CMS video provides information to patients on new Medicare cards
Are your Medicare patients aware that beginning in April they will receive new beneficiary ID cards? Help keep them up to date by playing the "New Medicare Cards are coming!" video in your waiting room. The Center for Medicare and Medicaid’s (CMS’s) short video informs patients of when and how they will receive the new card. This initiative will help prevent fraud and identity theft and protect beneficiaries’ financial information. Start readying your systems to accept the new MBI format now to ensure that your systems will reflect these changes. For information on how to prepare your practice for the new cards, visit CMS’ Provider webpage.
MedPAC recommends changes to MIPS in annual report to Congress
In its annual report to Congress, the Medicare Payment Advisory Commission (MedPAC) recommended replacing the Merit-based Incentive Payment System (MIPS) with a Voluntary Value Program (VVP). MedPAC believes that MIPS is overly complex and burdensome and will not succeed. The VVP would assess clinicians on clinical quality, patient experience and value. MedPAC believes that the VVP would significantly reduce clinician burden, while not affecting beneficiaries’ access to care, and will get clinicians comfortable with being measured in a manner similar to Advanced Alternative Payment Models (A-APMS).
The report outlines three important features that distinguish a VVP from MIPS:
- Clinicians would be eligible to receive a payment adjustment at a voluntary group level. A VVP would require minimal administrative structure and would entail less risk and reward than is required in A-APMs.
- The voluntary groups would be assessed on a uniform set of population-based measures.
- Clinicians would no longer need to report quality data to Medicare because all measures would be calculated by CMS from claims and surveys.
It is important to note that this the VVP is a recommendation to Congress, and there is no guarantee that Congress will act on this recommendation.
Billing for Maintenance Care
It has recently come to our attention the dissemination of information that alludes that it would be appropriate to use ICD-10 code Z00.00 when billing Medicare for annual wellness exams, initial preventive physical examinations (IPPE), or similar chiropractic wellness or maintenance care. Given the limitations for reimbursement of chiropractic services under Medicare, it is not appropriate to submit claims for wellness or maintenance care to Medicare in this manner. Chiropractors should always use the M99.0 ICD-10 code category, even when billing for wellness or maintenance care, and procedure codes 98940-98942 with the GA modifier appended. Additionally, doctors should make sure they have the current version of the ABN form signed by the patient on file. For private insurance, providers should always review the payer policy for maintenance or wellness care. In some cases, S8990 (the HCPCS code for “physical or manipulative therapy performed for maintenance rather than restoration”) can be used as the procedure code. However, acceptance by payers varies, and chiropractors should verify use/coverage with each payer. If the payer allows S8990, then the appropriate ICD-10 code should be used.
Reminder: CERT Reviews
Recently ACA has received reports that chiropractors are receiving CERT requests for medical record documentation. Because CERT reviews determine the accuracy of Medicare claims processing (i.e., the error rate), ACA reminds doctors that first and foremost, it is imperative to respond to these requests. Not responding to a CERT records request factors into the error rate for “no documentation” for the profession. If you receive a CERT records request: first, don’t panic – CERT reviews are random in nature; second - thoroughly review the letter for the specific items of documentation requested and the response deadline; and finally, review ACA’s CERT information and resources. If you have any questions, please send an email to Medicare@acatoday.org.
11/01/2017 - Physician Compare Preview Period is Now Open Until Dec. 1 at 8pm ET
(Note: These resources indicate that providers only have until Nov. 17 to preview their data; however, due to technical difficulties that have been resolved, CMS has extended the deadline until Dec. 1.)
To learn more about the PY 2016 performance information and PY 2015 clinician utilization data that are available for preview, download the measure crosswalks from the Physician Compare Initiative page:
10/27/2017 - ACA submits comments on HHS Strategic Plan FY 2018-2022