News and articles related to CMS

Update to Medicare Signature Requirements


During a recent Compliance Officers meeting CGS Part B Medical Director, Dr. Earl Berman, was approached with a question about signature timeliness guidelines for electronic medical records. Based on this discussion the Kentucky Medical Association recently published an article referencing CGS’ CMD’s response to a two day signature requirement for electronic medical records.

Informal Review Request Period for the 2017 Value Modifier Open Now Through November 30, 2016


The 2015 Annual Quality and Resource Use Reports (QRURs) were released on September 26, 2016. The 2015 Annual QRURs show how physician groups and physician solo practitioners performed in 2015 on the quality and cost measures used to calculate the 2017 Value Modifier as well as their 2017 Value Modifier payment adjustment. Access and review your 2015 Annual QRUR now to determine whether you are subject to the 2017 Value Modifier payment adjustment.

Guidance on Electronic Signatures Is Available


For medical review purposes, Medicare requires that services provided/ordered be authenticated by the author. The method used shall be a handwritten or electronic signature. Stamped signatures are not acceptable.

Provider who need additional information on the guidelines for using an electronic signature may reference CMS' Medicare Program Integrity Manual

Providers who inappropriately balance bill QMB individuals are subject to sanctions.


QMB is a Medicaid program for Medicare beneficiaries that exempts them from liability for Medicare cost-sharing. State Medicaid programs may pay providers for Medicare deductibles, coinsurance and copayments. However, as permitted by federal law, States can limit provider reimbursement for Medicare cost-sharing under certain circumstances.

CMS Creates

Category: is a physician portal with virtual and includes virtual/in-person training and strategic partnerships that will help circulate CMS’ ICD-10 resources across the small physician practice community. Sections of the website include:

- ICD-10 Overview
- Physician Perspectives
- Webcasts
- Quick References
- Template Library
- Events

The ICD-10 Overview includes a sections on ICD-10 Basics, What is different with ICD-10, and How will my practice benefit from ICD-10.

Medicare to accept revised CMS-1500 claim form starting in January


The CMS-1500 Claim Form has been recently revised with changes including those to better support the use of the ICD-10 diagnosis code set. The revised CMS-1500 form version 02/12 will replace version 08/05. The revised form will give providers the ability to indicate whether they are using ICD-9 or ICD-10 diagnosis codes, which is important as the October 1, 2014, transition approaches. It also allows for additional diagnosis codes, expanding from four possible codes to 12.

Breach Reporting Update


Privacy and Security is extremely important to Health Insurance Exchanges. CMS has submitted a request for a review of the reporting system due to "because public harm is reasonably likely to result if the normal clearance procedures are followed,” The request for review has been published in the federal register. The bottom line, if the request is approved then Health Insurance Exchanges will be required to report breaches or even suspected breaches within 24 hours. This is due to the large amount of patient data that will be stored in these exchanges.

CMS Launches new E-Health Website


CMS was at the 2013 HIMSS Meeting in New Orleans and representatives from CMS were on hand to discuss the new CMS E-Health Website. The site includes resources for providers to assist with understanding how to implement Health Information Technology. This site is coupled with a listserv that is intended to become “single source” of information on coordinating efforts toward implementing ICD-10, EHRs and meaningful use, operating standards, electronic quality measurement, and payment models.

AHIMA reports RAC Prepayment Reviews to Begin Soon


RAC prepayment audits were originally scheduled to start shortly after January 1, 2012, but have been pushed back until sometime during the summer of 2012. CMS has made it clear the RAC prepayment reviews are in addition to all current claim review processes that are already in place. CMS is looking for these audits to prevent improper payments, so that there will be a decreased need for post payment audits. This is a demonstration project which means that based upon the success / failure of the demonstration this may or may not become a permanent program.

Federal Budget Deal does not fix the SGR


The deal between the White House and Congress will keep the federal government operating through the first quarter of 2013. Based upon current estimates SGR cuts may be as high as 30%, with the Congressional Budget Office estimating cuts to be in the 22% to 26% range. There are many options on the table to deal with the SGR, but based upon the current agreement, those options will be addressed after the budget deal has been passed.

HHS announces 89 new Accountable Care Organizations


2.4 million people with Medicare to receive better, more coordinated care

Health and Human Services (HHS) Secretary Kathleen Sebelius announced today, that as of July 1, 89 new Accountable Care Organizations (ACOs) began serving 1.2 million people with Medicare in 40 states and Washington, D.C. ACOs are organizations formed by groups of doctors and other health care providers that have agreed to work together to coordinate care for people with Medicare.


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