American Academy of Neurology

Medicare & Regulatory Issues: CMS to Eliminate Outpatient Mental Health Treatment Limitation

webmaster@aan.com (Webmaster) — Thu, 19 Nov 2009 16:29:00 GMT

As part of its final 2010 ruling on the physician fee schedule, the Centers for Medicare and Medicaid Services has initiated a plan to phase out the current limitation on payment for outpatient mental health treatment.

Medicare & Regulatory Issues: What Should Neurologists Know About the 'Stark' Law?

webmaster@aan.com (Webmaster) — Fri, 13 Nov 2009 20:47:00 GMT

The physician self-referral or "Stark" law, first enacted by Congress in 1989, and amended many times since, was intended to prevent overutilization that was perceived to stem from arrangements in which physicians benefited financially from their referrals

Payment Policy & Decision Making: 2010 Medicare Fee Schedule Changes Include Elimination of Payment for Consultation Codes

webmaster@aan.com (Webmaster) — Mon, 09 Nov 2009 15:39:00 GMT

On November 1, the CMS released its final ruling regarding the 2010 Physician Fee Schedule. One of the major announcements in the Final Rule is the elimination of payment for consultation codes as of January 1, 2010.

Payment Policy & Decision Making: FTC Red Flags Rule Delayed Until June 1

webmaster@aan.com (Webmaster) — Mon, 02 Nov 2009 21:12:00 GMT

In a last-minute decision, the Federal Trade Commission (FTC) announced that the Red Flags rule will be delayed until June 1, 2010. The AMA has been urging the FTC and Congress that physicians are not "creditors" and should not be subject to the rule

Medicare & Regulatory Issues: CMS to Redistribute Payment for Evaluation and Management Services Starting January 1

webmaster@aan.com (Webmaster) — Mon, 02 Nov 2009 20:51:00 GMT

The CMS has announced plans to stop paying for consultation codes and to redistribute those dollars to other E/M services as part of its 2010 Final Medicare Physician Fee Schedule.

Medicare & Regulatory Issues: Medicare Releases Results of Provider Satisfaction Survey

webmaster@aan.com (Webmaster) — Wed, 30 Sep 2009 19:18:00 GMT

The Medicare Contractor Provider Satisfaction Survey (MCPSS) enables CMS to gauge provider satisfaction with key services performed by the contractors that process and pay the more than $300 billion in Medicare claims each year.

Medicare & Regulatory Issues: Academy Responds to Proposal to Eliminate Consultation Codes

webmaster@aan.com (Webmaster) — Wed, 02 Sep 2009 16:24:00 GMT

On August 31, the Academy submitted a detailed comment letter to the Centers for Medicare and Medicaid Services (CMS) on its proposed 2010 Medicare Physician Fee Schedule. Among other issues, the letter stated the Academy's opposition

Medicare & Regulatory Issues: Recovery Audit Contractors: Here To Stay in 2010

webmaster@aan.com (Webmaster) — Tue, 25 Aug 2009 19:00:00 GMT

Section 302 of the Tax Relief and Health Care Act of 2006 makes the Recovery Audit Contractor (RAC) Program permanent and requires the Secretary to expand the program to all 50 states by 2010.

Medicare & Regulatory Issues: FTC Delays Enforcement of 'Red Flag' Rules until November 1, 2009

webmaster@aan.com (Webmaster) — Mon, 24 Aug 2009 17:18:00 GMT

he "Red Flags" Rule is an anti-fraud regulation, requiring "creditors" and "financial institutions" with covered accounts to implement programs to identify, detect, and respond to the warning signs, or "red flags,"

Medicare & Regulatory Issues: Update Your NPPES Record

webmaster@aan.com (Webmaster) — Wed, 05 Aug 2009 17:15:00 GMT

The National Plan and Provider Enumeration System has assigned more than 700,000 NPIs to physicians. Many physicians were assigned their NPIs upon their graduation from medical school.

Medicare & Regulatory Issues: CMS Releases Proposed 2010 Medicare Physician Fee Schedule

webmaster@aan.com (Webmaster) — Thu, 16 Jul 2009 14:51:00 GMT

The Centers for Medicare & Medicaid Services published its proposed 2010 Medicare Physician Fee Schedule. The proposed rule contains a number of important policy changes that have implications for neurologists.

Payment Policy & Decision Making: Request Health Insurer Documents Before Settlements End

webmaster@aan.com (Webmaster) — Thu, 09 Jul 2009 16:02:00 GMT

Due to recent insurer settlements with WellPoint/Anthem, Health Net, Humana and Blue Cross Blue Shield, physicians can provide written requests to the health insurers for copies of their contracts and fee schedules.

Medicare & Regulatory Issues: Recovery Audit Contractor Audit Letters Coming Soon

webmaster@aan.com (Webmaster) — Mon, 06 Jul 2009 20:51:00 GMT

The first batch of audit letters from Recovery Audit Contractors (RACs) is currently on its way to 24 states; the remaining 26 states will begin receiving letters in August. Due to the strict deadlines for responses and appeals upon receipt of a RAC letter, it is a good idea to set up a RAC Response Team if you haven't already done so.

Medicare & Regulatory Issues: Information You Need to Know: Medicare Private Fee for Service Plans

webmaster@aan.com (Webmaster) — Mon, 22 Jun 2009 19:18:00 GMT

A Medicare Advantage Private Fee for Service Plan (PFFS) is a particular product in which the rules for participation are defined by Medicare. It is a Medicare Advantage (MA) health plan, offered by a state-licensed, risk-bearing entity (sometimes a private insurance company).

Medicare & Regulatory Issues: CMS Issues Scam Alert to Physicians

webmaster@aan.com (Webmaster) — Fri, 19 Jun 2009 15:16:00 GMT

The Centers for Medicare & Medicaid Services (CMS) has become aware of a scam in which perpetrators send faxes to physicians' offices posing as the Medicare carrier

Medicare & Regulatory Issues: CMS Goes Green: Electronic Medicare Handbooks Now Available

webmaster@aan.com (Webmaster) — Mon, 11 May 2009 15:36:00 GMT

CMS is going green - new in 2009, the Centers for Medicare and Medicaid Service is happy to bring to Medicare beneficiaries an electronic option to receive their Medicare and You handbooks each year.

Medicare & Regulatory Issues: Red Flag Rules Start August 1

webmaster@aan.com (Webmaster) — Wed, 06 May 2009 14:54:00 GMT

The Federal Trade Commission (FTC) has indicated that enforcement of the Red Flags Rule will be delayed until August 1, 2009. The rule–designed to prevent identity theft—requires that physicians (as well as many other businesses) implement procedures to verify identity and protect patient information.

Medicare & Regulatory Issues: FTC 'Red Flags' Rule Takes Effect May 1, 2009, Likely Applies to Your Practice

webmaster@aan.com (Webmaster) — Mon, 06 Apr 2009 17:25:00 GMT

The Federal Trade Commission (FTC) "Red Flags" Rule requires many businesses and organizations to implement a written Identity Theft Prevention Program designed to detect the warning signs of identity theft in their day-to-day operations. Health care providers should pay particular attention to the requirements that the Red Flags Rule applies to "creditors."

Payment Policy & Decision Making: Academy Members Encouraged to Challenge Inappropriate Insurer Rankings

webmaster@aan.com (Webmaster) — Thu, 26 Mar 2009 15:28:00 GMT

Although insurer physician ranking plans are not currently in place in every state or market, a number of large national health plans such as UnitedHealth Care and Aetna will be rolling out their quality designation and grading programs this spring and simultaneously sending notifications to physicians regarding opportunities to appeal their rating(s).

Medicare & Regulatory Issues: RACs Become a Reality

webmaster@aan.com (Webmaster) — Mon, 23 Mar 2009 18:59:00 GMT

Practitioners and hospitals will soon find Recovery Audit Contractors (RACs) are a reality. This service offers a valuable way to retrieve Medicare overpayments (and underpayments), and also help prevent future overpayments.

Medicare & Regulatory Issues: All About CMS' Carrier Advisory Committees

webmaster@aan.com (Webmaster) — Thu, 19 Mar 2009 19:52:00 GMT

Saty Satya-Murti, MD, FAAN, answers questions about the role of CACs in setting policies and establishing standards of patient care...

Payment Policy & Decision Making: Updated CPT Code Crosswalk Table Now Available

webmaster@aan.com (Webmaster) — Thu, 12 Mar 2009 21:28:00 GMT

In response to direct feedback from physicians and medical societies, a CPT Code Crosswalk Table was implemented in 2007 to support the UnitedHealthcare Radiology Notification Program. The crosswalk table houses CPT code information that will enable physicians

Payment Policy & Decision Making:

webmaster@aan.com (Webmaster) — Thu, 12 Mar 2009 21:20:00 GMT

Payment Policy & Decision Making: AMA Practice Tip: Losing Revenue Through Inappropriate Health Insurer Adjustments

webmaster@aan.com (Webmaster) — Tue, 10 Mar 2009 13:38:00 GMT

The American Medical Association has developed the educational resource "Is your practice losing revenue through inappropriate health insurer adjustments?" to alert physician practices to the need to carefully review

Payment Policy & Decision Making: Reminder Regarding CAP Drugs

webmaster@aan.com (Webmaster) — Fri, 20 Feb 2009 18:56:00 GMT

In September 2008 the CMS announced the postponement of the Competitive Acquisition Program for 2009. Any physicians who participated in the 2008 program have until February 28, 2009 to return unused CAP drugs to the approved vendor

Payment Policy & Decision Making: AMA Practice Tip: Negotiating Contracts

webmaster@aan.com (Webmaster) — Tue, 17 Feb 2009 20:38:00 GMT

Taking command of payer contracts and thoroughly understanding their implications is essential to the success of a physician practice. Protect your practice from inappropriate payer discounts by understanding the implications of contract provisions.

Payment Policy & Decision Making: Competitive Acquisition Program Postponed by CMS

webmaster@aan.com (Webmaster) — Thu, 12 Feb 2009 22:25:00 GMT

Physicians who participated in the 2008 program have until February 28, 2009, to return unused CAP drugs to the approved vendor.

Payment Policy & Decision Making: UnitedHealth Care Extends Physician Appeal Deadline to February 11

webmaster@aan.com (Webmaster) — Fri, 30 Jan 2009 22:02:00 GMT

As a result of requests by the AMA, UnitedHealthcare has agreed to extend the January 27, 2009, physician appeal deadline for its UnitedHealth Premium PDP two full weeks to February 11, 2009.

Payment Policy & Decision Making: Major Settlements Reached with UHG and Aetna over Ingenix Database

webmaster@aan.com (Webmaster) — Thu, 29 Jan 2009 21:00:00 GMT

New York Attorney General Andrew Cuomo has reached a settlement with UnitedHealth Group, requiring the insurer to pay $50 million to finance the creation of a new database for determining the "usual, reasonable, and customary (UCR)" charges for medical care.

Payment Policy & Decision Making: Information Updated for Physicians Appealing Rating in UHC's Premium Designation Program

webmaster@aan.com (Webmaster) — Tue, 27 Jan 2009 17:00:00 GMT

Further Information for physicians who wish to appeal their rating before February 27 has been released. Physicians must visit the UnitedHealth Premium® Designation Program web page and log in

Payment Policy & Decision Making: Appeal Your Rating in UHC's Premium Designation Program Before January 27

webmaster@aan.com (Webmaster) — Thu, 22 Jan 2009 22:46:00 GMT

Physicians should appeal their rating in United Healthcare's (UHC) Premium Designation Program (PDP) by January 27 if they believe it is wrong.

Payment Policy & Decision Making: UnitedHealth Premium Designation Program Assessment Results Now Available to Physicians

webmaster@aan.com (Webmaster) — Tue, 13 Jan 2009 17:02:00 GMT

UnitedHealthcare recently completed the annual UnitedHealth Premium® physician designation program quality and cost efficiency assessment, then mailed the results to physicians across the country.

Medicare & Regulatory Issues: Providers Urged to Participate in Annual MCPSS

webmaster@aan.com (Webmaster) — Tue, 13 Jan 2009 15:53:00 GMT

The Medicare Provider Satisfaction Survey offers providers the opportunity to contribute directly to CMS' understanding of Medicare contractor performance, as well as aid future process improvement efforts at the contractor level.

Payment Policy & Decision Making: NCOIL Model Act Paves Way for Favorable State Regulation of Rental Network PPO Market

webmaster@aan.com (Webmaster) — Tue, 16 Dec 2008 21:24:00 GMT

As part of an ongoing advocacy campaign to promote fair physician contracting and payment practices, the American Medical Association has actively encouraged the National Conference of Insurance Legislators, which consists of lead state legislators who handle insurance issues, to adopt model legislation to regulate the rental network PPO market.

Medicare & Regulatory Issues: Decrease Medicare Paperwork Time by 50 Percent

webmaster@aan.com (Webmaster) — Mon, 15 Dec 2008 16:37:00 GMT

Now there's a better way for physicians and non-physician practitioners to enroll or make a change in their Medicare enrollment information.

Payment Policy & Decision Making: Payment Policy Subcommittee Seeks Collaborative Working Relationships with Health Plans

webmaster@aan.com (Webmaster) — Mon, 24 Nov 2008 19:36:00 GMT

By Joel Kaufman, MD, FAAN - The mission of the Payment Policy Subcommittee of the Medical Economics and Management Committee (MEM) is to foster positive relationships with the health insurance industry in working together toward health care solutions, and to establish itself as a primary point of contact for members and payers seeking policy definition and development.

Payment Policy & Decision Making: AMA Reminds Physicians: 'November is National Heal that Claim Month'

webmaster@aan.com (Webmaster) — Fri, 07 Nov 2008 21:07:00 GMT

As part of its national campaign to save the health system billions of dollars by improving the accuracy and efficiency of medical claims processing, the AMA announced last week it has selected this month as the first national "Heal that Claim"™ month.

Medicare & Regulatory Issues: Medicaid Requires One Out of Three Features for Handwritten Prescriptions

webmaster@aan.com (Webmaster) — Tue, 07 Oct 2008 05:00:00 GMT

Effective October 1, 2008, requirements for prescriptions to meet Medicaid tamper-proof requirements moved to a second phase. The National Association of State Medicaid Directors (NASMD) has provided additional information. Handwritten prescriptions must now have at least one of three tamper-resistant features:

Payment Policy & Decision Making: Aetna Will Allow Outside Panel(s) of Physicians to Decide on Rescissions

webmaster@aan.com (Webmaster) — Fri, 26 Sep 2008 21:00:00 GMT

Aetna, the third-largest US health insurer, has announced that it will let an independent panel of physicians decide whether to rescind health insurance policies for sick plan members suspected of submitting false or incomplete information on their applications.

Medicare & Regulatory Issues: CMS Develops Discharge Planning Checklist for Patients, Caregivers

webmaster@aan.com (Webmaster) — Wed, 24 Sep 2008 21:00:00 GMT

The Centers for Medicare & Medicaid Services (CMS) is pleased to announce the availability of a useful checklist that prompts patients and caregivers to ask questions about key discharge planning topics including their likely care needs, the options for continuing care, post-discharge care instructions, community-based resources, and more.

Medicare & Regulatory Issues: Sept. 21–27 is National Adult Immunization Awareness Week

webmaster@aan.com (Webmaster) — Mon, 22 Sep 2008 21:00:00 GMT

The Centers for Medicare & Medicaid Services (CMS) remind health care professionals that Medicare Part B reimburses health care providers who accept the Medicare-approved payment amount for influenza, pneumococcal, and hepatitis B vaccines and their administration.

Payment Policy & Decision Making: 'Heal that Claim' Month: Take Time to Review and Appeal Inappropriately Paid Claims

webmaster@aan.com (Webmaster) — Wed, 17 Sep 2008 23:00:00 GMT

November is "Heal that Claim"™ month. All physician practices are encouraged to hold health insurance companies accountable for making claims processing more cost effective and transparent as part of the American Medical Association's (AMA) "Heal the Claims Process"™ campaign, which the AMA launched earlier this year.

Medicare & Regulatory Issues: CMS Announces Postponement of the Competitive Acquisition Program (CAP) for Part B Drugs

webmaster@aan.com (Webmaster) — Mon, 15 Sep 2008 15:30:00 GMT

The Centers for Medicare & Medicaid Services has announced the postponement of the 2009 Medicare Part B Competitive Acquisition Program. The program will continue through December 31, 2008.

Payment Policy & Decision Making: UnitedHealth Care Announces Its Next Review Cycle for the UnitedHealth Premium Designation Program

webmaster@aan.com (Webmaster) — Mon, 15 Sep 2008 15:00:00 GMT

UnitedHealth Care has announced that the assessment reports for the next Premium® designation cycle are based on refreshed paid claims data and will be sent to physicians in October. Physicians are encouraged to access information on UnitedHealthcare's physician website in order to prepare for the review of their individual data when the reports are issued in October.

Medicare & Regulatory Issues: Fee-For-Service Contractors Continue to Get Good Marks from Medicare Providers

webmaster@aan.com (Webmaster) — Fri, 05 Sep 2008 23:00:00 GMT

Results of the 2007 Medicare Contractor Provider Satisfaction Survey (MCPSS) conducted by The Centers for Medicare & Medicaid Services (CMS) show that Medicare health care providers are reasonably satisfied with services provided by Medicare fee-for-service contractors.

Payment Policy & Decision Making: Academy Takes a Stand on Principles of Physician Profiling Programs

webmaster@aan.com (Webmaster) — Fri, 25 Jul 2008 18:16:00 GMT

The American Academy of Neurology Professional Association (AANPA) has adopted a statement of principles that it believes should be included in increasingly popular physician profiling programs that rank physicians according to various criteria.

Medicare & Regulatory Issues: CMS Extends Appeal Rights When Applications for Medicare Billing Privileges Are Denied or Revoked

webmaster@aan.com (Webmaster) — Fri, 04 Jul 2008 16:00:00 GMT

The Centers for Medicare & Medicaid Services (CMS) have issued a final rule that extends appeal rights to all providers and suppliers enrollment applications for Medicare billing privileges are denied or revoked by CMS or a Medicare contractor. The rule will also allow providers and suppliers to seek judicial review after they have exhausted the administrative appeals process.

Payment Policy & Decision Making: Join the AMA in its 'Heal the Claims Process' Campaign

webmaster@aan.com (Webmaster) — Thu, 19 Jun 2008 18:00:00 GMT

The American Medical Association rolled out its "Heal the Claims Process" campaign on Monday, June 16, at the AMA House of Delegates meeting in Chicago. Working in conjunction with the National Health Insurer Report Card (NHIRC), the campaign seeks to reduce unnecessary administrative waste in the health care claims process.

Payment Policy & Decision Making: Make an Impact on Patient Care: Take the Physician Survey

webmaster@aan.com (Webmaster) — Wed, 18 Jun 2008 14:51:00 GMT

The American Medical Association has teamed up with the Ohio State Medical Association and the Toledo Blade to distribute a national survey to physicians regarding the impact of third-party payers on patient care. Results will be published as part of a series of stories being written by The Toledo Blade.

Medicare & Regulatory Issues: NPI: A Work in Progress

webmaster@aan.com (Webmaster) — Mon, 16 Jun 2008 20:00:00 GMT

In an effort to help iron out problems with inconsistent information between National Plan and Provider Enumeration System (NPPES) and the IRS database, the Centers for Medicare and Medicaid Services (CMS) are mailing out letters to organization health care providers whose information doesn't match.

Payment Policy & Decision Making: CIGNA Healthcare Announces Medical Home Pilot Project

webmaster@aan.com (Webmaster) — Thu, 12 Jun 2008 09:00:00 GMT

In the interest of providing better coordination of care, CIGNA and Dartmouth-Hitchcock recently announced that they have launched a "patient-centered medical home" pilot program. Among the goals of the program are the further enhancement of the coordination of care and the improvement of care quality for patients covered by a CIGNA plan.

Medicare & Regulatory Issues: Exceptions to Outpatient Therapy Caps Restricted on or After July 1

webmaster@aan.com (Webmaster) — Wed, 11 Jun 2008 15:12:00 GMT

CMS allowed exceptions to outpatient therapy caps from January 1, 2008, to June 30, 2008, for medically necessary services that were appropriately billed with KX modifiers. On or after July 1, 2008, the exceptions to therapy caps are restricted to those medically necessary services billed by the outpatient departments of hospitals, and use of the KX modifier will no longer be effective.

Medicare & Regulatory Issues: CMS Announces Updates Part B CAP Drug List Effective July 1, 2008

webmaster@aan.com (Webmaster) — Wed, 11 Jun 2008 15:03:00 GMT

The Centers for Medicare and Medicaid Services (CMS) implemented the Competitive Acquisition Program (CAP) for Medicare Part B drugs and biologicals not paid on a cost or prospective payment system basis. The CAP is an alternative to the average sales price ASP (buy and bill) methodology for acquiring certain Part B drugs which are administered incident to a physician's services.

Medicare & Regulatory Issues: CMS Rescinds Transmittal to Clarify 'Incident-To' Billing Rules

webmaster@aan.com (Webmaster) — Mon, 02 Jun 2008 19:36:00 GMT

The Centers for Medicare and Medicaid Services (CMS) have announced that they are rescinding the transmittal issued on May 2, which was intended to clarify "incident-to" billing rules. CMS will reissue the transmittal, presumably with changes, once they have met with medical community and heard their concerns.

Payment Policy & Decision Making: Aetna Reveals 'Guiding Principles for Physician Relations'

webmaster@aan.com (Webmaster) — Fri, 30 May 2008 14:30:00 GMT

On May 28th, Aetna posted its "Guiding Principles for Physician Relations" document online. The Principles coincide with the June 2, 2008, expiration of the Physicians Settlement Agreement with Aetna.

By publishing the Guiding Principles, Aetna seeks to formally define its commitment to building solid relationships with the medical community and to working collaboratively to improve the quality of health care. Specifically, the Principles identify behaviors and business actions that govern Aetna in its interactions with health care professionals.

Medicare & Regulatory Issues: Recovery Audit Contractors: Not Just an Experiment Anymore

webmaster@aan.com (Webmaster) — Mon, 12 May 2008 20:50:00 GMT

The Medicare Modernization Act of 2003 requires the Centers for Medicare and Medicaid Services (CMS) to perform a pilot test of Recovery Audit Contractors (RACs), which helps recover what has been estimated as $10.8 billion in Medicare overpayments and underpayments each year. This initiative started as a three-year demonstration project in California, Florida, and New York–and, as a result of its success, the project is currently being expanded.

Payment Policy & Decision Making: AANPA Develops Principles for Appropriate Coding of Intraoperative Neurophysiological Monitoring and Testing (IOM)

webmaster@aan.com (Webmaster) — Fri, 02 May 2008 17:25:00 GMT

The American Academy of Neurology Professional Association (AANPA) Board of Directors recently approved a document designed to assist payers in the development of medical policies for intraoperative neurophysiologic monitoring and testing.

Payment Policy & Decision Making: CIGNA to Stop Reimbursing Hospitals for Never Events and Avoidable Hospital Conditions

webmaster@aan.com (Webmaster) — Tue, 22 Apr 2008 14:31:00 GMT

CIGNA HealthCare recently announced its intent to stop reimbursing hospitals for so-called "never events" and avoidable hospital conditions, which are errors in patient care that can and should be prevented. The message comes as part of CIGNA's ongoing focus on improving health care quality.

Payment Policy & Decision Making: WellPoint No Longer Paying for 11 Preventable Errors

webmaster@aan.com (Webmaster) — Fri, 04 Apr 2008 16:48:00 GMT

On April 2, WellPoint announced it is following the lead of the U.S. Centers for Medicare and Medicaid Services, which last year announced a plan to end payments for some medical mistakes, so-called "never events." WellPoint is changing its policy and halting reimbursement payments to hospitals and doctors for 11 medical errors that are considered preventable.

Medicare & Regulatory Issues: 3 Things to Know About "Tamper Resistant" Prescription Pads

webmaster@aan.com (Webmaster) — Mon, 31 Mar 2008 15:47:00 GMT

Starting on April 1, 2008, the first phase of the new requirement on the use of tamper-resistant prescription pads in the Medicaid program will go into effect.

Medicare & Regulatory Issues: Third Annual Medicare Contractor Provider Satisfaction Survey (MCPSS)

webmaster@aan.com (Webmaster) — Tue, 25 Mar 2008 13:31:00 GMT

You still have time to participate in the Third Annual Medicare Contractor Provider Satisfaction Survey (MCPSS). A random selection of 35,000 Medicare physicians, providers, and suppliers is chosen to participate in the survey.

Medicare & Regulatory Issues: CMS Announces Expansion of Coverage of CPAP for OSA

webmaster@aan.com (Webmaster) — Fri, 21 Mar 2008 18:28:00 GMT

The Centers for Medicare and Medicaid Services (CMS) have announced changes to their 2005 National Coverage Determination (NCD) for Continuous Positive Airway Pressure (CPAP) Therapy for Obstructive Sleep Apnea (OSA) to allow coverage of CPAP.

Medicare & Regulatory Issues: New CMS Claims Approval Policies Underscore the Importance of Verifying NPPES Data

webmaster@aan.com (Webmaster) — Tue, 11 Mar 2008 14:25:00 GMT

The Centers for Medicare and Medicaid Services (CMS) recently discovered a significant problem in the National Provider Identifier (NPI) filing system. Provider verification of information held in the National Plan and Provider Enumeration System (NPPES) is now critical to avoid rejection of claims.

Medicare & Regulatory Issues: Important Changes to Advanced Beneficiary Notice Process

webmaster@aan.com (Webmaster) — Mon, 10 Mar 2008 19:04:00 GMT

As of March 3, 2008, CMS has replaced the Advanced Beneficiary Notice (ABN) and the Lab ABN with the ABN of Noncoverage. There will be a six-month transition period beginning March 3 and extending until no later than September 1. All providers must begin using the new ABN during this period.

Payment Policy & Decision Making: NY Attorney General Begins Lawsuit Against Ingenix® for Possible Fraud

webmaster@aan.com (Webmaster) — Fri, 07 Mar 2008 17:20:00 GMT

On February 13, 2008, New York State Attorney General Andrew Cuomo announced that he had expanded an investigation that focused on Ingenix, an arm of UnitedHealth. Ingenix collects, sorts, and analyzes a large array of data, including therapeutic outcomes and billing information. After an initial six-month investigation, the AG has begun a lawsuit against Ingenix and has subpoenaed many New York health insurers to gather additional information on how they used the Ingenix data.

Payment Policy & Decision Making: UnitedHealthcare Announces User Feedback Survey

webmaster@aan.com (Webmaster) — Thu, 28 Feb 2008 15:27:00 GMT

A new survey on UnitedHealthcareOnline.com allows members the chance to provide their information and offer suggestions for future design updates to the website.

Medicare & Regulatory Issues: April 1 Deadline Approaches for Required Use of Medicaid Tamper-proof Prescription Pads

webmaster@aan.com (Webmaster) — Thu, 21 Feb 2008 18:57:00 GMT

Medicaid prescriptions will require use of tamper-proof pads; physicians encouraged to order their supplies now.

Payment Policy & Decision Making: More BCBS Plans Agree to Pay $10 Million

webmaster@aan.com (Webmaster) — Thu, 14 Feb 2008 14:53:00 GMT

Several additional Blue Cross Blue Shield (BCBS) plans have reached settlements in the class action lawsuit brought by 90,000 physicians. Physicians who treated a BCBS patient are encourage to file their claim forms for their portion of the Highmark Settlement Fund soon. Claim forms are due by February 27.

Payment Policy & Decision Making: February 27 is Deadline for Physicians to Collect Settlement Shares from Highmark Settlement

webmaster@aan.com (Webmaster) — Mon, 11 Feb 2008 22:14:00 GMT

The AMA encourages physicians who treated Blue Cross Blue Shield patients between May 22, 1999, and May 31, 2007, to recover their portion of the $10 million Highmark Settlement Fund.

Medicare & Regulatory Issues: NPI Required on Medicare Claims Starting March 1

webmaster@aan.com (Webmaster) — Thu, 07 Feb 2008 16:37:00 GMT

Beginning March 1, 2008, all 837P and CMS-1500 claims, when required for Medicare claim submission, must have an NPI or NPI/legacy pair in the required primary provider fields.

Medicare & Regulatory Issues: Upcoming Training for the Medicare Part B Drugs Competitive Acquisition Program (CAP)

webmaster@aan.com (Webmaster) — Tue, 15 Jan 2008 15:46:00 GMT

Noridian Administrative Services, the designated carrier for the CAP, offers interactive, online workshops about the CAP for Part B Drugs and Biologicals.

Medicare & Regulatory Issues: Updates Made to the 2008 Medicare Fee Schedule

webmaster@aan.com (Webmaster) — Tue, 15 Jan 2008 14:57:00 GMT

The 2008 Medicare Fee Schedule has been updated to reflect the changes voted on by Congress which went into affect on January 1, 2008.

Payment Policy & Decision Making: WellPoint Launches New Physician Rating System

webmaster@aan.com (Webmaster) — Mon, 14 Jan 2008 16:01:00 GMT

Health benefits company, Wellpoint, announces plans to rollout a physician rating service for patients using Zagat surveys (famous for restaurant rating guidebooks).

Medicare & Regulatory Issues: CMS Launches 3rd Annual Medicare Contractor Provider Satisfaction Survey

webmaster@aan.com (Webmaster) — Mon, 14 Jan 2008 14:47:00 GMT

January marks the beginning of the Centers for Medicare & Medicaid Services (CMS) third Medicare Contractor Provider Satisfaction Survey (MCPSS)–an effort aimed at measuring physicians' and other providers' satisfaction with Medicare fee-for-service contractors.

Medicare & Regulatory Issues: Natalizumab Added to List of Part B CAP Drugs; 2008 Election Period Extended

webmaster@aan.com (Webmaster) — Thu, 03 Jan 2008 21:00:00 GMT

Effective January 1, 2008, natalizumab (J2323), will be available through the Medicare Part B Drug Competitive Acquisition Program (CAP).

Medicare & Regulatory Issues: CMS Delays Certain Anti-Markup Provisions to January 1, 2009

webmaster@aan.com (Webmaster) — Thu, 03 Jan 2008 20:26:00 GMT

The Centers for Medicare & Medicaid Services (CMS) announced a delay in the implementation date of most of the anti-markup provisions discussed in the Physician Fee Schedule Final Rule.

Payment Policy & Decision Making: New York Attorney General Reaches Agreements with Insurers on Physician Ranking Programs

webmaster@aan.com (Webmaster) — Fri, 21 Dec 2007 21:13:00 GMT

AMA and the New York Attorney General's office have reached agreements with various insurers to curtail unfair physician ranking programs.

Medicare & Regulatory Issues: Medicare Physician Participation Options: CMS Extends December 31^st Deadline by 45 Days

webmaster@aan.com (Webmaster) — Wed, 19 Dec 2007 17:02:00 GMT

Physicians wishing to change their current Medicare participating or non-participating status must do so prior to this extended deadline (approximately February 15, 2008).

Medicare & Regulatory Issues: AANPA, AMA, Others Request Delay in CMS' Proposed Anti Mark-up Revisions

webmaster@aan.com (Webmaster) — Wed, 12 Dec 2007 14:55:00 GMT

Starting January 1, 2008, CMS will require physicians to be in compliance with new provisions to the rule prohibiting the mark-up of diagnostic tests, published for the first time in the final 2008 Physician Fee Schedule on November 27, 2007.

Medicare & Regulatory Issues: Register Now for the Individuals Authorized Access to CMS Computer Services-Provider Community (IACS-PC)

webmaster@aan.com (Webmaster) — Mon, 03 Dec 2007 14:43:00 GMT

The Centers for Medicare & Medicaid Services (CMS) will be announcing new online enterprise applications that will allow Medicare fee-for-service providers to access, update, and submit information online.

Medicare & Regulatory Issues: 2008 Medicare Physician Fee Schedule Released

webmaster@aan.com (Webmaster) — Fri, 16 Nov 2007 16:02:00 GMT

The 2008 Medicare Physician Fee Schedule, effective January 1, includes a number of revisions that directly affect neurologists.

Payment Policy & Decision Making: AMA Invites Physicians to Share Concerns About Insurers' Physician Profiling Programs

webmaster@aan.com (Webmaster) — Wed, 31 Oct 2007 19:40:00 GMT

The AMA is encouraging physicians in all states to voice their concerns regarding inaccurate physician profiling systems in the wake of United Healthcare's Premium Designation Program, an online rating system for in-network physicians that grades "quality and efficiency."

Medicare & Regulatory Issues: CMS and Noridian to Offer Workshop for Physicians Electing Into 2008 Part B CAP

webmaster@aan.com (Webmaster) — Fri, 26 Oct 2007 16:40:00 GMT

Physicians electing into the 2008 Competitive Acquisition Program (CAP) are invited to participate in an online workshop for Part B drugs and biologicals.

Medicare & Regulatory Issues: Six-month Delay Announced on Medicaid Tamper-Resistant Prescription Pad Mandate

webmaster@aan.com (Webmaster) — Wed, 03 Oct 2007 13:11:00 GMT

New law requires physicians to use tamper-resistant prescription pads by spring of 2008.

Medicare & Regulatory Issues: Phase III of CMS' Physician Self-referral Rule to Go into Effect December 4, 2007

webmaster@aan.com (Webmaster) — Fri, 21 Sep 2007 17:04:00 GMT

The Phase III final rule is the third phase of a final rulemaking amending the CMS regulations regarding the physician self-referral prohibition as part of the Social Security Act. This rule finalizes and addresses public comments regarding the Phase II interim final rule, published in March 2004.

Medicare & Regulatory Issues: Medicare Part B CAP Physician Election Period Starts October 1

webmaster@aan.com (Webmaster) — Fri, 21 Sep 2007 17:03:00 GMT

The 2008 Physician Election Period for the Medicare Part B Drug Competitive Acquisition Program (CAP) will begin on October 1, 2007, and will conclude on November 15, 2007. The CAP is a voluntary program that offers physicians the option to acquire many injectable and infused drugs they use in their practice from an approved CAP vendor, thus reducing the time they spend buying and billing for drugs. The 2008 CAP program will run from January 1 to December 31, 2008.

Medicare & Regulatory Issues: Effective October 1, CMS Requires Use of Tamper-Resistant Prescription Pads

webmaster@aan.com (Webmaster) — Mon, 17 Sep 2007 19:51:00 GMT

CMS will require physicians to write prescriptions on tamper-resistant prescription pads beginning October 1, 2007 to curb prescription misuse.

Medicare & Regulatory Issues: CMS to Require the Completion of Present On Admission (POA) Indications

webmaster@aan.com (Webmaster) — Fri, 14 Sep 2007 14:19:00 GMT

Beginning on October 1, 2007, Medicare providers should submit a Present On Admission (POA) Indicator for every diagnosis on impatient acute care hospital claims. Some facilities, such as critical access hospitals, Maryland waiver hospitals, long term care hospitals, cancer hospitals, psychiatric hospitals, inpatient rehabilitation facilities, and children's inpatient facilities are exempt from this requirement. It is important to be sure that your billing staff is aware of the requirement.

Payment Policy & Decision Making: Blue Cross Blue Shield Settlement Claim Forms Due October 19, 2007

webmaster@aan.com (Webmaster) — Wed, 05 Sep 2007 19:41:00 GMT

The deadline to submit claim forms for the BCBS settlement is approaching. The deadline to opt out You is September 14, 2007.

Medicare & Regulatory Issues: Incorrect NPI Implementation Schedule Published, CMS Clarifies

webmaster@aan.com (Webmaster) — Wed, 05 Sep 2007 13:58:00 GMT

Due to an incorrect schedule published by a trade publication, CMS advises providers to look to their Medicare contractors for official schedule information and details.

Medicare & Regulatory Issues: CMS to Disclose NPPES Health Care Provider Data September 4, 2007

webmaster@aan.com (Webmaster) — Wed, 08 Aug 2007 19:46:00 GMT

National Plan and Provider Enumeration System (NPPES) health care provider data will be disclosed to the public via the internet by CMS beginning on September 4, 2007.

Medicare & Regulatory Issues: CMS Publishes NPI Data Dissemination Notice

webmaster@aan.com (Webmaster) — Mon, 18 Jun 2007 15:51:00 GMT

CMS has published its NPI Data Dissemination Notice, asserting who will have access to physicians’ NPI numbers as well as other information from their NPI application. Physicians have 30 days to remove any “optional” data.

Medicare & Regulatory Issues: Physician Election Period Open Until June 15 for CMS' Part B CAP

webmaster@aan.com (Webmaster) — Wed, 23 May 2007 16:26:00 GMT

An additional election period for physicians who are not currently participating in the Part B Competitive Acquisition Program (CAP) is underway. The CAP is an alternative to the Average Sales Price (ASP) method of acquiring many drugs and biologicals administered incident to a physician's services.

Medicare & Regulatory Issues: CMS Posts Final Decision Memorandum for Carotid Stenting

webmaster@aan.com (Webmaster) — Fri, 18 May 2007 17:19:00 GMT

CMS has elected not to modify covered indications outlined in its National Coverage Decision proposed changes for Percutaneous Transluminal Angioplasty (PTA) of the Carotid Artery Concurrent with Stenting, The CMS decision is consistent with AAN opinion on the issue.

Medicare & Regulatory Issues: Medicare Fee For Service NPI Contingency Plan

webmaster@aan.com (Webmaster) — Wed, 25 Apr 2007 22:21:00 GMT

Effective May 23, 2007, Medicare fee for services (FFS) is establishing a contingency plan for implementing the National Provider Identifier (NPI). This plan includes the stipulation that, as soon as Medicare considers the number of claims submitted with an NPI for primary providers (billing, pay-to, and rendering providers) is sufficient, Medicare will begin rejecting claims without an NPI for primary providers. The plan could be implemented as early as July 1, 2007.

Medicare & Regulatory Issues: AAN Responds to CMS' Proposed National Coverage Determination (NCD) Change for Carotid Artery Stenting

webmaster@aan.com (Webmaster) — Fri, 09 Mar 2007 15:39:00 GMT

On February 1, 2007, CMS announced a proposal to extend coverage of percutaneous transluminal angioplasty (PTA) of the carotid artery concurrent with stenting. The AAN worked in collaboration with the Neurovascular Coalition (NVC) to submit comments on the proposed changes and also put forward our own letter to CMS outlining AAN concerns with portions of the proposal.

View the proposed NCD revisions on the CMS website

Medicare & Regulatory Issues: 2007 Medicare Fee Schedule for Neurologists

webmaster@aan.com (Webmaster) — Thu, 22 Feb 2007 15:40:00 GMT

The fee schedule designed for neurologists and derived from national Medicare Relative Value Units (RVUs) as published annually in the Federal Register is now available. The dollar values shown here are based on the Medicare RVUs multiplied by the Medicare conversion factor (also published annually in the Federal Register). Actual reimbursement may vary based on geography.

Medicare RVUS (.pdf)
Dollar Values (.pdf)

The AAN submitted comments on the 2007 final Medicare physician fee schedule.

Read the comment letter (.pdf)

Medicare & Regulatory Issues: New Taxonomy Codes for Diagnostic Neuroimaging

webmaster@aan.com (Webmaster) — Wed, 21 Feb 2007 15:00:00 GMT

The National Uniform Claim Committee approved a request from the AAN for new taxonomy codes for diagnostic neuroimaging. New listings for Diagnostic Neuroimaging are located under both Psychiatry & Neurology and Radiology. The codes were released January 1, 2007, and are effective April 1, 2007. To view the health care provider taxonomy code set, visit www.wpc-edi.com/taxonomy. Providers include a taxonomy code on the national provider identifier (NPI) application.