2011 Medical Billing Updates

The 2011 conversion factor (CF) has been established at $33.9764, an 8% decrease from the 2010 CF of $36.8729.  Although the physician fee schedule update is 0%, the physician fee schedule final rule resulted in a number of changes in both the practice expense component of the RVU as well as adjustments to the calculation of the MEI in order for the financial effect to be budget neutral.

The new conversion factor was calculated by adding a 0.4% RVU budget neutral adjustment and adjusting the MEI calculation by a negative (8.3%).  The Medicare contractors have published their 2011 fee schedule with this new conversion factor.

You may view the 2011 reimbursement rates by clicking below on one of the  “fee schedules”  in blue. The state(s) serviced by the contractor is located after the name of the contractor.

NHIC – MA, ME, RI, VT, NH – NHIC Fee Schedules for 2011

NGS – CT – NGS Fee Schedule

Highmark – NJ – Highmark Fee Schedule

First Coast – FL – First Coast Fee Schedule

On December 30, 2010, CMS enhanced their Physician Directory with new information about physicians and non-physician providers with a new tool called Physician Compare.  This new site was developed in response to requirements designated by the Affordable Care Act of 2010.

This site is designed to be consumer-friendly and help patients locate health professionals in their communities.  Current information about Medicare providers on this site includes:

• Contact and address information
• Physician’s medical specialty
• Gender
• Where the provider completed his/her degree, residency or other clinical training
• Whether the provider speaks a foreign language
• Whether the provider is a participating Medicare provider

This tool will also report whether the practice reported certain data to CMS through the PQRS measures program. 

Later in 2011, CMS plans a second phase of the web site which will indicate whether providers prescribe medicines electronically and chose to participate in the eRx measure program.

In future years, Physician Compare will be expanded with information on the quality of care Medicare beneficiaries receive from their providers.

To view this website, please click below.

Physician Compare

The Affordable Care Act also required CMS to create the “Center for Medicare and Medicaid Innovation” also known as the Innovation Center, which will “explore innovations in healthcare delivery and payment” designed to:

• enhance the quality of care for Medicare and Medicaid beneficiaries,
• improve the health of the population, and
• lower costs through improvement.

The Center will consult with hospitals, doctors, consumers, payers, states, employers, advocates, relevant federal agencies and others to obtain direct input and build partnerships to create:

• Better care for individuals by improving care for patients in formal care settings and developing innovations that make care safer, more patient-centered, efficient, effective, timely and equitable.  The program also includes promoting the use of “bundled payments” where providers collaborate to manage multiple procedures as part of a single episode with a single payment rather than the current fee-for-service model.
• Coordinate care to improve health outcomes for patients by developing models that make it easier for doctors and clinicians in different care settings to work together to care for a patient.
• Community care models by exploring steps to improve public health and identify interventions of concern such as obesity, smoking and heart disease.

In conjunction with the launch of the Innovation Center, CMS is also announcing new initiatives to improve care for patients enrolled in the Medicare and Medicaid programs such as:

• Expansion of the Multi-Payer Advanced Primary Care Practice Demonstration – Eight states have been chosen to participate (ME, VT, RI, NY, PA, NC, Michigan and Minnesota.)  This project will evaluate the effectiveness of doctors and other health professionals working in a more integrated fashion and receiving payment from Medicare, Medicaid and private plans. CMS projects the participation of over 1,200 medical homes serving approximately 1 million patients.
• Federally Qualified HealthCenter (FQHC) and Advanced Primary Care Practice Demonstration – This will test the effectiveness of providers working in teams to treat low-income patients at community health centers.  CMS projects up to 500 FQHCs will participate in providing patient -centered, coordinated care to approximated 195,000 patients with Medicare.
• Medicare Health HomeState Plan Option – States will adopt plans that allow Medicaid patients with at least two (2) chronic conditions to designate a provider as a “health home” to help coordinate treatments for the patient.  States that participate will receive financial resources from the federal government to help support the health home.
• Future demonstrations willexamine programs that fully integrate care for individuals who are eligible for both Medicare and Medicaid which accounts for 16%-18% of enrollees in the Medicare and Medicaid programs.

CMS states that by 2012, the Innovation Center will be a partner in over 1,500 patient-centered primary care practices that will provide integrated, coordinated care to millions of Medicare and Medicaid beneficiaries as well as others who receive care in these systems.

You may view the Innovations Center website by clicking below:

CMS Innovations Center

Effective for claims processed as of 1/1/2011, CMS (Medicare) requires that the HOME place of service (POS) must contain the address of the service.  The zip code of the patient’s (or family’s) home, where services were rendered, will determine the correct payment locality.  This information must be provided for any other POS that contractors consider to be a “home” place of service.  The complete address and the 5-digit or 9-digit zip code must appear in the address block of the Medicare claim.

Please be sure to supply us with the “home” address where your services were performed when billing any service at a patient’s home.

To read more on this change, click below.  

MM6947 – Home Place of Service

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