You have until February 17, 2012 to submit your 2011 data.  An easy way to do this is through ACC's PQRIwizard.  By doing this you could be eligible for a 1% payment.  Need more information? Forgot to listen to the webcast on January 26, 2012?  You can find the recording on the ACC website if you couldn't make it last week.  To access the recording of the webcast from January click here to login.  The webcast will cover the ACC method to submit your data as well as reviewing the changes for the 2012 program.  

 

Reporting quality is here to stay -- we need to ensure no cardiologist is left behind!  Let us know if you need help.

 

 

Depending on your performance in 2011, you may see a penalty on your current claims.  If you did not not meet the eRx criteria, you will see an "LE" indicator on the remittance advice since this denotes the penalty.  You should carefully review your claims for this indicator.  The criteria for avoiding the e-prescribe adjustment for 2012 was to have 10 eRx between 1/1/11 and 6/30/11 or have filed for a hardship exemption.

 

Additional penalties for unsuccessful e-prescribers in Medicare are coming for 2013 and 2014. This year, there are four options for avoiding the penalty in addition to filing a hardship exemption. 

 

Timeframes for avoiding 2013 eRx payment adjustments

• Report 25 eRx on claims for 12 - month period (Jan 1- Dec 31, 2011)
• Report 25 eRx through an approved Registry for 12 - month period (Jan 1- Dec 31, 2011)
• Report 25 eRx through EHR vendor for 12 - month period (Jan 1- Dec 31, 2011)
• Report 10 eRx on claims for 6 - month period (Jan 1- June 30, 2012)

 

Timeframes for avoiding 2014 eRx payment adjustments

• Report 25 eRx on claims for 12 - month period (Jan 1- Dec 31, 2012)
• Report 25 eRx through an approved Registry for 12 - month period (Jan 1- Dec 31, 2012)
• Report 25 eRx through EHR vendor for 12 - month period (Jan 1- Dec 31, 2012)
• Report 10 eRx on claims for 6 - month period (Jan 1- June 30, 2013)

 

Under the program, providers who do not meet certain criteria or are not granted an exemption will face a 1.5 % payment decrease for all Medicare Part B-covered professional services starting Jan. 1, 2013 and a 2% payment decrease in 2014.

 

It is critical to remember that hardship exemptions for 2013 must be filed by June 30, 2012 and hardship exemptions for 2014 have to be filed by June 30, 2013.

 

 

 

Did you miss the recent Cardiovascular Care Summit in Las Vegas and still at a loss on how to survive in 2012?  Whether in academia, private practice, or an integrated group, you are undergoing change at a never seen before rate!  If you missed PINNACLE's series of webinars, they are now  available on demand and at no charge!  Presented by Navigant Healthcare (formerly Paragon Health) this series could be your practice's lifeline. Choose from among the following topics or watch all six:

•          Physician-Hospital Alignment: The Fundamentals of Integration
•          Integration is not Alignment: Constructing Sustainable Models
•          Effective Governance: Best Practices in Decision Making
•          Cardiovascular Service Line: Building a Foundation for Success
•          Private Practice Success Strategies: How to Optimize Revenue Cycle Management
•          Aligning Incentives Through Co-Management Models

Be on the lookout for our 2012 webinar series brought to you at a new time 7 - 8 PM EST.  Details coming soon!  

 

Bumbled bundling? Your ACC is investigating complaints regarding numerous health plans incorrectly bundling the reimbursement for interpreting echoes into the inpatient E&M procedure codes based on claims management software developed by McKesson. The ACC, along with the American Society of Echocardiography and American Medical Association, has sent letters of opposition to McKesson and several health plans including Aetna, BCBS of Texas and Horizon, and BCBS of New Jersey. McKesson and Aetna responded that they agree both services should be separately reimbursed when the services meet CPT reporting standards. However, payers report that medical record reviews have routinely seen physicians bill both services without completing the documentation requirements, namely the separate written report for the echo interpretation. McKesson and Aetna have concluded that when the reporting standards are met, the use of a modifier -25 (significantly, separate identifiable E&M service) or a modifier -59 (distant procedural service) will be recognized. For the full reporting standards, consult the ACC/AMA CPT Reference Guide for Cardiovascular Coding. Your ACC reminds members too fully and completely document services rendered in the patient's charts for accurate claims submission. 

 

 

 On Thu Feb 2, CMS proposed that Medicare patients across the county have access to a new procedure, known as "transcatheter aortic valve replacement" (TAVR).

The result of an unprecedented level of collaboration between CMS, the Food and Drug Administration, the Agency for Healthcare Research and Quality, the American College of Cardiology, the Society of Thoracic Surgeons and Edwards Lifesciences, this Proposed Coverage Decision Memorandum for TAVR continues CMS's commitment to cross-agency collaboration and ensuring patients have access to the latest and best medical technology.

We are requesting public comments on this proposed determination pursuant to section 1862(l) of the Social Security Act. We are specifically interested in public comments on the use of Coverage with Evidence Development (CED) in this decision. After considering the public comments, we will make a final determination and issue a final decision memorandum.

The proposed decision will be open for 30 days of public comment before CMS issues a final decision later this year. To read the full proposal, click here.

The full text of this excerpted blog post can be found on the CMS blog by clicking the following link. click here   

For more information on this event click here

If you have any questions or comments regarding the information provided in this newsletter, please email us at ilacc@ilacc.org