The Medicare Monthly Review, MMR-2011-01, January 2011 - CGS

More documents

Recommendations

Info

Centers for Medicare & Medicaid Services Articles for Part A ProvidersIncentive Payment Program for Primary Care Services, Section 5501(a)of the Patient Protection and Affordable Care Act, Payment to aCritical Access Hospital Paid Under the Optional MethodMLN Matters® Number: MM7115Related Change Request (CR) #: 7115Related CR Release Date: December 3, 2010Effective Date: April 1, 2011Related CR Transmittal #: R2081CPImplementation Date: April 4, 2011Provider Types AffectedCritical access hospital (CAH) under the optional method who provide primary care services to Medicarebeneficiaries and bill Medicare administrative contractors (A/B MACs) or fiscal intermediaries (FIs) areimpacted by this issue.Provider Action NeededImpact to YouThe Affordable Care Act provides for a 10 percent Medicare incentive payment for primary care serviceseffective 2011 through 2015. Payments will be made on a quarterly basis.What You Need to KnowThe Affordable Care Act defines a primary care practitioner as: (1) a physician who has a primaryspecialty designation of family medicine, internal medicine, geriatric medicine, or pediatric medicine; or(2) a Nurse Practitioner, Clinical Nurse Specialist, or Physician Assistant, and in all cases, for whomprimary care services accounted for at least 60 percent of the allowed charges under the MedicarePhysician Fee Schedule (MPFS) for the practitioner in a prior period as determined appropriate by thesecretary.What You Need to DoSee the Background section below for specifics.BackgroundSection 5501(a) of The Affordable Care Act revises section 1833 of The Social Security Act and will add anew paragraph “Incentive Payments for Primary Care Services.” The Social Security Act now states thatin the case of primary care services furnished on or after January 1, 2011 and before January 1, 2016 by aprimary care practitioner, there also shall be paid on a monthly or quarterly basis an amount equal to 10percent of the payment amount for such services under the MPFS.Note: The former “Quarterly Health Professional Shortage Area (HPSA) and Scarcity Report for CriticalAccess Hospital (CAHs)” is now known as the “Special Incentive Remittance for CAHs.” This change isnecessary as Primary Care Incentive Program (PCIP) payments are made for all primary care servicesfurnished by eligible primary care practitioners, regardless of the geographic location where the primarycare services are furnished.The PCIP payments will be based on 10 percent of 115 percent of the MPFS amount that the CAH waspaid for the professional service.CPT codes and descriptors are only copyright 2010 American Medical Association (or such other date publication of CPT)The Medicare Monthly Review 70 MMR 2011-01, January 2011
Primary Care ServicesThe Affordable Care Act defines primary care services as those services identified by the following CPTcodes:• 99201 through 99215 for new and established patient office or other outpatient evaluation andmanagement (E&M) visits;• 99304 through 99340 for initial, subsequent, discharge, and other nursing facility E&M services; newand established patient domiciliary, rest home (e.g., boarding home), or custodial care E&M services;and domiciliary, rest home (e.g., assisted living facility), or home care plan oversight services; and• 99341 through 99350 for new and established patient home E&M visits.These codes are displayed in the table below. All of these codes remain active in calendar year (CY) 2011and there are no other codes used to describe these services.Primary Care Services Eligible for Primary Care Incentive Payments in CY 2011CPT Code Description99201 Level 1 new patient office or other outpatient visit99202 Level 2 new patient office or other outpatient visit99203 Level 3 new patient office or other outpatient visit99204 Level 4 new patient office or other outpatient visit99205 Level 5 new patient office or other outpatient visit99211 Level 1 established patient office or other outpatient visit99212 Level 2 established patient office or other outpatient visit99213 Level 3 established patient office or other outpatient visit99214 Level 4 established patient office or other outpatient visit99215 Level 5 established patient office or other outpatient visit99304 Level 1 initial nursing facility care99305 Level 2 initial nursing facility care99306 Level 3 initial nursing facility care99307 Level 1 subsequent nursing facility care99308 Level 2 subsequent nursing facility care99309 Level 3 subsequent nursing facility care99310 Level 4 subsequent nursing facility care99315 Nursing facility discharge day management; 30 minutes99316 Nursing facility discharge day management; more than 30 minutes99318 Other nursing facility services; evaluation and management of a patient involving anannual nursing facility assessment.99324 Level 1 new patient domiciliary, rest home, or custodial care visit99325 Level 2 new patient domiciliary, rest home, or custodial care visit99326 Level 3 new patient domiciliary, rest home, or custodial care visit f99327 Level 4 new patient domiciliary, rest home, or custodial care visit99328 Level 5 new patient domiciliary, rest home, or custodial care visit99334 Level 1 established patient domiciliary, rest home, or custodial care visit99335 Level 2 established patient domiciliary, rest home, or custodial care visit99336 Level 3 established patient domiciliary, rest home, or custodial care visit99337 Level 4 established patient domiciliary, rest home, or custodial care visit99339 Individual physician supervision of a patient in home, domiciliary or rest homerecurring complex and multidisciplinary care modalities; 30 minutesCPT codes and descriptors are only copyright 2010 American Medical Association (or such other date publication of CPT)The Medicare Monthly Review 71 MMR 2011-01, January 2011
Page 2 and 3:
Centers for Medicare & Medicaid Ser
Page 4:
National Government Services Articl
Page 7:
R4 (effective 12/16/2010): Due to a
Page 10 and 11:
Article for Cardiovascular Nuclear
Page 13 and 14:
For dates of service prior to 01/01
Page 15 and 16:
Article for Magnetic Resonance Imag
Page 17 and 18:
LCD for Scanning Computerized Ophth
Page 19 and 20: Article for Determination of Cardia
Page 21 and 22: • CMS Internet-Only Manual (IOM),
Page 23 and 24: to the third party but no notificat
Page 25 and 26: Provider Types AffectedThis article
Page 27 and 28: • HCPCS codes Q2026, Q2027, and G
Page 29 and 30: Calendar Year 2011 Annual Update fo
Page 31 and 32: Mapping Information• New code 829
Page 33 and 34: Waiver of Coinsurance and Deductibl
Page 35 and 36: Ambulance Inflation Factor for CY 2
Page 37 and 38: Key Points of CR 7049CMS is adding
Page 39 and 40: Medicare-covered preventive service
Page 41 and 42: staff, please visit http://www.cms.
Page 43 and 44: CMS has decided to follow the same
Page 45 and 46: 2011. This amendment’s expanded c
Page 47 and 48: • Rural Health Clinics (TOB 71X)
Page 49 and 50: Note: CMS requests provider, physic
Page 51 and 52: If you have any questions, please c
Page 53 and 54: Quarterly Update to Correct Coding
Page 55 and 56: • Peak oxygen consumption.Note: V
Page 57 and 58: more than 12 months after a person
Page 59 and 60: last year, increased by 1.1 percent
Page 61 and 62: CodePayment LimitQ4027 $17.23Q4028
Page 63 and 64: BillingIn general, it is inappropri
Page 65 and 66: Provider Action NeededImpact to You
Page 67 and 68: IntroductionAnnual outbreaks of sea
Page 69: • CMS Frequently Asked Questions
Page 73 and 74: The Affordable Care Act authorizes
Page 75 and 76: Implementation of Changes in End-St
Page 77 and 78: Home Health Face-to-Face Encounter
Page 79 and 80: collaborate with and inform the com
Page 81 and 82: News Flash - A revised Medicare Lea
Page 83 and 84: DisclaimerThis article was prepared
Page 85 and 86: Provider Types AffectedThis program
Page 87 and 88: News Flash - Each Office Visit is a
Page 89 and 90: Provider Types AffectedPhysicians,
Page 91 and 92: On January 28, 2010, CMS made avail
Page 93 and 94: spelling the Ordering/Referring Pro
Page 95 and 96: • Doctor of podiatric medicine;
Page 97: ased on the CPT code descriptor, re
show all

The Medicare Monthly Review, MMR-2011-01, January 2011 - CGS

Create successful ePaper yourself

Delete template?

Save as template?