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Friday, April 26, 2013

National Unifom Claim Committe - NUCC Approves a Revised 1500

The NUCC will be releasing the new CMS 1500 form soon. There will be an update to accommodate the changes in 5010, 837P and 5010A1 and also to prepare for the implementation of ICD-10. We are currently using the 08/05 version of the CMS 1500 form. Beginning June 1, 2013, you can begin using the 02/12 version. The 02/12 version will replace the current form October 1, 2013 and will no longer be accepted by insurance carriers. The new form is awaiting approval, so it isn’t available just yet. You can learn more about the 02/12 claim form on the NUCC’s website at


CMS Today issued a proposed rule that would increase rewards paid to Medicare beneficiaries and others whose tips about suspected fraud lead to the recovery of funds. In addition, the rule would allow the agency to deny Medicare enrollment to providers affiliated with any entity that has unpaid Medicare debt; deny enrollment or revoke billing privileges of a provider or supplier if a managing employee has been convicted of certain felony offenses; and revoke billing privileges for providers and suppliers who “have a pattern or practice of billing for services that do not meet Medicare requirements” CMS said.

The proposed rule will be published in the April 29 Federal Register with comments accepted for 60 days. In addition, the Department of Health and Human Services’ Administration for Community Living this month announced up to $7.3 million in funding to expand Senior Medicare Patrol activities. Each of the current 54 SMP projects is eligible for varying funding levels, up to a total of $7.3 million across the program, CMS said. See the proposed rule at

Monday, April 1, 2013

CMS to host calls on ICD-10 preparation

From our friends at AMBA

The Centers for Medicare & Medicaid Services on Thursday, April 18, at 1:30 p.m. Eastern Time, will host a national provider call on transitioning to the ICD-10 coding system. The call will provide a basic overview as well as strategies for planning and preparing for ICD-10 implementation. To register, see the call notice. Hospitals and other entities covered by the Health Insurance Portability and Accountability Act must convert to the ICD-10 coding system by Oct. 1, 2014. In addition, CMS contractor National Government Services will host a series of listening sessions to gather feedback from providers on end-to-end testing of ICD-10 and other HIPAA administrative simplification requirements. For more information, see the CMS website.  

2% Medicare cuts begin today as a result of sequestration

Starting today April, 1st, 2013, reimbursements for medical services that are provided and procedure that are performed to Medicare patients will be cut by 2% due to the sequester federal budget cuts.

Patients responsibilities will not change as they still have to pay their co-insurance, deductibles or copays. they still have to pay their full patient responsibility.  So, Medicare patients are not getting ta 2% discount on what they owe.  Medicare is reducing their share of the payment by 2%.  To illustrate with an example, if a doctor bills $150.00 for a procedure and the patient is responsible for a $50.00 co-insurance and Medicare is responsible for the remaining $100.00.  The patient is still responsible for the entire co-insurance amount while Medicare will deduct 2% out of its $100.00 responsibility and pay $98.00.

See below the CMS Provider enews that came out on March 8th, 2013 (brought by the Medicare Learning Network)

To All Health Care Professionals, Providers, and Suppliers

Mandatory Payment Reductions in the Medicare Fee for Service (FFS) Program -“Sequestration”

The Budget Control Act of 2011 requires, among other things, mandatory across - the - board reductions in Federal spending, also known as sequestration. The American Taxpayer Relief Act of 2012 postponed sequestration for 2 months. As required by law, President Obama issued a sequestration order on March 1, 2013. The Administration continues to urge Congress to take prompt action to address the current budget uncertainty and the economic hardships imposed by sequestration.

This listserv message is directed at the Medicare FFS program (i.e., Part A and Part B). In general, Medicare FFS claims with dates - of - service or dates - of - discharge on or after April 1, 2013, will incur a 2 percent reduction in Medicare payment. Claims for durable medical equipment (DME), prosthetics, orthotics, and supplies, including claims under the DME Competitive Bidding Program, will be reduced by 2 percent based upon whether the date - of - service, or the start date for rental equipment or multi - day supplies, is on or after April 1, 2013.

The claims payment adjustment shall be applied to all claims after determining coinsurance, any applicable deductible, and any applicable Medicare Secondary Payment adjustments.

Though beneficiary payments for deductibles and coinsurance are not subject to the 2 percent payment reduction, Medicare’s payment to beneficiaries for unassigned claims is subject to the 2 percent reduction. The Centers for Medicare & Medicaid Services encourages Medicare physicians, practitioners, and suppliers who bill claims on an unassigned basis to discuss with beneficiaries the impact of sequestration on Medicare’s reimbursement.

Questions about reimbursement should be directed to your Medicare claims administration contractor. As indicated above, we are hopeful that Congress will take action to eliminate the mandatory payment reductions.