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Golden West Medical Billing, Inc
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Medical billing and management services nationwide
Medical billing and management services nationwide

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PQRS

Due to the many questions regarding the Physicians Quality Reporting System (PQRS), we have posted the following links to provide some useful information on the subject. GW 

This gives a good overview of what PQRS is, who can participate, etc. 
 
http://www.medicare.gov/find-a-doctor/staticpages/data/pqrs/physician-quality-reporting-system.aspx  
How to get started:
 
http://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/PQRS/How_To_Get_Started.html
 
PQRS will remain an incentive program through 2014, but will change to a penalty program in 2015. Providers must begin reporting in 2013 to avoid the 1.5% deduction in 2015.
 
http://www.asha.org/Publications/leader/2012/120828/2013-Medicare-Proposal-Outlines-New-Reporting-Rules.htm
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Palmetto, GBA has posted the 2013 Medicare fee schedule (go to our website for the link). To all my friends and clients out there, this fee schedule is not yet written in stone. Please read the following articles and let’s hope that Congress does its magic at midnight on the 31st and the 26.5 percent sustainable growth rate (SGR) cut is nothing but misunderstood text taken out of the Mayan calendar.  Happy Holidays 
Ed Rivas
GWMB 

2013 Medicare fee schedules posted
Article posted by the California Medical Association
The 2013 Medicare fee schedule has been posted on Palmetto GBA’s website. The fee schedule includes the 26.5 percent sustainable growth rate (SGR) cut that is scheduled to take effect on January 1, 2013.

There is unanimous agreement in Congress that cuts of this magnitude would result in serious disruptions in care for the nation’s elderly and disabled populations, and cannot be allowed to occur. The California Medical Association (CMA) has been working with Congress to stop the SGR cut and the additional 2 percent sequestration cut during the lame duck session in December.

If Congress passes legislation stopping the cut, new fee schedules will be posted. CMA encourages members to periodically check the Palmetto website for changes to the fee schedules before January 1, 2013.

Should Congress fail to act on the SGR before the end of the year, the Centers for Medicare & Medicaid Services (CMS) may instruct Medicare contractors to hold claims for 2013 services for the first 10 business days of January, as they have in the past. Physicians should be aware of the possibility of delays in claims processing as a result of any late fee schedule changes and may want to establish a contingency plan in the event of such cash flow disruptions.

Fiscal Cliff Confusion
By Laura Joszt
Published: Tuesday, December 4th 2012
physiciansmoneydigest.com
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Surprisingly few people actually know what the going over the fiscal cliff would do to the U.S. deficit, according to a survey.
 
With less than a month until the end of the year, coverage of the fiscal cliff talks have been all over the news, making it hard for someone not to have heard about it. Yet, despite the wide coverage, a survey by Business Insider revealed that people are woefully misinformed about what affect the fiscal cliff will have on our national deficit.
 
The online news site posed one simple questions: “Were the United States to ‘go over the fiscal cliff,’ what do you expect would happen to the National Deficit?”
 
Keep in mind, the so-called “fiscal cliff” is the result of a host of tax cuts expiring the same time that the government slashes spending. Ultimately, this means that the U.S. government will receive even more money and spend a lot less of it. The point is to reduce our terribly large national deficit — currently at $16.341 trillion.
 
Yet, almost half (47.4%) of the respondents to BI’s survey said that going over the fiscal cliff will increase our national deficit. Another 28.1% admitted they have no idea what would happen.
  

 
To be fair, there could be some confusion since going over the fiscal cliff would very likely push the U.S. into another recession.
  
“Technically, there is an argument to be made that the Fiscal Cliff would increase the national deficit because of the impact it would have on the economy. The idea is that the cuts would cause job losses, thus reducing tax revenues, and causing the National Debt to increase. However this is not the expectation of a majority of economists.”
 
Although President Barack Obama and House Speaker John Boehner seem unwavering in their demands, in all likelihood it’s just posturing until the deadline is upon them and they both agree to concessions to pass a deal.
 
BI reported that political insiders among the White House and congressional Republicans have revealed that the deal will most likely include $1 trillion in additional tax revenue over the next decade with the Bush tax cuts expiring for those earning more than $250,000. Plus, there will be around $1 trillion in spending cuts, including $400 billion to Medicare.
 
The White House has asked for the removal of the debt ceiling, but what is more likely is that a deal will be made to raise it now and avoid another fight not-too-far down the line.
 
Unfortunately, the deal might not happen until January:
  
“…both sides can tell constituents that they did not vote to raise taxes (because taxes will have already gone up), but, instead, voted to cut taxes and spending.”
 
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It will probably be easier to eliminate all Medicare fraud before they can cut the red tape…but let’s hope they do. ER

FOR IMMEDIATE RELEASE
Monday, April 9, 2012

New health care law provisions cut red tape, save up to $4.6 billion


Department of Health and Human Services (HHS) Secretary Kathleen Sebelius today announced a proposed rule that would establish a unique health plan identifier under the Health Insurance Portability and Accountability Act of 1996 (HIPAA). The proposed rule would implement several administrative simplification provisions of the Affordable Care Act.

The proposed changes would save health care providers and health plans up to $4.6 billion over the next ten years, according to estimates released by the HHS today. The estimates were included in a proposed rule that cuts red tape and simplifies administrative processes for doctors, hospitals and health insurance plans.

“The new health care law is cutting red tape, making our health care system more efficient and saving money,” Secretary Sebelius said. “These important simplifications will mean doctors can spend less time filling out forms and more time seeing patients.”

Currently, when health plans and entities like third party administrators bill providers, they are identified using a wide range of different identifiers that do not have a standard length or format. As a result, health care providers run into a number of time-consuming problems, such as misrouting of transactions, rejection of transactions due to insurance identification errors, and difficulty determining patient eligibility.

The rule simplifies the administrative process for providers by proposing that health plans have a unique identifier of a standard length and format to facilitate routine use in computer systems. This will allow provider offices to automate and simplify their processes, particularly when processing bills and other transactions.

The proposed rule also delays required compliance by one year– from Oct. 1, 2013, to Oct. 1, 2014– for new codes used to classify diseases and health problems. These codes, known as the International Classification of Diseases, 10th Edition diagnosis and procedure codes, or ICD-10, will include new procedures and diagnoses and improve the quality of information available for quality improvement and payment purposes.

Many provider groups have expressed serious concerns about their ability to meet the Oct. 1, 2013, compliance date. The proposed change in the compliance date for ICD-10 would give providers and other covered entities more time to prepare and fully test their systems to ensure a smooth and coordinated transition to these new code sets.
The proposed rule announced today is the third in a series of administrative simplification rules in the new health care law. HHS released the first in July of 2011 and the second in January of 2012, and plans to announce more in the coming months.

More information on the proposed rule is available on fact sheets (4/9/12) at http://www.cms.gov/apps/media/fact_sheets.asp.

The proposed rule may be viewed at www.ofr.gov/inspection.aspx. Comments are due 30 days after publication in the Federal Register.
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HHS Press Release: HHS Secretary Kathleen Sebelius Announces Delay of ICD-10 until October 1, 2014
In a new press release from HHS, Secretary Kathleen Sebelius announced a proposed rule that would delay the compliance date for ICD-10 from October 1, 2013 to October 1, 2014

The ICD-10 compliance date change is part of a proposed rule that would adopt a standard for a unique health plan identifier (HPID), adopt a data element that would serve as an “other entity” identifier (OEID), and add a National Provider Identifier (NPI) requirement. The proposed rule was developed by the Office of E-Health Standards and Services (OESS) as part of its ongoing role, delegated by HHS, to establish standards for electronic health care transactions under the Health Insurance Portability and Accountability Act of 1996 (HIPAA). OESS is part of the Centers for Medicare & Medicaid Services (CMS).

The full release can be found on the CMS Website, and more information about this proposed rule can be found on the proposed rule ICD-10 fact sheet. A segment of the HHS press release is located below.

The Department of Health and Human Services (HHS) today announced a proposed rule that would establish a unique health plan identifier (HPID). The change would save the health care industry up to $4.6 billion over ten years by enabling greater automation of electronic health care transactions, in turn helping physicians spend less time interacting with health plans — and more time with patients.

The proposed rule was developed by the Office of E-Health Standards and Services (OESS), as part of its ongoing role, delegated by HHS, to adopt standards for electronic health care transactions under the Health Insurance Portability and Accountability Act of 1996 (HIPAA). OESS is part of the Centers for Medicare & Medicaid Services (CMS). The proposed rule would implement several administrative simplification provisions of the Affordable Care Act.

The proposed rule also would delay by one year, until Oct. 1, 2014, the date by which covered entities must comply with International Classification of Diseases, 10th Edition diagnosis and procedure codes (ICD-10). Covered entities are defined in HIPAA as (1) health plans, (2) health care clearinghouses, and (3) health care providers who electronically transmit any health information in connection with a transaction for which HHS has adopted a standard .

Some provider groups have expressed serious concerns about their ability to meet the October 1, 2013 compliance date. CMS and HHS believe the change in the compliance date for ICD-10, as proposed in this rule, would give providers and other covered entities more time to prepare and fully test their systems to ensure a smooth and coordinated transition among all industry segments.
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