The bill allows the Health and Human Services secretary to exempt physicians on a case-by-case basis if complying with e-prescribing would be a “significant hardship,” such as a physician practicing in a rural area without sufficient Internet access.
The bill would delay the first round of Medicare's competitive acquisition program until 2009. Critics of the program, which began July 1, have said that it makes it too difficult for vulnerable seniors to get supplies, including diabetes testing supplies. The bill also establishes an ombudsman for the program, who would be responsible for responding to complaints and inquiries from suppliers and individuals.
Just days before the passage of H.R. 6331, officials at the Centers for Medicare and Medicaid Services released the 2009 Medicare Physician Fee Schedule proposed rule including new measures for the PQRI, new requirements for physicians offering diagnostic testing services, and plans to reevaluate services and supplies potentially valued incorrectly. For PQRI, the agency is recommending 56 new measures for 2009, bringing the total number to 175.
Officials at the Centers for Medicare and Medicaid Services also are proposing new “measures groups” to allow physicians report on subsets of measures related to a condition. New measures groups for 2009 include coronary artery disease, coronary artery bypass surgery, HIV/AIDS, rheumatoid arthritis, care during surgery, and back pain.
What Happens to My Claims Now?
Now that H.R. 6331 is law, Medicare contractors are working to make sure physicians are paid at the correct rate.
However, it may take up to 10 business days for some contractors to begin paying claims at the higher (0.5%) rate, according to CMS. Once the local contractors start paying claims at the increased rate, they will go back and reprocess any claims paid at the lower amount.
Most claims will be automatically reprocessed, but a few providers may need to contact their local contractor for direction on getting their claims adjusted. For example, physicians who have submitted charges that are lower than the Medicare fee schedule amount will need to contact their local contractor, CMS said. In addition, nonparticipating physicians who submitted unassigned claims at the reduced nonparticipation amount will need to request an adjustment from the carrier.
There may be some variation in how different contractors handle this process, said Brett Baker, director of the regulatory affairs at the American College of Physicians, with some paying claims at the new amount immediately and others taking slightly longer to retool their systems. But for the most part, physicians won't need to take any additional steps to ensure they receive their full payments, he said.