

Identified individuals have 30 days from the date of the letter to be fingerprinted. Failure to comply with the fingerprint requirements could result in denial of your Medicare enrollment application or revocation of your Medicare billing privileges. Visit Accurate Biometrics for fingerprinting procedures, to find a fingerprint collection site, and to ensure the fingerprint results are accurately submitted to the Federal Bureau of Investigation (FBI) and properly returned to CMS. For more information on this requirement, see MLN Matters® Special Edition Article #SE1427, “Fingerprint-based Background Check Begins August 6, 2014.” If 
you have any questions, contact Accurate Biometrics at 866- 361-9944, or visit their website at www.cmsfingerprinting.com.

National Breast Cancer Awareness Month


October is National Breast Cancer Awareness Month. During this national health observance, CMS reminds health professionals that breast cancer is the second most common form of cancer in women. Medicare provides coverage for screening mammography to facilitate the early detection of breast cancer for women with no signs or symptoms of disease. Medicare does not require a physician’s prescription or referral for screening mammography. The screening mammography is a Medicare Part B benefit with no co-pay/co-insurance or deductible. Medicare does not cover screening mammography for men. However, Medicare does provide coverage for diagnostic mammography for men and women who meet certain coverage criteria. 

A clinical breast exam is also covered under Medicare Part B as part of the screening pelvic examination for beneficiaries who meet coverage criteria. There is no copay/co-insurance or deductible for this screening benefit.

Also see: Coverage information for Screening Mammography

Claims with HCPCS code A9552 reported for Oncologic conditions will be held by Medicare


Claims for fluorodeoxyglucose (FDG) positron emission tomography (PET) for solid tumors submitted October 6 through November 10 will be held to ensure Medicare systems can accurately calculate payments. Specifically, these are claims containing Healthcare Common procedure Coding System (HCPCS) A9552 for all oncologic conditions. These claims will be processed beginning November 11 after the system has been fully tested. No action is required by providers.

For more information: http://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/Downloads/MM8739.pdf

CMS Announces 2013 PQRS Incentive Payments are Now Available


CMS is pleased to announce that the 2013 Physician Quality Reporting System (PQRS) incentive payments are now available for eligible professionals and group practices who submitted data for Medicare Physician Fee Schedule Part B services between January 1, 2013 and December 31, 2013. The PQRS incentive payments are for EPs and groups practices who met the PQRS satisfactory reporting criteria, regardless of participation in another program (i.e., Medicare Shared Savings Program Accountable Care Organization, Comprehensive Primary Care Initiative, etc.).

As required by law, President Obama issued a sequestration order on March 1, 2013. Under these mandatory reductions, PQRS incentive payments made to eligible professionals and group practices have been reduced by 2%. This 2% reduction affected PQRS incentive payments for reporting periods that ended on or after April 1, 2013. All 2013 incentive payments are subject to sequestration.

For more information on the PQRS incentive payments, please review the Analysis and Payment webpage of the CMS website. For more information on interpreting the data in the report, please review the 2013 PQRS Feedback Report User Guide.

If needed, please contact the QualityNet Help Desk for assistance. They can be reached at 1-866-288-8912 (TTY 1-877-715-6222) or via qnetsupport@hcqis.org from 7:00 a.m. to 7:00 p.m. CST Monday through Friday.

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