A few tidbits of information were released over the past week that affect providers. Below is a summary of these important updates:

PECOS – Originally, the deadline for performing and ordering physicians to have their provider enrollment information updated in the PECOS system was January 3rd, 2011. This past Wednesday, CMS released an interim final rule that moves this date up to July 6, 2010. From the date of this writing, this now gives providers 60 days to complete re-validation in the PECOS system.

One thing to keep in mind is that this affects all providers. If a physician performs services or furnishes items that were either ordered or referred by a provider who is not updated in the PECOS system, the performing physician possibly faces claims denials for services rendered.

UHC Class Action Lawsuit – If you are a provider who has billed a United Healthcare insurance product in the past 8 years, chances are you or your billing entity received a mailing in the past ten days informing you of an impending settlement of a class action lawsuit brought against UHC.

The suit was originally filed by the American Medical Association and was in relation to UHC’s and their subsidiaries’ method of paying benefits for out-of-network claims from a period beginning on January 1, 2002 and ending on May 18, 2010. If you as a provider furnished out-of-network services for a UHC or allied insurance after this date, you may qualify for a portion of the negotiated settlement amount, currently listed as $350 million.

If you fall into the above category, you now have until October 5, 2010 to file a claim for payment from the settlement fund. If you yourself have not received a mailing from UHC, the AMA has set up a resource link on their website.

Pay Fix Update – And what would a weekly industry roundup be without yet another update in the continuing soap opera that is the delayed fix to the physician fee schedule?

The latest deadline for the implementation of the 21.3% cut to physician fees is now May 31st, but given the painful lessons we have learned about the American legislative process throughout the Winter and early Spring, the actual deadline date to look at is June 14, 2010. CMS has shown their willingness to delay claims processing for the full limit allowed by law of ten working days after any deadline in order to give Congress more time to work on the problem. So far, the Congressional solutions brought forward have been akin to fixing a traumatic amputation with packed mud and a loosely fastened oily rag. I can only imagine which suddenly cost-conscious senator will get on his or her soapbox this time out and complain about costs. 

Adding to the debate on a permanent pay fix was a Congressional Budget Office report of costs associated with the fee schedule being kept in its current form through 2020. CBO estimates a cost of $275 billion for that time period if no adjustments are made to the fee schedule. It remains to be seen how this report will be spun by both sides in the upcoming debate.

National media interest in a permanent pay fix was beginning to increase before the cataclysmic events in the Gulf of Mexico changed the Beltway focus from health care policy to energy policy. With the impending Memorial Day holiday, I fully expect this topic to be handled in the needlessly sloppy and emergent way that it has been addressed in the recent past.

10:35 am, May 7th, 2010 |