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March 2010 Medicare Updates

NGS Requires 855A Revalidation


National Government Services is sending notices to providers requiring them to complete and submit a Medicare Enrollment Application (CMS 855A) form and supporting attachments. The due date is 60 days from the postmark date of the letter. You can request an extension in writing to Provider Enrollment if you need additional time to complete this application. When completing this application you will need to select "Revalidate" in Section 1 (A) and complete the necessary sections as indicated. This will start the provider’s five year revalidation cycle. Failure to submit a completed CMS 855A along with supporting information within the 60 days may result in your Medicare billing privileges being revoked. 

Medicare Physician Fee Schedule


Effective January 1, 2010 the Medicare physician fee schedule was to be reduced by 21%. Congress had delayed that reduction until February 28, 2010 and has now extended it until March 31, 2010. The previous Medicare Part B fee screens we issued are effective until March 31, until Congress makes some type of decision regarding the Medicare physician fee schedule. Please keep in mind this is a temporary fix until March 31, 2010. 

Medicare Part B Therapy Cap Exception Process


The exception process was set to expire on December 31, 2009. It has been extended through March 31, 2010. If you have been holding your claims, you may now submit claims with January 1, 2010 to March 31, 2010 dates of service with the KX modifier to receive reimbursement from Medicare for these services. If you submitted claims and they were denied for being over the therapy cap limit, please contact your Medicare contractor to request the claim be adjusted to include the KX modifier if appropriate under the exception process. Please keep in mind this is a temporary fix until March 31, 2010.

The 2010 therapy cap amount is $1,860 for physical therapy and speech therapy combined. For occupational therapy the limit is $1,860.

Given that the limits may not be extended past March 31, it will be important for you to track the amount of therapy being delivered for each resident. In addition, make sure you are checking online how much therapy they have used prior to being admitted into your building.

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