JANUARY 2011

Dear FCACC Collegaues:

Happy New Year! I hope your holiday season was joyous and each of you had some time to reflect and relax. Over the break, news on several payment fronts was released. The realization that we have to be vocal and vigilant and have work to do in 2012 is very evident from these issues.

PREPAYMENT AUDITS In December we sent emails about the 100% pre-payment audits on all inpatient hospital stays relative to 11 cardiac-related DRGs by FirstCoast Service Options (FCSO) our Medicare carrier. Click here for a synopsis of our previous explanations which will effect you. We found out that FCSO has postponed implementing this program for 30 days. We have not learned the reason yet but this small amount of breathing room gives your FCACC advocacy team time to get more information, for each member to have a discussion about documenting medical need with hospitals and for us to push for a more reasonable approach. Ask your colleagues if they've heard about this audit and spread the word that we've had an impact but the audit will happen and everyone needs to be prepared. We continue to stress the following:

• Continue to take excellent care of your patients
• Document compulsively and completely. Use textual and narrative discussions as much as possible rather than lists of diagnoses. Be especially careful with EMR documentation. Be detailed on symptoms and review the noninvasive testing results which prompted any invasive procedure or device implant
• Consider putting your office notes into the hospital chart as this could be helpful
• Inform the hospitals where you have privileges. Partner with them on efforts to improve documentation, if necessary

SGR CUT AVERTED At the last moment Congress prevented the SGR cut of 29.5% that was to take place on January 1st, however, this is a temporary fix and will only last 60 days. This made the national headlines as Medicare payments will not be held in January as was announced by CMS in the face of uncertainty about an early January vote. This issue continues to haunt everyone in the medical field. Stay tuned because messages to contact your representatives will be coming again. For all of you who made those important phone calls, thank you.

MEDICARE REVALIDATING YOUR PROVIDER STATUS Under the new risk screening criteria required by the Affordable Care Act, Medicare contractors will be alerting providers enrolled in the Medicare program regarding revalidation of their enrollment, if enrolled before March 2011. The revalidation process has four steps. Upon notification, providers will need to: 1) update enrollment through the online Provider Enrollment, Chain and Ownership System (PECOS) or complete the 855; 2) sign the certification statement on the application; 3) pay any fees through pay.gov and 4) mail supporting documents and certification statement to their MAC. To help providers better understand and prepare for this process review the Medicare Learning Network’s fact sheet for more information.

Sincerely,

Juan Aranda, Jr., MD, FACC
President