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Newsletter September 11, 2015

Friday, October 9, 2015   (0 Comments)
Posted by: Diane Berg
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Florida Orthopedic Community Bulletin

 

 

September 11, 2015

 

 

 

 

2014 Annual Quality and Resource Use Reports Available

 

The 2014 Annual Quality and Resource Use Reports (QRURs) are now available for every group practice and solo practitioner nationwide. Groups and solo practitioners are identified in the QRURs by their Taxpayer Identification Number (TIN). The QRURs are also available for groups and solo practitioners that participated in the Medicare Shared Savings Program, the Pioneer Accountable Care Organization (ACO) Model, or the Comprehensive Primary Care initiative in 2014, and to those TINs consisting only of non-physician eligible professional (EPs).

 

Read more

 

Physician Quality Reporting System 2016 Informal Review Process

 

In 2016, CMS will apply a negative payment adjustment to individual eligible professionals (EPs), Comprehensive Primary Care (CPC) practice sites, and group practices participating in the Physician Quality Reporting System (PQRS) group practice reporting option (GPRO) (including Accountable Care Organizations [ACOs]) that did not satisfactorily report PQRS in 2014. Individuals and groups that receive the 2016 negative payment adjustment will not receive a 2014 PQRS incentive payment.

 

Read more

Source:CMS Physician Quality Reporting System (PQRS) Listserv

 

 

Ruling could help providers recover money from Medicare Advantage sequestration cuts

 

A recent decision by a federal judge may help bolster providers' lawsuits against Medicare Advantage plans over those plans' decisions to slash reimbursement rates in response to federal budget cuts.

In the case at issue, 11 Florida providers are suing Humana, saying the insurer wrongly cut payments to them in response to the 2013 federal budget cuts known as sequestration. During sequestration, the CMS reduced payments to Medicare Advantage organizations by 2%, and many of those organizations then passed those cuts on to providers in the form of lower payments.Read More


Source: Modern Healthcare

 

 

CMS Conducts Final Successful Medicare FFS ICD-10
End-to-End Testing Week in July

From July 20 through 24, 2015, Medicare Fee-For-Service (FFS) health care providers, clearinghouses, and billing agencies participated in a third successful ICD-10 end-to-end testing week with all Medicare Administrative Contractors (MACs) and the Durable Medical Equipment (DME) MAC Common Electronic Data Interchange (CEDI) contractor. CMS was able to accommodate most volunteers, representing a broad cross-section of provider, claim, and submitter types.

 

This final end-to-end testing week demonstrated that CMS systems are ready to accept and process ICD-10 claims. Approximately 1,200 providers and billing companies participated, and testers submitted over 29,000 test claims.View the results.

Read more

Source: CMS ICD-10 News

 

 

Office Announces 2016 PPACA Individual Market Health Insurance Plan Rates to Increase 9.5% on Average

The Florida Office of Insurance Regulation announced today that premiums for Florida individual major medical plans in compliance with the federal Patient Protection & Affordable Care Act (PPACA) will increase an average of 9.5% beginning January 1, 2016. Per federal guidelines, a total of 19 health insurance companies submitted rate filings for the Office's review in May with final rate determinations due by August 25, 2015. These rate filings consisted of individual major medical plans to be sold both on and off the Exchange. Following the Office's rate filing review, the average approved rate changes on the Exchange range from a low of -9.7% to a high of 16.4%. This information can be located in the "Individual PPACA Market Monthly Premiums for Plan Year 2016" document.Read more

 

Source: Florida Office of Insurance Regulation

 

 

Florida's Narrow Networks

 

A new report from the Robert Wood Johnson Foundation and the University of Pennsylvania found that 79 percent of Florida's exchange-based provider networks are "narrow," meaning that they include only a small proportion of the office-based physicians who practice in the network's rating areas. More specifically, the researchers found that 43 percent of exchange networks in Florida included fewer than 10 percent of physicians and that an additional 36 percent of networks included fewer than 25 percent of physicians. Not a single exchange-based network in Florida included 40 percent or more of the physicians located in the applicable rating areas. Click here to read a full reportby FMA Director of Payment Advocacy Jarrod Fowler.

 

Source: FMA News

 

 

Florida Medicaid Health Care Alert -September 2015

Provider Type(s): 25, 26, 27, 28, 29, 30, 31, 34, 35, 36, 60, 61, 62, 63, 66, 68, 69, 70, 77

Provider Fee Schedule Update

Effective September 3, 2015 the Agency will be utilizing the rates published on the January 1, 2015 practitioner fee schedules. The January 1, 2015 fee schedules will be used until further notice. Claims reimbursed at the rates published on the August 1, 2015 fee schedules will be reprocessed in accordance with the rates specified on the January 1, 2015 fee schedules. Although not required, providers have the option of voiding and resubmitting their claim(s) ahead of the reprocessing.

The effected fee schedules are as follows:

 

Advance Registered Nurse Practitioner
Chiropractic
Dental General
Hearing
Independent Lab
Licensed Midwife
Optometric
Oral Maxillofacial Surgery
Outpatient Hospital Laboratory

Physician Assistant
Physician Evaluation and Management
Physician Laboratory
Physician Medical
Physician Radiology
Physician Surgical
Podiatry
Registered Nurse First Assistant
Visual


The January 1, 2015 fee schedules can be found atportal.flmmis.com/FLPublic/

 

For further questions regarding the fee schedule updates please contact Medicaid Program Finance at MPFFEEREQUEST@ahca.myflorida.com.

 

 

Merit Based Incentive Payment System (MIPS)

Congress passed and the President signed into law H.R. 2, "The Medicare Access and CHIP Reauthorization Act" (MACRA) which permanently repealed the Sustainable Growth Rate (SGR) formula and included the establishment of the Merit-Based Incentive Payment System (MIPS).

The current scheme of penalties under the Physician Quality Reporting System (PQRS), Electronic Health Records/Meaningful Use (MU) and the Value-Based Payment Modifier (VBM) will end at the close of 2018.

Click here to read a summary of the MIPS program.

 

 

Upcoming Events

 

2015 BSOF Annual Conference

September 25 - 27, 2015

J W Marriott OrlandoGrande Lakes, Orlando

 

Click here to view the updated Preliminary Program

Get the latest information on speakers, agenda, schedule,

social events, and exhibitors.

 

The program has been approved for16.5 CEU'sfrom AAPC.

 

 

2015 ICD-10 Coding Course for Physicians

Saturday September 26, 2015

J W Marriott Orlando Grande Lakes Orlando



The Florida Orthopaedic Society and Bones Society of Florida will host an

ICD-10 Coding Course for Physicians takingplace during the2015 BSOF Annual Meeting at theJ W Marriott Orlando Grande Lakes, (4040 Central Florida Pkwy,Orlando, Florida 32837).

 

The course is specifically designed for physicians to discuss documentation tips and best practices to ensure you give your staff the information they need to make sure you get paid.

 

Saturday September 26, 2015

10:00 AM - 1:30 PM

$75 for FOS & BSOF Members

$300 for Non Members

Click here for more information and to register.

 

 

PNG LogoFOS Announces Emerging Leaders Retreat

 

TheFOSBoard of Directors is pleased to announce an Emerging Leaders Retreat to take placeNovember 20-22 at the Biltmore Hotel in Miami, Florida.Dr. Carlos Lavernia, President, will be the host of the retreat.

 

The retreat is designed to identify and provide a platform for a dozen future leaders within the profession. It is our hope that the orthopaedic surgeons selected will lead our organization for the next 10 to 20 years. The program will include presentations on leadership and organized orthopaedics and will include a number of invited speakers including AAOS President, David Teuscher, M.D.

 

FOS will pay for transportation and hotel rooms for those surgeons selected to participate.

 

Candidates for consideration must be 45 years old or younger. Interested members will need to submit an application for consideration by Monday, September 14, 2015. The application should include their CV as well as a brief statement (under 500 words) on why they would like to be selected for participation. The CV and Statement should be emailed to Fraser Cobbe atfcobbe@cobbemanagement.com.

 

 

 

 

 

 

Corporate Partners

 

 

 

Stay Connected

 

Like us on FacebookFollow us on TwitterView our profile on LinkedInView our videos on YouTube

 

Forward this email


This email was sent to diane@cobbemanagement.com by fcobbe@cobbemanagement.com |

Update Profile/Email Address | Rapid removal with SafeUnsubscribe| About our service provider.


Florida Orthopaedic Community
| 1215 E Robinson Street | Orlando | FL | 32801

 

 

 

 

Florida Orthopedic Community Bulletin

 

 

September 11, 2015

 

 

 

 

2014 Annual Quality and Resource Use Reports Available

 

The 2014 Annual Quality and Resource Use Reports (QRURs) are now available for every group practice and solo practitioner nationwide. Groups and solo practitioners are identified in the QRURs by their Taxpayer Identification Number (TIN). The QRURs are also available for groups and solo practitioners that participated in the Medicare Shared Savings Program, the Pioneer Accountable Care Organization (ACO) Model, or the Comprehensive Primary Care initiative in 2014, and to those TINs consisting only of non-physician eligible professional (EPs).

 

Read more

 

Physician Quality Reporting System 2016 Informal Review Process

 

In 2016, CMS will apply a negative payment adjustment to individual eligible professionals (EPs), Comprehensive Primary Care (CPC) practice sites, and group practices participating in the Physician Quality Reporting System (PQRS) group practice reporting option (GPRO) (including Accountable Care Organizations [ACOs]) that did not satisfactorily report PQRS in 2014. Individuals and groups that receive the 2016 negative payment adjustment will not receive a 2014 PQRS incentive payment.

 

Read more

Source:CMS Physician Quality Reporting System (PQRS) Listserv

 

 

Ruling could help providers recover money from Medicare Advantage sequestration cuts

 

A recent decision by a federal judge may help bolster providers' lawsuits against Medicare Advantage plans over those plans' decisions to slash reimbursement rates in response to federal budget cuts.

In the case at issue, 11 Florida providers are suing Humana, saying the insurer wrongly cut payments to them in response to the 2013 federal budget cuts known as sequestration. During sequestration, the CMS reduced payments to Medicare Advantage organizations by 2%, and many of those organizations then passed those cuts on to providers in the form of lower payments.Read More


Source: Modern Healthcare

 

 

CMS Conducts Final Successful Medicare FFS ICD-10
End-to-End Testing Week in July

From July 20 through 24, 2015, Medicare Fee-For-Service (FFS) health care providers, clearinghouses, and billing agencies participated in a third successful ICD-10 end-to-end testing week with all Medicare Administrative Contractors (MACs) and the Durable Medical Equipment (DME) MAC Common Electronic Data Interchange (CEDI) contractor. CMS was able to accommodate most volunteers, representing a broad cross-section of provider, claim, and submitter types.

 

This final end-to-end testing week demonstrated that CMS systems are ready to accept and process ICD-10 claims. Approximately 1,200 providers and billing companies participated, and testers submitted over 29,000 test claims.View the results.

Read more

Source: CMS ICD-10 News

 

 

Office Announces 2016 PPACA Individual Market Health Insurance Plan Rates to Increase 9.5% on Average

The Florida Office of Insurance Regulation announced today that premiums for Florida individual major medical plans in compliance with the federal Patient Protection & Affordable Care Act (PPACA) will increase an average of 9.5% beginning January 1, 2016. Per federal guidelines, a total of 19 health insurance companies submitted rate filings for the Office's review in May with final rate determinations due by August 25, 2015. These rate filings consisted of individual major medical plans to be sold both on and off the Exchange. Following the Office's rate filing review, the average approved rate changes on the Exchange range from a low of -9.7% to a high of 16.4%. This information can be located in the "Individual PPACA Market Monthly Premiums for Plan Year 2016" document.Read more

 

Source: Florida Office of Insurance Regulation

 

 

Florida's Narrow Networks

 

A new report from the Robert Wood Johnson Foundation and the University of Pennsylvania found that 79 percent of Florida's exchange-based provider networks are "narrow," meaning that they include only a small proportion of the office-based physicians who practice in the network's rating areas. More specifically, the researchers found that 43 percent of exchange networks in Florida included fewer than 10 percent of physicians and that an additional 36 percent of networks included fewer than 25 percent of physicians. Not a single exchange-based network in Florida included 40 percent or more of the physicians located in the applicable rating areas. Click here to read a full reportby FMA Director of Payment Advocacy Jarrod Fowler.

 

Source: FMA News

 

 

Florida Medicaid Health Care Alert -September 2015

Provider Type(s): 25, 26, 27, 28, 29, 30, 31, 34, 35, 36, 60, 61, 62, 63, 66, 68, 69, 70, 77

Provider Fee Schedule Update

Effective September 3, 2015 the Agency will be utilizing the rates published on the January 1, 2015 practitioner fee schedules. The January 1, 2015 fee schedules will be used until further notice. Claims reimbursed at the rates published on the August 1, 2015 fee schedules will be reprocessed in accordance with the rates specified on the January 1, 2015 fee schedules. Although not required, providers have the option of voiding and resubmitting their claim(s) ahead of the reprocessing.

The effected fee schedules are as follows:

 

Advance Registered Nurse Practitioner
Chiropractic
Dental General
Hearing
Independent Lab
Licensed Midwife
Optometric
Oral Maxillofacial Surgery
Outpatient Hospital Laboratory

Physician Assistant
Physician Evaluation and Management
Physician Laboratory
Physician Medical
Physician Radiology
Physician Surgical
Podiatry
Registered Nurse First Assistant
Visual


The January 1, 2015 fee schedules can be found atportal.flmmis.com/FLPublic/

 

For further questions regarding the fee schedule updates please contact Medicaid Program Finance at MPFFEEREQUEST@ahca.myflorida.com.

 

 

Merit Based Incentive Payment System (MIPS)

Congress passed and the President signed into law H.R. 2, "The Medicare Access and CHIP Reauthorization Act" (MACRA) which permanently repealed the Sustainable Growth Rate (SGR) formula and included the establishment of the Merit-Based Incentive Payment System (MIPS).

The current scheme of penalties under the Physician Quality Reporting System (PQRS), Electronic Health Records/Meaningful Use (MU) and the Value-Based Payment Modifier (VBM) will end at the close of 2018.

Click here to read a summary of the MIPS program.

 

 

Upcoming Events

 

2015 BSOF Annual Conference

September 25 - 27, 2015

J W Marriott OrlandoGrande Lakes, Orlando

 

Click here to view the updated Preliminary Program

Get the latest information on speakers, agenda, schedule,

social events, and exhibitors.

 

The program has been approved for16.5 CEU'sfrom AAPC.

 

 

2015 ICD-10 Coding Course for Physicians

Saturday September 26, 2015

J W Marriott Orlando Grande Lakes Orlando



The Florida Orthopaedic Society and Bones Society of Florida will host an

ICD-10 Coding Course for Physicians takingplace during the2015 BSOF Annual Meeting at theJ W Marriott Orlando Grande Lakes, (4040 Central Florida Pkwy,Orlando, Florida 32837).

 

The course is specifically designed for physicians to discuss documentation tips and best practices to ensure you give your staff the information they need to make sure you get paid.

 

Saturday September 26, 2015

10:00 AM - 1:30 PM

$75 for FOS & BSOF Members

$300 for Non Members

Click here for more information and to register.

 

 

PNG LogoFOS Announces Emerging Leaders Retreat

 

TheFOSBoard of Directors is pleased to announce an Emerging Leaders Retreat to take placeNovember 20-22 at the Biltmore Hotel in Miami, Florida.Dr. Carlos Lavernia, President, will be the host of the retreat.

 

The retreat is designed to identify and provide a platform for a dozen future leaders within the profession. It is our hope that the orthopaedic surgeons selected will lead our organization for the next 10 to 20 years. The program will include presentations on leadership and organized orthopaedics and will include a number of invited speakers including AAOS President, David Teuscher, M.D.

 

FOS will pay for transportation and hotel rooms for those surgeons selected to participate.

 

Candidates for consideration must be 45 years old or younger. Interested members will need to submit an application for consideration by Monday, September 14, 2015. The application should include their CV as well as a brief statement (under 500 words) on why they would like to be selected for participation. The CV and Statement should be emailed to Fraser Cobbe atfcobbe@cobbemanagement.com.

 

 

 

 

 

 

Corporate Partners

 

 

 

Stay Connected

 

Like us on FacebookFollow us on TwitterView our profile on LinkedInView our videos on YouTube

 

Forward this email


This email was sent to diane@cobbemanagement.com by fcobbe@cobbemanagement.com |

Update Profile/Email Address | Rapid removal with SafeUnsubscribe| About our service provider.


Florida Orthopaedic Community
| 1215 E Robinson Street | Orlando | FL | 32801

 

 


more Calendar

8/11/2019 » 8/14/2019
2019 WCI Conference

10/10/2019 » 10/12/2019
2019 Bones Society of Florida Annual Meeting

12/6/2019 » 12/7/2019
2019 Winter FOS & BSOF Coding & Reimbursement Conference

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