Medicare Updates

New OTO-Tech and Audiology Billing Resources - (2/16/2012)
We received a number of questions regarding the requirements for billing audiology services. In response to these questions, the Academy has developed new resources clarifying CMS' coding and billing parameters for physicians, auxililary personnel, and audiologists performing audiology diagnostic tests and incedent to services.

FAQs on Audiology- Provides clarification and guidance for proper billing of audiologic services.

Clarifying Medicare Audiology Billing Services: Audiology and OTO-Techs- answers questions on audiology billing and what services OTO-techs can bill.

New Bundled Codes for Audiological Services - (01/05/2010)
There are three new codes for CPT 2010 that have bundled together several audiology tests. These new codes were created because the Centers for Medicare and Medicaid Services (CMS) discovered that these tests were frequently billed together in the Medicare population. As a result, CMS felt that they were paying multiple times for the pre- and post- work that was included in each of the CPT codes.  CMS requested that the American Medical Association (AMA) CPT Editorial Panel and the Relative Value Update Committee (RUC) create bundled codes to address the situation, and to recommend relative values for the new codes.

The Academy is Advocating for You! - (07/29/2010)
The Health Policy department is aware of the challenges that CMS’s elimination of the consultation codes poses to our members. As a result, apart from our comment letter to CMS opposing this change in the CY 2011 proposed rule for the Medicare Physician Fee Schedule (MPFS), the Academy joined the AMA and a coalition of other medical societies to disseminate a survey to obtain tangible data on the negative impact of the regulation. After our analysis of the survey results, we sent a letter to CMS and plan to address this issue in our comment letter to the agency on the proposed rule for the CY 2011 MPFS.  Highlights from the survey

FAQs on CMS’ Revisions to its Payment Policy for Consultation Services - (12/17/2009)
We created this document to clarify and address the Center for Medicare and Medicaid’s (CMS) decision to eliminate the use of all consultation codes (inpatient and office/outpatient codes for various places of service except for Telehealth consultation G-codes).

First Medicare Electronic Health Record (EHR) Incentive Payments Issued - (5/26/2011)
On May 20, CMS announced that it would begin sending out the first incentive payments (IP) for the Medicare EHR Incentive Program. If you have successfully attested to meeting meaningful use and have met all other program requirements, expect to receive your 2011 incentive payments soon. The maximum IP you can receive for your first participation year is $18,000. More

Attestation for the Medicare EHR Program Has Begun - (04/21/2011)
Attestation for the Medicare EHR Incentive Program began on April 18, 2011. To ensure you receive your incentive payment from Medicare, you must attest through CMS' web-based Medicare and Medicaid EHR Incentive Programs Registration and Attestation System.

Registration for the EHR Incentive Programs Begins on January 3, 2011 - (01/06/2011) 
Beginning January 3, 2011, registration will be available for eligible professionals who wish to participate in the Medicare EHR incentive program.  On January 3, registration in the Medicaid EHR Incentive Program will also be available in Alaska, Iowa, Kentucky, Louisiana, Oklahoma, Michigan, Mississippi, North Carolina, South Carolina, Tennessee, and Texas.  In February, registration will open in California, Missouri, and North Dakota.  Other states likely will launch their Medicaid EHR Incentive Programs during the spring and summer of 2011.

CMS Proposes New Exemption Categories under the Medicare E-Rx Program - (06/02/2011)
As a result of the advocacy of the Academy and several specialty societies, the Centers for Medicare and Medicaid Services (CMS), on May 26, issued a proposed rule, which if finalized will add new exemption categories for physicians to avoid the 2012 Medicare E-Rx penalty. If you fall under any of these new exemptions, you must attest as such through an on-line web portal by October 1, 2011. If you do not fall under any exemption categories, by June 30, 2011, you must still report on 10 unique electronic prescribing events (using the e-Rx measure G8553 on your Medicare claims) associated with office visits. More on the new exemption categories

Avoiding Penalties in the 2011 Electronic Prescribing (eRx) Incentive Program - (02/24/2011)
For calendar year 2012, eligible professionals who are not successful electronic prescribers based on their Medicare Part B claims submitted between January 1, 2011 to June 30, 2011 may be subject to a -1% penalty. To find out whether the 2012 eRx penalty will not apply to you, please visit

Summary of Workshop on Accountable Care Organizations (ACOs)  - (11/2/2010) 
ACOs were mandated by Congress in the Patient Protection and Affordable Care Act (PPACA).  ACOs will be integrated delivery systems comprising of doctors, hospitals, and other providers whose reimbursement will partially be based on meeting certain quality and cost targets. The provision for ACOs under PPACA requires that they are started by January 1, 2012. On October 5, 2010, some federal agencies hosted a workshop to discuss processes they can adopt to reduce the probability of ACOs stifling competition, promoting innovation within ACOs, and ensuring that the current anti-trust, physician self-referral and civil monetary penalty laws don’t impede the ACOs from accomplishing their quality and cost saving goals.

CMS Issues Comparative Billing Reports on Advanced Diagnostic Imaging (3/1/2012)
On February 16th, the Centers for Medicare and Medicaid Services (CMS) issued Comparative Billing Reports explaining provider's billing and payment patterns compared to their peers. At this time, CBRs are not intended to be punitive or sent as an indication of fraud, but are intended as a proactive statement that will help providers identify errors in their billing practice.

For more informaiton on Comparative Billing Reports, see the Academy's Advanced Imaging webpage.

Advanced Imaging Accreditation
Providers who furnish the technical component (TC)  for advanced imaging services (MRI, PET, CT, and nuclear medicine imaging) must be accredited by January 1, 2012 by the:

• American College of Radiology (ACR)
• Intersocietal Accreditation Commission (IAC)
• The Joint Commission (TJC)

Learn more about the accreditation process

Academy Sends Comment Letter on ACR Appropriateness Criteria      (4/21/2011)
The Academy provided input on the American College of Radiology’s (ACR) Appropriateness Criteria. The ACR created these evidence based guidelines to assist referring physicians in making the most appropriate imaging or treatment decisions for specific medical conditions. We thank Gavin Setzen, MD, for leading this endeavor and also the Academy’s Imaging, Allergy, Asthma & Immunology, Equilibrium, Hearing, Pediatric Otolaryngology, Rhinology and Paranasal Sinus, and Skull Base Surgery committees.  

2011 MPFS Conversion Factor Update  - (01/13/2011)
On December 15, 2010, President Obama signed into law, “The Medicare and Medicaid Extenders Act of 2010.”   This law prevented the 25% cut to the Medicare Physician Fee Schedule (MPFS) that would have been effective from January 1, 2011. The conversion factor for 2011 is now $33.9764. The overall impact of the 2011 MPFS for otolaryngologists is +3% based on the mix of services provided.

New Time Guidelines for Filing Medicare Claims - (11/1/2010)
Under the Patient Protection and Affordable Care Act (PPACA), claims with dates of service October 1, 2009, through December 31, 2009, must be submitted by December 31, 2010. Providers will need to submit claims for services performed in the last three months of 2009 by December 31, 2010. For those services furnished on or after January 1, 2010 providers must submit the claims for these services before the end of one calendar year after the date of service. There are three exceptions to this provision: when a Medicare beneficiary becomes retroactively eligible for Medicare benefits but was not entitled when the service was performed initially, dual eligible Medicare/Medicaid patients and retroactive disenrollment from Medicare Advantage plans or PACE provider organizations.

Page Last Updated on February 14, 2012