Medicare

Of Note:

New Form 1500 required as of April 1 for paper Medicare claims:  If you file paper claims with Medicare, starting April 1, 2014, you will have to use a new 1500 claim form, version 02/12.  April 1 is the deadline for when you have to use the new forms (the old ones will no longer be processed after this date) , but can start using them as soon as you get them.  The new form is required in readiness for the switch to ICD-10 codes from ICD-9 that will be required as of October 1, 2014, according to the current schedule.  Just a reminder for psychiatrists, the DSM-V lists both the ICD-9 and ICD-10 codes for each diagnosis.

Information regarding the Holding of April 2014 Claims for Services Paid Under the 2014 Medicare Physician Fee Schedule
The 2014 Medicare Physician Fee Schedule (MPFS) final rule stipulated a negative update to the MPFS that was to be effective January 1, 2014. That reduction was averted for three months with the passage of the Pathway for SGR Reform Act of 2013, which provided for a 0.5 percent update for services paid under the MPFS through March 31, 2014.

CMS is hopeful that there will be congressional action to prevent the negative update from taking effect on April 1, 2014. CMS has instructed the Medicare Administrative Contractors to hold claims continaining services paid under the MPFS for the first 10 business days of April (i.e., through April 14, 2014). This hold would only affect MPFS claims with dates of service April 1, 2014, and later. The hold should have minimal impact on provider cash flow, because under current law, clean electronic claims are not paid any sooner than 14 calendar days (29 days for paper claims) after the date of receipt. All claims for services delivered on or before March 31, 2014, will be processed and paid under normal procedures, regardless of any Congressional actions.

 All  psychiatry services provided to Medicare patients as of January 1, 2014, will be reimbursed at 80%, just as all other medical services are.

Good news for psychiatrists who provide care to Medicare beneficiaries. CMS announced it has accepted the RUC recommendations for the new codes in the Psychiatry Section of CPT.  Read more...

2% Sequestration Medicare Fee Cut:

  As of April 1, 2013, Medicare fees were effectively cut by 2% as part of the overall federal cuts required by sequestration.  For participating providers, patients will still be required to pay the same copay they paid before sequestration (even though the percentage of the total will be slightly higher than it was since the amount received from Medicare will be lower), but the provider will receive 2% less from Medicare.  Nonparticipating providers may continue to charge patients the limiting charge for the service, and the 2% will be subtracted from the reimbursement they get from Medicare.  

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Medicare was created in 1965 as part of the Social Security Act.  The program was divided into two parts.  Part A is hospital insurance and helps to pay for care provided in a hospital, skilled nursing facility, nursing home, or hospice.  It covers the room, board, and ancillary charges billed directly by the facility.  Part B covers the professional services of physicians and nonphysician healthcare providers and a variety of outpatient services including x-rays, laboratory work, and durable medical equipment. Since 2006 there has also been a prescription drug benefit that Medicare beneficiaries can buy into known as Medicare Part D.

Practice help is available to Members through the Practice Management HelpLine by phone [800.343.4671] or email us at hsf@psych.org.

Enrollment

PQRS

Medicare e-Prescribing Program

Medicare Fee Schedule

Medicare Part D

Medicare Participation: Know Your Options

Troubleshooting Medicare


Information on Medicaid

 


More online/print practice resources supported by OHSF:

Quick Practice Info Guides – Documents exploring common practice management issues encountered by psychiatrists.

Practice Management for Psychiatrists: The Basics  [free online to Members. The  e-book is posted both as a single document download and as a chapter-by-chapter download for ease of printing.

 [free online to Members. The  e-book is posted both as a single document download and as a chapter-by-chapter download for ease of printing.

Information on Mental Health Parity can be found on the APA website www.psych.org under Managing A Practice or on the APA co-sponsored site www.parityispersonal.org.