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

BackgroundIn accordance with the Social Security Act (Section 1833(f) athttp://www.ssa.gov/OP_Home/ssact/title18/1833.htm on the Internet), the Centers for Medicare &Medicaid Services (CMS) is increasing the calendar year (CY) payment rates for Rural Health Clinics(RHCs) and Federally Qualified Health Centers (FQHCs) effective for services on or after January 3, 2011,through December 31, 2011 (i.e., CY 2011) as follows:• The Rural Health Clinic (RHC) upper payment limit per visit is increased from $77.76 to $77.99effective January 3, 2011, through December 31, 2011 (i.e., CY 2011). The 2011 rate reflects a 0.3percent increase over the 2010 payment limit in accordance with the rate of increase in the MedicareEconomic Index (MEI).• The Federally Qualified Health Center (FQHC) upper payment limit per visit for urban FQHCs isincreased from $125.72 to $126.10 effective January 3, 2011, through December 31, 2011 (i.e., CY 2011);and the maximum Medicare payment limit per visit for rural FQHCs is increased from $108.81 to$109.14 effective January 3, 2011, through December 31, 2011. The 2011 FQHC rates reflect a 0.3percent increase over the 2010 rates in accordance with the rate of increase in the MEI.Medicare contractors will not retroactively adjust individual RHC/FQHC bills paid at previous upperpayment limits. However, they have the discretion to make adjustments to the interim payment rate or alump sum adjustment to total payments already made to take into account any excess or deficiency inpayments to date.Additional InformationThe official instruction, CR 7101, issued to your FI or MAC regarding this change may be viewed athttp://www.cms.gov/Transmittals/downloads/R2063CP.pdf on the CMS Web site. If you have anyquestions, please contact your FI or MAC at their toll-free number, which may be found athttp://www.cms.gov/MLNProducts/downloads/CallCenterTollNumDirectory.zip on the CMS Web site.News Flash - It’s a Busy Time of Year. Make each office visit an opportunity to talk with your patientsabout the importance of getting the seasonal flu vaccination and a one-time pneumococcal vaccination.Remember, Medicare pays for these vaccinations for all beneficiaries with no co-pay or deductible. Theseasonal flu and invasive pneumococcal disease kill thousands of people in the United States each year,most of them 65 years of age or older. The Centers for Disease Control and Prevention (CDC) alsorecommends that health care workers and caregivers be vaccinated against the seasonal flu. Protect yourpatients. Protect your family. Protect yourself. Get Your Flu Vaccine - Not the Flu. Remember – Influenzavaccine plus its administration are covered Part B benefits. Note that influenza vaccine is NOT a Part Dcovered drug. For information about Medicare’s coverage of the influenza vaccine and its administration,as well as related educational resources for health care professionals and their staff, please visithttp://www.cms.gov/MLNProducts/Downloads/Flu_Products.pdf andhttp://www.cms.gov/AdultImmunizations on the Centers for Medicare & Medicaid Services(CMS) Web site.DisclaimerThis article was prepared as a service to the public and is not intended to grant rights or impose obligations. This article may contain references or links tostatutes, regulations, or other policy materials. The information provided is only intended to be a general summary. It is not intended to take the place of eitherthe written law or regulations. We encourage readers to review the specific statutes, regulations and other interpretive materials for a full and accurate statementof their contents.CPT codes and descriptors are only copyright 2010 American Medical Association (or such other date publication of CPT)The Medicare Monthly Review 80 MMR 2011-01, January 2011