Legislative Update

LEGISLATIVE ALERTS:  January 24, 2012

As of 01/01/12, Illinois law states that an insurance company can no longer recoup a payment 18 months after the original payment is made.

Here's a portion of the law:  

 

No recoupment or offset may be requested or withheld from future payments 18 months or more after the original payment is made, except in cases in which:
(1) a court, government administrative agency, other tribunal, or independent third-party arbitrator makes or has made a formal finding of fraud or material misrepresentation;2) an insurer is acting as a plan administrator for the Comprehensive Health Insurance Plan under the Comprehensive Health Insurance Plan Act; or3) the provider has already been paid in full by any other payer, third party, or workers' compensation insurer. 

 

Click here to view the entire Public Act 097-0556

Medicare Participation Enrollment Deadline Extended; Know Your Medicare Options

On December 22, CMS announced that it would extend the 2012 Annual Participation Enrollment Period. Physicians have until February 14, 2012, to determine their Medicare participation status for 2012. CMS extended the annual enrollment period from the original deadline of December 31 after Congress delayed the 27.4% cut in payments to physicians through February. The effective date for any participation status change during the extension, however, remains January 1, 2012, and will be in force for the entire year. Contractors will accept and process any participation elections or withdrawals made during the extended enrollment period that are post-marked on or before February 14, 2012.

WHAT CAN YOU DO?

Determine Your Medicare Participation Status 

Physicians have three choices with respect to their Medicare status:

  • Sign participation agreements (PAR) and agree to accept Medicare’s allowed charge as payment in full for all of their Medicare patients;
  • Decline to sign participation agreements (non-PAR), accept assignment on a case-by-case basis, and balance bill subject to limits imposed by Medicare and/or state law; or
  • Opt-out of Medicare and become private contracting physicians, agreeing to bill patients directly and forego any payments from Medicare to their patients or themselves. It is important to note that to become a private contractor, physicians must give 30 days’ notice before the first day of the quarter the contract takes effect. Once physicians have opted out of Medicare, under current law, they cannot submit claims to Medicare for any of their patients for a two-year period. 

CMS: Medicare enrollment information brochure 

 

Upcoming Important Medicare Electronic Health Record (EHR) Incentive Program Deadline
On Saturday, December 31, 2011, the reporting year ended for EPs who began reporting for the EHR Incentive Program in 2011, which means that they must have completed their 90-day reporting period.
 
February 29, 2012 is the last day to register and attest to receive an Incentive Payment for calendar year (CY) 2011. A complete/certified EHR system will provide a report of the numerators, denominators, and other information, that must be entered in to the CMS online Attestation System. Providers will qualify for a Medicare EHR incentive payment after successful attestation. The system will provide a summary immediately after you submit your results, whether or not it was successful.Payments to EPs are based on 75% of the Part B allowed charges for covered professional services furnished by the EP during the entire payment year. If the EP did not meet the $24,000 threshold in Part B allowed charges by the end of CY2011, CMS expects to issue an incentive payment for the EP in April 2012 for 75% of the EP's Part B charges from 2011.2012 Attestation User Guide 

Provider Call: HIPAA Version 5010 and D.0 Transactions – 
Wednesday, Jan 25; 2:00-3:30 PM ETCMS will host a call regarding the Medicare FFS implementation of HIPAA Version 5010 and D.0 transaction standards. As 2012 begins, it is important to keep your focus on compliance with Version 5010 and beginning to plan for the transition to ICD-10. Upgrading to Version 5010 is a critical first step for the nationwide transition to ICD-10 that will take place on October 1, 2013. It is important that you finish this process so that you can continue to prepare your organization for the ICD-10 transition.Agenda (there will be no slide presentation for this call):

  • HIPAA Version 5010 Implementation update
  • Question & answer session

REGISTER


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