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A trifecta of practice benefits

March 7, 2016

A trifecta of practice benefits

Trifecta tri-fec-ta noun: a variation of the perfecta in which a bettor wins by selecting the first three finishers of a race in the correct order of finish. – A run of three grand events.

The Advocacy Council has a trifecta of practice benefits to fill you in on, including:

Reimbursement for venom antigens below cost

Several College members have recently contacted us to report low reimbursement for venom immunotherapy, for each of the five venom immunotherapy CPT codes 95145 – 95149. The Advocacy Council compared the costs of venom extract with the cost recognized by CMS in the Medicare fee schedule. Our investigation supported your statements about reimbursement below the level of your actual cost.

We emailed a letter to CMS demonstrating that the cost of venom antigens has increased considerably since these items were last priced. We are hopeful of receiving a positive response prior to the 2017 Medicare fee schedule determination.

The Advocacy Council can try to help with these kinds of problems, but can only do so when you call it to our attention. When you or your billing office become aware of possible practice issues, make us aware of the problem. We will assess and act to resolve the issue as quickly as possible.

Provider revalidation of enrollment in Medicare

CMS completed the initial round of Medicare enrollment revalidations and is beginning its second round, during which providers will be required to revalidate their entire Medicare enrollment record every five years. The revalidation schedule varies from physician to physician, and Medicare will send a revalidation notice two to three months prior to the revalidation due date either by email or regular mail. However, effective immediately, providers can also check their revalidation due dates online. Providers due for revalidation will display a revalidation due date, and all other providers not up for revalidation will display a “TBD” (to be determined). We strongly recommend you check this website regularly to see if you are due for revalidation, since Medicare may send your revalidation notice to an incorrect mailing address or email address.

The fastest and most efficient way to submit your revalidation information is by using Internet-based PECOS. To review CMS’ validation requirements and the revalidation process, view this CMS Resource.

CMS can deactivate your billing privileges for failure to complete a revalidation application by the due date. Deactivated providers will be required to submit a new full and complete application in order to reestablish their provider enrollment record and related Medicare billing privileges.

Meaningful use hardship exemption extended

CMS has recently extended the meaningful use hardship exemption deadline to July 1 so providers will have sufficient time to complete their applications. The AMA notes this hardship exemption is a result of the delay of the 2015 MU modification rule. You will not be subject to the 2017 meaningful use penalty if you complete this hardship application. Providers are encouraged to select Option 2.2.d under the “EHR Certification/Vendor Issues (CEHRT Issues)” category in Section 2 of the hardship application. Instructions are available from CMS.

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