Public Payor News

2012 Annual Medicare Participation Enrollment Program Extended

CMS is anticipating that Congress will avert the negative update for the 2012 Medicare Physician Fee Schedule, so it is extending the 2012 Annual Participation Enrollment Period through Tuesday, February 14, 2012. The effective date for any participation status change during the extension, however, remains Sunday, January 1, 2012, and will be in force for the entire year. Palmetto GBA and other Medicare contractors will accept and process any participation elections or withdrawals made during the extended enrollment period that are post-marked on or before Tuesday, February 14, 2012.

CMS Unable To Provide Feedback Report for Electronic Prescribing Program

CMS has advised physicians and other Medicare providers that it cannot provide a 2012 Electronic Prescribing (eRx) Incentive Program payment adjustment feedback report as it had intended. CMS says a high volume of significant hardship requests make it technically unfeasible to do the report. CMS will continue to explore alternatives to notify eligible professions that they are subject to the 2012 eRx payment adjustment.

Eligible professionals are urged to review remittance advices for claims submitted for dates of service on or after Sunday, January 1, 2012. Eligible professionals and group practices that receive the 2012 eRx payment adjustment will see the term “LE” on their remittance advice for all Medicare Part B Services rendered January 1 – December 31, 2012.

The remittance advice will also contain the following Claim Adjustment Reason Code (CARC) and Remittance Advice Remark (RARC):

CARC 237 – Legislated/Regulatory Penalty. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT).

RARC N545 – Payment reduced based on status as an unsuccessful e-prescriber per the Electronic Prescribing Rx Incentive Program.

If an eligible professional or group practice receives the payment adjustment in error, the claim will be reprocessed to return the 1.0 percent and the remittance advice for the reprocessed claim will include the following codes and messages:

CARC 237 – (As noted above)

RARC N546 – Payment represents a previous reduction based on the Electronic Prescribing Incentive Program.

For more information on how the 2012 eRx payment adjustment will be assessed and applied, please refer to MLN Matters Article SE1141 for additional information, or visit the eRx Incentive Program webpage at

Important Changes in Medicare for 2012 that Physicians Need to Know

Medicare cost-sharing for Part B Services will decline in some cases, and for the first time, the Part B deductible will decrease by $22, to $140. Additionally, health care professionals will be paid more to provide certain important services for people covered by Medicare. CMS has increased the payment amount for the initial and annual wellness visit—which has no cost sharing for patients—to account for the introduction of health risk assessment (HRA). CMS wants to balance the comprehensiveness of the HRA with the potential burden on patients and health professional time constraints. CMS will allow for variation in the content of the HRA.

Also, primary care physicians, nurse practitioners, clinical nurse specialists, and physician assistants may be eligible to receive an incentive payment equal to 10 percent of their allowed charges for primary care services under Medicare Part B. This incentive is paid in addition to any physician incentive payments for services furnished in Health Professional Shortage Areas.

North Carolina Physicians Named as Innovation Advisors to CMS

Three North Carolina physicians and a practice group manager have been selected as Innovation Advisors to the Centers for Medicare and Medicaid Services (CMS). The following were selected from more than 900 applications from the Southeast:

Pamela Duncan, MD, Wake Forest Baptist Health, Winston-Salem

Suzanne Landis, MD, Mountain Area Health Education Center (MAHEC), Asheville

Ze’ev Neuwirth, MD, Carolinas Healthcare System, Charlotte

Rod Baird, Geriatric Practice Management, Inc., Asheville

Innovation Advisors will work with the CMS Innovation Center to test new models of health care delivery in their own organizations and communities. They will also create partnerships to find new ideas that work and share them regionally and across the United States. Funding for this initiative is provided by by the Patient Protection and Affordable Care Act.


Share this Post