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Tuesday, June 2, 2015

Not all valid vaccine codes are in the book

Vaccine development and subsequent approval by the Food and Drug Administration (FDA) does not always nicely coincide with publication of the Current Procedural Terminology (CPT) manual. Consequently, the American Medical Association (AMA) uses its website to feature updates to the codes for these products, based on actions taken by the CPT Editorial Panel and the FDA.

In general, once approved by the CPT Editorial Panel, AMA makes vaccine CPT codes available for release twice a year, on July 1 and Jan. 1. As part of this electronic distribution, there is a six-month implementation period from the initial release date (i.e., codes released on Jan. 1 are eligible for use on July 1, and codes released on July 1 are eligible for use Jan. 1). In case you missed them, we will discuss some vaccine codes and code changes that do not yet appear in the CPT manual.  

First, the AMA released new codes 90620, for “Meningococcal recombinant protein and outer membrane vesicle vaccine, Serogroup B, 2 dose schedule, for intramuscular use,” and 90621, for “Meningococcal recombinant lipoprotein vaccine, Serogroup B, 2 or 3 dose schedule, for intramuscular use,” on Nov. 1, 2014, for implementation Feb. 1, 2015. Payers may have decided to acknowledge and implement both codes for reporting purposes prior to Feb. 1, but from a CPT perspective, they are now available to use, even though they won’t appear in the CPT manual until 2016. Both vaccines are FDA-approved.

Similarly, the AMA released new code 90697, for “Diphtheria, tetanus toxoids, acellular pertussis vaccine, inactivated poliovirus vaccine, Haemophilus influenza type b PRP-OMP conjugate vaccine, and hepatitis B vaccine (DTaP-IPV-Hib-HepB), for intramuscular use,” on July 1, 2014, for implementation on Jan. 1, 2015. This vaccine is not yet FDA-approved, and the new code will appear in the 2016 CPT manual.

The 2015 CPT manual does include a new code, 90630, for “Influenza virus vaccine, quadrivalent (IIV4), split virus, preservative free, for intradermal use,” and a new code, 90651, for “Human Papillomavirus vaccine types 6, 11, 16, 18, 31, 33, 45, 52, 58, nonavalent (HPV), 3 dose schedule, for intramuscular use.” Both codes are designated in the manual as not yet having FDA approval. However, the product represented by 90630 received FDA approval on Dec. 11, 2014, and the product represented by 90651 received FDA approval on Dec. 10, 2014. The 2016 CPT manual will reflect their FDA approval status.

As a reminder, the codes above only identify the vaccine product. To report the administration of a vaccine/toxoid product, you will need to use an appropriate CPT immunization administration code (e.g., 90460, “Immunization administration through 18 years of age via any route of administration, with counseling by physician or other qualified health care professional; first or only component of each vaccine or toxoid administered”) or an appropriate Healthcare Common Procedure Coding System code, such as G0008, “Administration of influenza virus vaccine.”

– Kent Moore, Senior Strategist for Physician Payment for the American Academy of Family Physicians

Thursday, May 28, 2015

CMS to change access to PQRS data in July

The Centers for Medicare & Medicaid Services (CMS) is changing how physicians and others access its computer system on July 13, a move that will particularly affect Physician Quality Reporting System (PQRS) participants and their staff.

Specifically, CMS is retiring the Individuals Authorized Access to CMS Computer Services (IACS) system. Current IACS user accounts will transition to another existing CMS system called Enterprise Identity Management (EIDM). The EIDM system allows CMS business partners to access multiple CMS applications.

CMS will move existing PQRS IACS users, their data, and roles to EIDM, all of which will be accessible from the “PQRS Portal” portion of the CMS Enterprise Portal. Users will then access the PQRS Portal to submit data (as needed), retrieve submission reports, view feedback reports, or conduct various administrative and maintenance activities. New PQRS users will need to register for an EIDM account.

CMS has promised more information and resources in the coming weeks. In the meantime, please make sure that your IACS account is active and current and that you’re able to log in. This will help ensure a smoother transition to EIDM. For additional assistance regarding IACS or EIDM, you can contact the QualityNet Help Desk at 1-866-288-8912 (TTY 1-877-715-6222) from 7:00 a.m. to 7:00 p.m. (Central Time) Monday through Friday, or via email at qnetsupport@hcqis.org.  

– Kent Moore, Senior Strategist for Physician Payment for the American Academy of Family Physicians

Thursday, May 21, 2015

July 1 deadline approaching to avoid 2016 Medicare cut

Physicians who did not successfully participate in the Centers for Medicare & Medicaid Services’ (CMS) Electronic Health Record Incentive Program (also known as "meaningful use") in 2014 are scheduled to see their Medicare payments cut in January 2016.

However, those physicians can avoid a cut if they apply for a hardship exception by July 1.

To qualify for a hardship exception, you must show CMS proof that a specific circumstance beyond your control significantly prevented you from complying with the requirements of the program.

You can download instructions and applications (both for individuals and groups) for the hardship exception on CMS’s Electronic Health Record Incentive Programs website.

CMS will review each hardship application and supporting documentation to determine if an exception is warranted.

Newly practicing physicians, hospital-based physicians, and physicians with certain Medicare Provider Enrollment, Chain, and Ownership System (PECOS) specialties (i.e., anesthesiology, pathology, diagnostic radiology, nuclear medicine, and interventional radiology) do not have to apply for a hardship exception. CMS will use Medicare information to determine if these physicians are eligible for an automatic exception.

A hardship exception applies only to the 2016 payment adjustment. You’ll have to submit another, separate application for subsequent years.

Tuesday, May 19, 2015

More answers to questions about chronic care management

The Centers for Medicare & Medicaid Services (CMS) this month released a set of frequently asked questions (FAQs) about the chronic care management (CCM) service for which Medicare began paying this year.

The FAQs reaffirm some of what was already known about CCM and clarify other areas. For instance, regarding date of service and when to submit claims for CCM, answer No. 4 states, in part, “practitioners may bill . . . at the conclusion of the service period or after completion of at least 20 minutes of qualifying services for the service period. When the 20 minute threshold to bill is met, the practitioner may choose that date as the date of service, and need not hold the claim until the end of the month.”

The CMS FAQs also clarify the prohibition on reporting CCM for “facility” patients. For instance, answer No. 6 notes, in part, “CPT code 99490 cannot be billed . . . for services provided to [skilled nursing facility] inpatients or hospital inpatients, because the facility is being paid for extensive care planning and care coordination services.” The answer goes on to say, however, that if the patient is not an inpatient the entire month, time that is spent furnishing CCM services to the patient while he or she is not an inpatient can be counted towards the minimum 20 minutes of service time that is required to bill for that month. Several other questions and answers address when it is acceptable to report CCM under the Medicare hospital outpatient prospective payment system.

Like the CMS fact sheet on CCM, the CMS FAQs emphasize that CCM must be initiated by the billing practitioner during a comprehensive evaluation and management (E/M) visit, annual wellness visit, or initial preventive physical exam (i.e., Welcome to Medicare visit). During an open door forum call for physicians, nurses, and allied health professionals on May 13, CMS staff clarified that, for purposes of CCM, “a comprehensive E/M visit” could be any face-to-face E/M service with a physician, including 99212-99214.

For more information on Medicare’s CCM service, including links to related content in Family Practice Management, check out the related web page on the American Academy of Family Physician’s web site.

– Kent Moore, Senior Strategist for Physician Payment for the American Academy of Family 

Wednesday, May 13, 2015

Testing, testing – check your ICD-10 readiness

Physicians who still would like to participate in the final scheduled test of whether they are ready to use ICD-10 codes ahead of this fall’s deadline are getting another opportunity.

The Centers for Medicare & Medicaid Services (CMS) is accepting additional volunteers for the ICD-10 end-to-end testing scheduled for the week of July 20-24. Volunteers will be able to apply from May 11-22. This appears to be the last chance to test coding systems with Medicare Administrative Contractors (MACs) and the Common Electronic Data Interchange (CEDI) prior to the Oct. 1 implementation date.

CMS will select approximately 850 volunteer submitters to participate in the July end-to-end testing. The selected volunteers will represent a broad cross-section of provider, claim, and submitter types, including claims clearinghouses that submit claims for large numbers of providers. Testers who participated in the January and April end-to-end testing weeks are able to test again in July without re-applying.

Volunteer forms are available on your MAC website, and you will need to complete your form by May 22 to volunteer as a testing submitter. CMS will review applications and select additional July testers, after which the MACs and CEDI will notify the volunteers selected to test and provide them with the information needed for the testing by June 12.

If you are selected, you must be able to submit future-dated claims. You must also be able to provide valid National Provider Identifiers (NPIs), Provider Transaction Access Numbers (PTANs), and beneficiary Health Insurance Claim Numbers that will be used for test claims. This information will be needed by your MAC for set-up purposes by the deadline on your acceptance notice. Testers will be dropped if information is not provided by the deadline.

For more information on end-to-end testing, look at these MLN Matters articles:
•    “ICD-10 Limited End-to-End Testing with Submitters for 2015”
•    “FAQs – ICD-10 End-to-End Testing”
•    “Medicare FFS ICD-10 Testing Approach”

Whether or not you are selected for end-to-end testing, you can still participate in acknowledgement testing with the MACs and the Durable Medical Equipment (DME) MAC CEDI contractor anytime before Oct. 1. Additionally, CMS has scheduled a dedicated ICD-10 acknowledgement testing week June 1-5, during which submitters will have access to real-time help desk support. This is the final dedicated acknowledgement testing week.

MLN Matters Special Edition Article SE1501 explains the differences between acknowledgement and end-to-end testing with Medicare. For acknowledgement testing, all electronic submitters are encouraged to participate, even if you submit claims through a clearinghouse. You can also find more information in the MLN Matters article “ICD-10 Testing - Acknowledgement Testing with Providers.”

Information on how to participate in acknowledgement testing is available on your MAC website or through your clearinghouse (if you use a clearinghouse to submit claims to Medicare). Any provider who submits claims electronically can participate in acknowledgement testing.

Here’s what you can expect during acknowledgement testing:
•    Test claims will receive the 277CA or 999 acknowledgement as appropriate, to confirm that the claim was accepted or rejected in the system.
•    Test claims will be subject to all current front-end edits, including edits for valid NPIs, PTANs, and codes, including Healthcare Common Procedure Coding System and place of service codes.
•    Testing will not confirm claim payment or produce a Remittance Advice (RA).
•    MACs and CEDI will be staffed to handle increased call volume during this week.

When doing acknowledgement testing, make sure test files have the "T" in the ISA15 field to indicate the file is a test file, and send ICD-10 coded test claims that closely resemble the claims that you currently submit. Also, use valid submitter identification, NPI, and PTAN combinations plus current dates of service on test claims. Do not use future dates of service, or your claim will be rejected.

For more information about ICD-10, please visit the ICD-10 and Medicare fee-for-service provider resources web pages on the CMS web site, and for help preparing for ICD-10 implementation, please visit the coding web page on the AAFP web site.

– Kent Moore, Senior Strategist for Physician Payment for the American Academy of Family Physicians

Thursday, May 7, 2015

Mid-year quality reports from CMS provide a glimpse of the real thing

This fall, the Centers for Medicare & Medicaid Services (CMS) will release the 2014 Annual Quality and Resource Use Reports (QRURs) for all solo physicians and medical groups who submitted claims to Medicare during calendar year 2014.

These reports examine patient outcomes and cost information, which in turn will be used to calculate the 2016 Value Modifier.

In the meantime, CMS last month released the 2014 mid-year QRUR to physicians and medical groups. It measures performance on care provided between July 1, 2013, and June 30, 2014, meaning it contains only part of the information that will be in the annual report – and count toward the value modifier.

Still, CMS sees the mid-year report as a good resource for physicians and groups to identify areas where they need to improve their quality and efficiency. In fact, CMS has provided a guide on how to use your mid-year QRUR.

If you haven’t looked at your own mid-year report, you can find information to do so on the How to Obtain a QRUR web page.

Tuesday, May 5, 2015

Time to bust some ICD-10 myths

There continue to be some significant myths among family medicine practices as they prepare to implement ICD-10 in October. This week, I will attempt to debunk some of these myths for you.

Myth:    Another delay in implementation is inevitable.   
Fact:    Under current law, the ICD-10 transition date remains Oct. 1, 2015, and the Centers for Medicare & Medicaid Services (CMS) plans to implement ICD-10 on that date. Based on experience and the our natural inclination to procrastinate, it is tempting to believe this will be pushed back again. CMS has made it clear, however, that the government, payers, and large providers have made a substantial investment in ICD-10 and that this cost will rise if the transition is delayed. So expect CMS to implement ICD-10 on time to avoid an unnecessary increase in health care costs.

Myth:    There will be a “grace period” for submitting ICD-9 codes for dates of services on or after Oct. 1, 2015.
Fact:    Only claims coded with ICD-10 can be accepted for services provided on or after Oct. 1. Claims filed with something other ICD-10 codes on or after that date will not be accepted.

Myth:    Family medicine practices will have to use 68,000 ICD-10 codes.
Fact:    The typical family medicine practice does not use all 13,000 diagnosis codes available in ICD-9, and it will not be required to use the 68,000 codes that ICD-10 offers. As you do now with ICD-9, your practice will likely use only a small subset of the codes available in ICD-10.

Myth:    Family medicine practices will have to learn a completely new process for finding diagnosis codes.
Fact:    You will use a similar process to look up ICD-10 codes that you use with ICD-9. Increasing the number of diagnosis codes and changing the way those codes are structured does not necessarily change the way you find a code. As with ICD-9, ICD-10 has an alphabetic index that helps with code selection, and electronic tools are available to help with code selection, just as there are now with ICD-9.

Myth:    ICD-10 changes the way physicians report the services that they provide.
Fact:    For physicians, ICD-10 only changes diagnosis coding. It does not affect the use of Current Procedural Terminology (CPT) and the Healthcare Common Procedure Coding System (HCPCS) for physician claims. Your practice will continue to use CPT and HCPCS to report physician services.

Myth:    ICD-10 will affect how much physicians are paid for their services on a fee-for-service basis.
Fact:    Medicare and most private payers’ fees are pegged to the CPT or HCPCS code submitted, not the diagnosis code, and as noted, CPT and HCPCS codes are not changing on Oct. 1. As with ICD-9 diagnosis codes, ICD-10 diagnosis codes may sometimes be used to determine coverage or medical necessity of a particular service; however, beyond that, they should not affect the payment amounts for covered services.

For more facts about ICD-10, please visit the ICD-10 web page on the CMS web site, and for help preparing for ICD-10 implementation, please visit the coding web page on the AAFP web site.

– Kent Moore, Senior Strategist for Physician Payment for the American Academy of Family 

Thursday, April 30, 2015

Top 5 things to know about Meaningful Use Stage 2 changes

Earlier this month, the Centers for Medicare & Medicaid Services (CMS) issued a proposed rule that included numerous changes to its Electronic Health Record (EHR) Incentive Program, also known as “Meaningful Use.”

The proposed guidelines are hundreds of pages long. So what is there to know without reading the voluminous rule? Here are five key takeaways from the new rule, which won’t be final until this fall but will affect Meaningful Use for 2015:

• Practices will no longer have to provide information on 10 measures that have been judged redundant, duplicative, or widely adopted. They include imaging results, family health history, electronic notes, patient list, patient reminders, clinical summaries, structured lab results, vital signs, smoking status, and patient demographics.
• The threshold for showing that a practice is successfully providing patients with electronic access to records will change from 5 percent of all patients to at least one patient.
• Showing that a practice is successfully providing patients with secure messaging options will change from meeting or exceeding a threshold of 5 percent of patients to a simple “yes or no” question.
• In 2015, all practices, regardless of when they started meaningful use, can show they are compliant using 90 days of data, as opposed to a full calendar year of data.
• In 2017, all practices, regardless of when they started meaningful use, must report a full calendar year of data to show compliance.

– Steven Waldren, MD, director of the Alliance for eHealth Innovation at the American Academy of Family Physicians

Tuesday, April 28, 2015

New PQRS reporting option for groups is now open

Physician groups wanting to avoid a 2 percent cut in Physician Quality Reporting System (PQRS) payments in 2017 have a new path to follow.

Registration is now open for groups with two or more eligible professionals to participate in the 2015 PQRS Group Reporting Option (GPRO) via the Physician Value - Physician Quality Reporting System (PV-PQRS). More information is available on the PQRS Payment Adjustment Information web page.

Groups can participate in the PQRS program for the 2015 performance period by selecting one of the GPRO reporting mechanisms between now and June 30:
•    Qualified PQRS Registry
•    Direct Eelectronic Health Record (EHR) using certified EHR technology (CEHRT) or CEHRT via Data Submission Vendor
•    Web Interface (for groups with 25 or more eligible professionals only)

Reporting the Consumer Assessment of Health Providers and Systems (CAHPS) for PQRS through a Centers for Medicare & Medicaid Services (CMS)-certified survey vendor is available to group practices taking part in PQRS under the GPRO in 2015 to supplement their PQRS reporting. This method is available to group practices of two or more eligible professionals. See CAHPS for PQRS Made Simple for complete details.

Meeting reporting requirements under PQRS in 2015 doesn’t just help avoid a PQRS pay cut in 2017, however. Failing to meet performance requirements this year also affects the Value Modifier in 2017 and could lead to an additional cut of 2 percent or 4 percent, depending on practice size. Satisfactorily reporting via PQRS GPRO is one of the ways groups can avoid automatic downward adjustments and potentially qualify for performance-based payment incentives under the Value Modifier. See What Physicians Need to Do in 2015 for the 2017 VM on the Value Modifier web page for more information.

Physician groups with two or more eligible professionals that choose not to register for GPRO may still avoid the automatic 2017 Value Modifier pay cut if they ensure that at least 50 percent of the eligible professionals in the group meet the criteria to avoid a 2017 PQRS payment adjustment as individuals.

You can access the Registration System for GPRO using a valid Individuals Authorized Access to the CMS Computer Services (IACS) account, and CMS provides instructions for obtaining an IACS account with the correct role on the PQRS GPRO Registration web page. CMS also provides instructions for registering to participate in the 2015 PQRS GPRO in the 2015 PQRS GPRO Registration Guide.

– Kent Moore, Senior Strategist for Physician Payment for the American Academy of Family Physicians

Friday, April 24, 2015

Reminder: CMS will soon require enrollment for Part D prescribing

As we first noted last December, the Centers for Medicare & Medicaid Services (CMS) this year will begin requiring physicians who write prescriptions for Medicare Part D drugs to be either enrolled in Medicare or have a valid record of opting out.

We also noted that while the new policy is effective June 1, CMS has delayed enforcement until Dec. 1. If you aren’t currently enrolled in Medicare or do not have a valid opt-out affidavit on file you should submit an enrollment application or opt-out affidavit to your Part B Medicare Administrative Contractor by June 1. This will ensure that CMS has enough time to process the paperwork ahead of the Dec. 1 deadline and make sure your patients don’t have their Part D prescription drug claims denied.

To prepare prescribers and Part D sponsors for enforcement, CMS is using an online file to identify physicians and eligible professionals who are enrolled in Medicare in an approved or opt out status. The first iteration of the enrollment file is now available. CMS will update the enrollment file every two weeks through the Dec. 1 enforcement date.

Note that enrollment is not the same as participation. A physician can enroll in Medicare without being a “participating” physician.

For more information, including how to enroll online, CMS has published an article, “Provider Enrollment Requirements for Writing Prescriptions for Medicare Part D,” through its MLN Matters information service. You can also find more information on the “Prescriber Enrollment Information” web page on the CMS web site.   

– Kent Moore, Senior Strategist for Physician Payment for the American Academy of Family Physicians

Wednesday, April 22, 2015

Physician compensation rises but so do frustrations

Most primary care and other medical specialties saw a modest gain in overall compensation last year, although many physicians are still unhappy with the state of medicine.

More than 19,000 physicians in 25 specialties were surveyed for the Medscape Physician Compensation Report for 2015 released this week. It showed that the average compensation for primary care physicians held steady at $195,000 in 2014 while other specialties reported an average of $284,000. Family medicine led the gains for primary care, increasing 10 percent over 2013 to $195,000. Internal medicine and pediatrics each gained 4 percent to $196,000 and $189,000, respectively.

While the pay is up, only 47 percent of primary care physicians and 48 percent of family physicians said they felt they were fairly compensated, compared with half of specialists. Also, while almost three-fourths of family physicians surveyed said they would again choose medicine as a career if they had it to do over, less than a third said they would stick with family medicine.

The trend of physicians choosing to work for hospitals and other large health care groups continued with 63 percent of survey responders saying they were employed while 32 percent said they remained in private practice. Employed primary care doctors appeared to be trading some compensation for the security and fewer regulatory headaches of employment as they made an average of $189,000 versus the $212,000 earned by self-employed physicians.

The wage gap between male and female physicians appears to be shrinking, albeit slowly. Male physicians made an average of $284,000, or 24 percent more than female physicians ($215,000). The difference was 28 percent when Medscape measured in 2011. The researchers suggested much of the difference in compensation levels comes from female physicians typically working fewer hours and weeks and tending to go into lower-paying specialties such as obstetrics/gynecology or pediatrics.

There has been a lot of focus on physicians moving to alternative practice styles, but real-world results are mixed. Just 3 percent of surveyed physicians said they were in a concierge practice, which typically charges an annual retainer, and 5 percent said they were in a cash-only practice, down from 6 percent in 2013. Thirty-seven percent said they were participating in or planning to participate in an accountable care organization (ACO), which can reward physicians and allied health care groups for lowering costs and improving care.

Primary care physicians are apparently more open to these new practice models with 4 percent in concierge practices, 5 percent in cash-only practices, and 43 percent in or planning to join an ACO.

To learn more about some of these subjects, visit the following FPM topic collections:

Thursday, April 16, 2015

Sustainable growth rate repeal: Now what?

As noted earlier this week, Congress has enacted the Medicare Access and CHIP (Children’s Health Insurance Program) Reauthorization Act of 2015 (MACRA). This legislation repeals the sustainable growth rate and negates a 21.2 percent cut in Medicare physician payments that technically went into effect for dates of service on or after April 1. President Obama is expected to sign the bill. MACRA will have a significant impact on Medicare physician payment for years to come, but what does it mean for your practice in the short run?

MACRA maintains the pre-April 1 rate for dates of service through June 30. For dates of service from July 1 through Dec. 31, Medicare payments will increase by 0.5 percent. For 2016, the Medicare payments increase another 0.5 percent.

To minimize financial headaches for physicians, the Centers for Medicare & Medicaid Services (CMS) had agreed to wait 10 business days before processing all affected claims with dates of service on or after April 1. CMS has now instructed the Medicare Administrative Contractors (MACs) to implement the rates contained in MACRA; however, the MACs probably will still process a small number of claims using the reduced rate before they can adjust their claims payment systems. These will likely be claims for dates of service early in April. The MACs will automatically reprocess claims paid at the reduced rate with the new payment rate, and you don't have to do anything if you have already submitted claims that fall on the affected dates.   

– Kent Moore, Senior Strategist for Physician Payment for the American Academy of Family Physicians

Wednesday, April 15, 2015

Medicare legislation repeals flawed physician payment formula, avoids cuts

Last night, the U.S. Senate voted 92-8 to repeal the sustainable growth rate formula that is used to calculate Medicare physician payment rates. The vote prevents a looming 21.2 percent cut for physicians and ends 12 years of perennial short-term fixes by Congress. The House passed the Medicare Access and CHIP (Children’s Health Insurance Program) Reauthorization Act of 2015 last month, also by an overwhelming margin. President Obama has said he will sign the bill into law.

In addition to preventing the payment cut and ensuring annual positive or flat fee updates for 10 years, the legislation, also known as MACRA, establishes new payment options that offer incentives to physicians who participate in alternative payment models. Those who remain in the fee-for-service system and meet certain performance benchmarks may also earn incentive payments.

MACRA also extends funding by two years for CHIP and other programs of importance to family medicine. Additional information about the legislation is available on the AAFP website, and additional details will be available as the regulations are developed.  

Friday, April 10, 2015

CMS sees ICD-10 claims acceptance rate rise in latest test

The Centers for Medicare & Medicaid Services (CMS) continues to rack up what it characterizes as successful tests of handling claims with ICD-10 codes.

CMS says 775 physicians and other providers submitted almost 9,000 claims during acknowledgement testing last month, and CMS accepted 91.8 percent of those claims. That is a higher acceptance rate than during acknowledgement testing weeks in November (76 percent) and March 2014 (89 percent).

The rejected claims included a number of user errors, such as using an invalid National Provider Identifier (NPI) or an NPI that wasn’t on the NPI crosswalk, using an invalid HCPCS code or postal ZIP code, or using service dates in the future. CMS said the tests revealed no problems in the fee-for-service billing system itself.

“Testing demonstrated that CMS is ready for ICD-10 and shows the tremendous progress of health professionals to be ready for the transition,” the agency said.

Physicians and other providers must switch to using ICD-10 codes beginning Oct. 1 of this year.

Acknowledgement testing, which ensures that the claim is received and then accepted or rejected, differs from end-to-end testing, which continues the test through to the submitter receiving an accurate remittance advice. CMS is completing end-to-end testing from April 27 to May 1 and from July 20 to July 24.

The final scheduled acknowledgement testing period is June 1-5. Physicians and other providers can conduct acknowledgement testing on their own at any time. You can contact your Medicare Administrative Contractor for more information.

For more information, check out the following Medicare Learning Network (MLN) articles:

•    “FAQs – International Classification of Diseases, 10th Edition (ICD-10) Acknowledgement Testing and End-to-End Testing"

•    “ICD-10 Testing - Acknowledgement Testing with Providers

•    “Medicare FFS ICD-10 Testing Approach

Tuesday, April 7, 2015

Open Payments review period begins

The Centers for Medicare & Medicaid Services (CMS) this week kicked off a 45-day review and dispute period for its Open Payment system (formerly known as the Sunshine Act).

During this process, physicians and teaching hospitals have a chance to look at financial information reported about them by pharmaceutical and medical device manufacturers and group purchasing organizations and point out any errors before CMS makes the information publicly available on June 30. After the review period ends, the CMS will continue to review disputed payments but won’t update the public records until next year.

This is the second year for Open Payments, and the records will cover payments made to physicians and teaching hospitals in 2014.

The review process is voluntary, but to participate and file disputes, you will need to register in both the CMS Enterprise Identity Management System (EIDM) and the Open Payments system itself.

If you registered last year, you don’t have to register again. Just go to the CMS Enterprise Portal, log in using your user ID and password, and navigate to the Open Payments system home page.

Note, however, that the CMS Enterprise Portal locks your account if there has been no activity for 60 days or more and deactivates it if there has been no activity for 180 days or more. If your account is locked, go to the CMS Enterprise Portal, enter your user ID and answer all challenge questions, and you’ll  be asked to reset your password. To reinstate a deactivated account, contact the Open Payments Help Desk at openpayments@cms.hhs.gov.

CMS is also holding a national provider call discussing the review period, entitled “Open Payments (Sunshine Act) 2015: Prepare to Review Reported Data – Registration Now Open.” The call is scheduled from 2 p.m. to 3:30 p.m. (EDT) on Wednesday, April 15. To register – and CMS says space may be limited – go to the CMS web page for upcoming calls.

CMS has more information, including educational materials, on its Open Payments website. It also can field questions during normal business hours at openpayments@cms.hhs.gov or by calling 1-855-326-8366.

– Kent Moore, Senior Strategist for Physician Payment for the American Academy of Family Physicians

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The views expressed here do not necessarily reflect the opinion of FPM or the AAFP. Some payers may not agree with the advice given. This is not a substitute for current CPT and ICD-9 manuals and payer policies. See Terms of Use.