Public Payor News

CMS Proposes Rule for Physician Financial Disclosure

The Centers for Medicare and Medicaid Services (CMS) released a proposed rule on Wednesday that establishes procedures for manufacturers of drugs, devices, biological, or medical supplies to report payments to physicians and teaching hospitals. In addition, applicable manufacturers and group purchasing organizations would have to disclose information about physician ownership and investment interests.

The reporting is required under the Patient Protection and Affordable Care Act. CMS plans to post the payment information on a public database, after the final rule is published in 2012. Originally, report collection was to have begun on January 1, 2012, but the date will be moved later into the year because of the delay in publishing the rule.

Under the rule, medical industry companies must disclose consulting fees and other payments, travel reimbursements, research grants and gifts valued at over $10 that are given to physicians and teaching hospitals. Entities affected by the reporting requirements will have the ability to review and correct inaccurate data before it is posted. Companies that fail to report gifts could be fined $150,000, or $1 million if they knowingly did not report such gifts.

CMS will accept comments on the proposed rule until February 17, 2012. Comments may be submitted electronically to:, or by mail to:

Centers for Medicare and Medicaid Services
Department of Health and Human Services
Attention: CMS-5060-P
PO Box 8013
Baltimore, MD 21244-8013

Please contact the NCMS if you have questions or desire assistance with the proposed rule.

Medicaid Deadline for Updated Trading Partner Agreement (TPA) is December 19

The Division of Medical Assistance’s (DMA) current fiscal agent, HP Enterprise Services (HPES), must receive an updated Trading Partner Agreement (TPA) – Appendix A from Medicaid providers, the provider’s clearinghouses or billing agents who submit electronic transactions directly to HPES, by December 19, 2011. This is to ensure adequate time to process the Appendix A prior to the federally mandated HIPAA 5010 implementation date of January 1, 2012. Failure to provide HPES with the updated Appendix A by the deadline may result in the inability to process your 5010 electronic transactions, including your Medicaid claims, which could impact provider payment. DMA began notifying providers about updating Appendix A starting with the July 2011 Medicaid bulletin and does not plan on issuing any cash advances as a result of a provider not being ready for 5010.

To access the Appendix A – HPES TPA form, please go to:

For more information about HIPAA 5010 implementation, please see:

CMS Requires New Medicare ABN Form for 2012

The Centers for Medicare and Medicaid Services (CMS) has revised the Advanced Beneficiary Notice of Noncoverage (ABN), Form CMS-R-131. This form is used by health care providers, including physicians, when they expect Medicare will deny payment. The revised form replaces ABN-G (Form CMS-R-131G), ABN-L (Form CMS-R-131L), and NEMB (form CMS-20007). The latest version of the ABN (release date March 2011) can be accessed here. Use of the revised ABN form will be mandatory, starting January 1, 2012.


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