ICD 10/VERSION 5010 NEWS
House and Senate Pass Tax Extenders and SGR Legislation; 27.4% Medicare Physician Payment Reduction Averted for 10 Months
Today, the House and the Senate passed the 10-month extension of the payroll tax holiday, unemployment benefits, and the current Medicare physician payment levels through the end of 2012. The bill passed the Senate 60-36. The House passed the bill, 293 to 132. Specifically, this prevents the 27.4% Medicare physician payment cut from going into effect on March 1, but due to the cliff financing physicians will face a 32% cut on January 1, 2013. The short term "fix" is offset through reductions in a number of health care programs, including Medicare bad debt payments to hospitals and the prevention fund created by the Affordable Care Act. Other expiring Medicare policies were also extended through the end of the year, including the “floor” on geographic adjustments to the physician work component of the Medicare fee schedule. President Obama is expected to sign the legislation.
Click here to view the summary.
ASCRS will continue to push for a permanent solution to the SGR formula during the 10 month reprieve. Additional details will be available in upcoming editions of Washington Watch Weekly.
2011 Medicare Claims Submission Deadline Reminder - February 29, 2012
Wednesday, February 29, 2012 is the deadline for EPs to submit any pending Medicare Part B claims from CY2011. Therefore, EPs have 60 days in 2012 to submit claims for allowed charges incurred in 2011.
Food and Drug Administration (FDA) to Congress: Double Fees from Device Makers
On February 15, the House Energy and Commerce Health Subcommittee met to discuss the Medical Device User Fee Act (MDUFA), which was sent to Congress earlier this month. Jeffery Shuren, MD, the head of the FDA's Centers for Devices and Radiological Health (CDRH), said that the $595 million in user fees that the FDA will collect from device makers from 2013 to 2017 -- pending congressional approval -- will allow the agency to hire 208 new full-time staff members, which will lead to shorter wait times for FDA approval of new devices. Shuren told the panel that it should have final language on the agreement in March, at which point the committee would have to turn the proposed wording for the act into an actual bill, approve it, and send it to the House for a full vote. It also would have to be passed by the Senate. Republicans on the panel seemed hesitant to give the FDA more money without proof that the device industry would see faster approvals with the user fee cash infusion to CDRH. Under the MDUFA proposal, a device company would have to pay about $220,000 to have its high-risk device reviewed under the FDA's premarket review process. Small device makers would be required to pay about $55,000 for a review of a new device. Review of low-risk devices (which are approved through a less stringent process called the 510(k) process) would be much cheaper -- ranging from about $2,000 to $4,000, depending on the size of the device company. The FDA's increased reliance on user fees was reflected in Pres. Obama's fiscal 2013 budget proposal, released earlier this week. Nearly half of the FDA's $4.5 billion proposed budget will come from user fees. MDUFA was first passed in 2002 and must be reauthorized every 5 years. Congress has until the end of September to reauthorize the law for the second time.
Calendar Year (CY)2013 FDA Budget Proposes $583 Million in New User Fees
On February 13, the FDA requested a $4.5 billion budget in the Obama administration's $3.8 trillion 2013 federal budget proposal, a figure that includes budget authority, current user fees, and proposed new fees, with total industry fees funding 98% of the agency's $654 million increase over fiscal 2012 funding levels. The fiscal 2013 proposal includes $1.97 billion in user fees, including $583 million in new fees. The current budget assumes the reauthorization of two user fees expiring in October, one for medical devices and one for drugs, and also includes seven new proposed fees, including a $299 million generic drug fee and a $20 million biosimilar fee.
Other new fee programs include: $14.7 million in reinspection fees for medical products to enable the FDA to assess fees for follow-up inspections after violations are found, $220 million in food facility registration and inspection fees to fund mandates under the Food Safety Modernization Act, $5.6 million in international courier fees to fund FDA surveillance of products imported through international couriers, $18.7 million in cosmetic facility registration fees to give the agency more capacity to oversee cosmetics, and $4.9 million in food contact substance fees to enhance oversight of food packaging and processing equipment.
CMS to Delay ICD-10 Implementation
On Thursday, Health and Human Services (HHS) Secretary Kathleen G. Sebelius announced that HHS will initiate a process to postpone the date by which certain healthcare entities have to comply with ICD-10 implementation. Key physician groups including the AMA have pressed CMS to postpone the Oct. 1, 2013 deadline for conversion of billing codes from ICD-9 to ICD-10 and on Feb. 2 asked the Obama administration to delay or scrap enforcement of the new electronic transaction system and give advance payments to physicians struggling to meet the 5010 mandate. Physicians complained to CMS and lawmakers in recent weeks that their payments have been held up due to difficulty in implementing the Version 5010 precursor to ICD-10 for filing Medicare and commercial payer claims. As we reported previously, medical practices throughout the nation are experiencing significant challenges implementing these new transactions, a situation that has led to considerable cash flow problems for physicians and their practices. Problems are being reported with both Medicare Administrative Contractors (MACs) and commercial plans.
Incentive Programs and the Year Ahead: Guides for the Ophthalmic Practice
The ASCRS Government Relations Department, in conjunction with the ASCRS/ASOA Health Information Technology Committee, created documents with important, straightforward information on what ophthalmic practices must know to participate in the EHR, eRx, and PQRS incentive programs. These documents include information on using a registry, as how to stay up to date on the process, and learn what each program requires from you and your practice.
Questions can be directed to Jenny Liljeberg, associate director of regulatory affairs, at jliljeberg@ascrs.org.
Medicare Electronic Health Record (EHR) Incentive Program Deadline Reminder
February 29, 2012 is the last day to register and attest to receive an Incentive Payment for calendar year (CY) 2011. A complete/certified EHR system will provide a report of the numerators, denominators and other information, which must be entered in to the CMS’ online Attestation System. Providers will qualify for a Medicare EHR incentive payment after successful attestation. The system will provide a summary immediately after you submit your results, whether or not it was successful.
Payment
Payments to EPs are based on 75% of the Part B allowed charges for covered professional services furnished by the EP during the entire payment year. If the EP did not meet the $24,000 threshold in Part B allowed charges by the end of CY2011, CMS will hold the incentive payment, allowing 60 days after the end of the CY2011 for all pending claims to be processed. This is done so the EP meets the threshold as described above and to maximize the amount of the EHR incentive payment they receive. CMS expects to issue incentive payments for these EPs in April 2012.
New Webpage on CQMs Added to the EHR Website
CMS added a new page to the electronic health record (EHR) website dedicated to the clinical quality measures (CQMs). The new CQM page of the website includes information on the following topics:
• General program definitions, like “Reporting Period”
• Eligible professional (EP) CQM reporting requirements
• Guide to CQMs
• CQM EP Reporting Table
Additional information on CQMs and guidance for ophthalmic practices is available on the ASCRS and ASOA websites.
Claims-Based Reporting for PQRS and ERX – Provider Call Tuesday, February 21, 1:30-3:00 PM ET
CMS will host a call on February 21, 1:30-3:00 PM ET, on the Physician Quality Reporting System & Electronic Prescribing Incentive Program, providing an overview on claims-based reporting for both programs.
Agenda:
eyePAC Adds New Contribution Levels for 2012
As of January 2012, eyePAC is offering 2 new contribution levels for ASCRS eyePAC contributors, in addition to, the established 5 contribution levels. Registration is now open for the eyePAC event at the Art Institute of Chicago on April 20, 2012 from 6:00 to 8:00 PM. An overview of all contribution levels and their benefits is listed below.
Presidential Club−A $5000 contribution; includes a plaque and special recognition at the annual eyePAC reception, admission for 10 for the annual eyePAC event, as well as admission to special, invitation-only, VIP events, and the eyePAC contributor newsletter.
Senatorial Club−A $2500 contribution; includes a membership pin, admission for 7 for the annual eyePAC event, as well as admission to special, invitation-only, VIP events, and the eyePAC contributor newsletter.
Congressional Gold Circle Club—A $1000 contribution; includes a membership pin, admission for 5 to the annual eyePAC event, as well as admission to special, invitation-only, VIP events, and the eyePAC contributor newsletter.
Congressional Insider Club—A $500 contribution; includes a membership pin, the newsletter, and admission for 3 to the annual eyePAC event.
Congressional Silver Club—A $300 contribution; includes a membership pin, the newsletter, and admission for 1 to our annual eyePAC Event.
Congressional Bronze Club—A contribution of $100; includes a membership pin.
Young Physicians Club—A contribution of $50.
For additional information, please contact ASCRS PAC/Grassroots Specialist Gerrie Gray-Benedi by email at gbenedi@ascrs.org or by phone at 703-591-2220.
Register for the Annual eyePAC Event Scheduled for Friday, April 20, 2012, from 6:00 to 8:00 PM at the Art Institute of Chicago
Registration is now open for the exclusive annual eyePAC event being held at the Art Institute of Chicago, Friday, April 20, 2012. Those eyePAC contributors who make a 2012 contribution of $300 or more will be invited to spend the evening with their guests and colleagues, which includes a private viewing of the gallery. If you are a young physician and have been in practice 3 years or less, please register HERE.
To find out more about the articles in this communication or to read more about legislative and regulatory issues that affect you and your practice, visit the ASCRS and ASOA websites. You can also visit http://www.specialtydocs.org/, the web site of the Alliance of Specialty Medicine.
© 2012 ASCRS/ASOA