Latest Medicare Changes That Will Impact Your Practice

The Centers for Medicare & Medicaid Services (CMS) has issued number of recent updates to the Medicare program which impact various providers and suppliers. 

Moratoria Extended in New Jersey

The government recently extended the temporary moratoria on new health agencies, home health agency sub-units, and part B ground ambulance suppliers for an additional 6 months in certain locations through out the United States to “prevent and combat fraud, waste, and abuse.” Such moratoria impacts new Part B ambulance suppliers wishing to enroll with Medicare in Burlington, Camden and Gloucester (NJ) counties. The prohibition went into effect on January 29, 2016. Affected providers can view the entire list of prohibited geographic locations in the Federal Register notice.

Face-To-Face Requirements

CMS recently published a final rule concerning the Medicaid face-to-face requirements for home health Services. For the initial ordering of home health services the final rule requires a physician to document a face-to-face encounter related to the primary reason for home health services no more than 90 days before or 30 days after the start of services. Similarly, for the initial ordering of certain medical equipment, the physician or authorized non-physician practitioners must document a face-to-face encounter (related to the primary reason the beneficiary requires medical equipment) no more than 6 months prior to the start of services. The final rule, among other things, also defines home health supplies, equipment, and appliances, to better align with the Medicare program’s definition of durable medical equipment and codified that home health services may not be subject to a requirement that the individual be “homebound.” The effective date of the rule is July 1, 2016 but States and providers have additional time to come into compliance with the rule. CMS is delaying compliance with the final rule for up to one year if legislature has met in that year, otherwise 2 years.

Using Modifier 25?  Update Your Fax in PECOS

CMS will soon issue a national provider Comparative Billing Report (CBR) on internal medicine physicians’ use of modifier 25. It is important that physicians have updated their fax numbers in the Medicare Provider Enrollment, Chain, and Ownership System (PECOS) as, by default, CBRs are distributed by fax. Contact the CBR Support Help Desk at 800-771-4430 or with questions or to receive CBRs through the U.S. Postal Service.

Qualified Medicare Beneficiary (QMB) Program Warning

CMS also recently reminded Medicare and Medicare Advantage providers that they may not bill beneficiaries enrolled in the Qualified Medicare Beneficiary (QMB) program for Medicare cost-sharing (such charges are known as “balance billing” for deductibles, co-insurance and copayments.). QMB exempts Medicare beneficiaries from Medicare cost-sharing liability. While State Medicaid programs may pay providers for Medicare deductibles, coinsurance and copayments, States can limit provider reimbursement for Medicare cost-sharing under certain circumstances. Medicare providers must accept the Medicare and Medicaid payment (if any) as payment in full for services rendered to a QMB beneficiary or possibly face sanctions. CMS advises providers to contact their State Medicaid Agency to learn ways to identify QMB patients and procedures applicable to Medicaid reimbursement for their Medicare cost-sharing.

If you have questions regarding the recent Medicare program updates, provider enrollment, revalidation, Phase 2 revalidation, exclusion or have other health law related questions, please contact our office.