Notes from the August 3^rd Carrier Advisory Committee

Brenda Lewis D.O – OSA CAC representative

Medicare Administrative Contractor update – In the new Medicare organization Ohio will have a new carrier now called a Medicare Administrative Contractor (MAC).  A MAC contractor will be responsible for both Part A and Part B claims for that region.  In the new Medicare MAC contractor map, Ohio and Kentucky will share the same contractor for Part A and B claims.  On July 8, 2010 CMS announced the contractor for J15 (Ohio and Kentucky MAC) was awarded to Cigna.  Since July 8^th there have been several protests against this decision so the Cigna decision is not final.   The current protests are supposed to be settled by November 3, 2010. However, further protests could delay that decision.   We will keep the OSA members updated with the progress of this situation. Until a final decision is made Palmetto GBA remains the Ohio Medicare Carrier.   According to CMS all 15 MAC Contractors are to b e in place by October 2011. 

Communication with Palmetto

This is a reminder that All Medicare providers must contact Palmetto for any address changes, new practice locations, or any changes to your Group’s name.  Changing your group name without contacting Palmetto can raise questions or concerns when claims are received under a new Group name that Palmetto doesn’t recognize as a legitimate group. 

Qui Tam-

An Ohio Hospital recently settled a case with the agency for over 100 million dollars.  The qui tam complaint was from a physician and the complaint involved antitrust and Kickback concerns.  The Qui Tam complaint originated from a physician. 

Conversion Factor-

Congress has approved a 2.2% increase in the physician conversion factor from June 1, 2010 until November 30, 2010.  Palmetto has updated all claims submitted from June 1, 2010 and made appropriate adjustments. 

New Palmetto Online Tool

If you file claims electronically you should be able to register for this online tool free of charge.  The tool allows you to electronically verify a beneficiary eligibility, check your claim status and remittances online, and provide financial information. Please contact Palmetto GBA if you are interested in this tool available only with Palmetto. 

July 12, 2010

 Jurisdiction 15 Medicare Administrative Contractor (MAC) Award Announcement

CMS has made a decision on the J15 Medicare Administrative Contract (MAC),
which includes Medicare Parts A and B for Ohio and Kentucky.  Palmetto GBA
teamed with another contractor to submit a proposal for Ohio and Kentucky.
This proposal was not successful during the rebid process. CMS has awarded
the J15 MAC to CIGNA.  We will continue to share information with you
through the Palmetto GBA Web site and listserv as more details become
available regarding how these decisions will affect you.  You may also
refer to the CMS Web site for press releases and updates to the Medicare
Contracting Reform Web page for additional updates.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/877QX27074?opendocument


Applies to:
Part B - Ohio / West Virginia//General - Part B

    June 25, 2010

Last night, Congress passed a 6 month doctor fix bill reversing the 21% reduction that took place June 1, 2010.  The bill restores physician payments and provides a 2.2% increase until November 30, 2010 and is retroactive to June 1, 2010.  CMS had ordered Medicare carriers to hold payments as of June 1, 2010 until June 14 pending anticipated Congressional action on physician payment calculations.  However, last Friday the agency began processing physician payments at the 21% reduced rate when Congress failed to correct the payment reduction.   The current bill is in effect until November 30, 2010 but permanent action is needed to fix the payment methodology once and for all. If congress doesn’t act then the calculated payment reduction possible for December 2010 is 23% and could be as high as 30% by January 2011.  

Brenda Lewis D.O

April 19, 2010

Announcement from Palmetto GBA on Congressional Action – 2009 Conversion Factor remains until the end of May 

The Continuing Extension Act of 2010 Extends Zero Percent Medicare Physician Fee Schedule (MPFS) Update 

On April 15, 2010, President Obama signed into law the 'Continuing Extension Act of 2010.' This law extends through May 31, 2010, the zero percent update to the MPFS that was in effect for claims with dates of service January 1, 2010 through March 31, 2010. The law is retroactive to April 1, 2010. Consequently, effective immediately, claims with dates of service April 1 and later, which were being held by Medicare contractors, are being released for processing and payment. Please keep in mind that the statutory payment floors still apply and, therefore, clean electronic claims cannot be paid before 14 calendar days after the date they are received by Medicare contractors (29 calendar days for clean paper claims).

April 15, 2010

Today the hold on Medicare Claims expires.  Claims for services provided after April will be processed on a rolling basis with a 21% payment reduction from 2009.  That means the anesthesia conversion Factor will be about $16.72 for Ohio. The conversion factor for non anesthesia services will be $28.39.  Congressional action to extend 2009 Medicare Rates to providers is still expected by several organizations.  If Congress does act and extends 2009 payment rates it is felt the payment extension would be retroactive to April 1^st, 2010.  We will try to keep the web site up to date with any changes to this important legislation.  For now, claims that have been held by contractors will start to be processed with a 21% payment reduction from 2009 rates.

Brenda Lewis D.O