Physicians and health plans have a kind of grace period for the first three months of 2012 before they must comply with new HIPAA Version 5010 claims transaction standards.
The Centers for Medicare & Medicaid Services' Office of E-Health Standards and Services (OESS) announced Nov. 17 that it will delay enforcement of the new rules, which govern the format of claims submissions and payments. CMS is calling the delay a “period of enforcement discretion.”
Physicians meeting criteria in 2011 to earn federal electronic medical record incentives will have more time before the Dept. of Health and Human Services requires them to satisfy tougher standards for attaining additional bonuses.
With no agreement yet in Congress, physicians continue to move closer to a 27 percent cut in Medicare reimbursement on Jan. 1 due to the sustainable growth rate (SGR) formula. This week, the U.S. House passed the Middle Class Tax Relief and Job Creation Act of 2011, which would halt the SGR cut for two years and replace it with 1 percent positive updates. The legislation now goes to the Senate for consideration, but Senate Democratic leaders have said there are not enough votes to pass the bill.
Recent conversations with Academy members suggest that a significant number of physician practices could face serious cash-flow issues at the beginning of next year, due to non-compliance with new HIPAA 5010 data standards by the Jan. 1 deadline (effectively, Dec. 30, since Jan. 1 is a Sunday). The potential good news is that CMS has said it may delay enforcement to March 31 from Jan. 1, but at this time, we cannot confirm that fact and many details remain unclear. Practices should continue to test and proceed as if the Jan. 1 deadline is still in place.
Attention Health Professionals: Information Regarding the Holding of 2012 Date-of-Service Claims for Services Paid Under the 2012 Medicare Physician Fee Schedule
As of Jan. 1, physician practices must be in compliance with new HIPAA 5010 standards. If they are not, all claims —including workers compensation in many states—may be rejected. The Centers for Medicare and Medicaid Services, however, has said it may delay enforcement until March 31. The Academy is encouraging practices to continue testing and proceed as if the Jan. 1 deadline is in place. For more information and resources, visit www.aao.org/hipaa5010.
On Friday, December 23, Congress reached an agreement that would extend the current Medicare payment rates for two months. Physicians were facing a 27 percent pay cut on January 1. A special committee will convene in January to work on a longer-term solution with the goal to extend the payment cut reprieve for two years.
Annually the Centers for Medicare and Medicaid (CMS) provide physicians with an option to change their Medicare participation status. The deadline for 2012 has been extended through February 14, however the effective date is January 1. This is the result of the anticipated change to the Medicare payment rates expected to come from Congress. Physicians can select one of three options:
As previously reported, CMS contractors will be holding all 2012 claims processing for up to 10 business days. The delay will allow CMS to develop and implement the new payment rate files, and completely test them. All 2012 claims should be released by January 18. There will be no delay in payments for claims with service dates occurring prior to January 1, 2012.
Physicians can determine if they are being penalized in the 2012 Medicare e-prescribing incentive program by reviewing their Medicare remittance advice, according to the Centers for Medicare and Medicaid Services (CMS). Ophthalmologists who did not participate in the e-prescribing program in 2011, or who have not been exempted from the program by CMS, will begin seeing a 1 percent reduction in their Medicare fee-for-service payments this year. CMS originally intended to notify physicians of their e-prescribing penalty status through feedback reports.
