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HPSA overpayment recovery error

The Centers for Medicare & Medicaid Services (CMS) is directing Medicare carriers and FIs to return any bonus payment to psychiatrists in mental health HPSAs that were incorrectly recovered in any overpayment actions taken since implementation of the HPSA mental health bonus payment on July 1, 2004, and to make bonus payment for those services that were initially withheld.

CAUTION – What You Need to Know

A Medicare bonus payment is payable for all professional services provided as authorized by license by psychiatrists in a mental health HPSA.

GO – What You Need to Do

Affected psychiatrists and CAHs should be aware of this action to be sure they receive correct payments for furnishing services to Medicare patients in mental health HPSAs.

Background

Federal law for Medicare bonus payments recognizes geographic-based, primary medical care and mental health HPSAs as eligible areas for receiving bonus payments. Consequently, physicians, including psychiatrists, furnishing services in primary medical care HPSAs are eligible to receive bonus payments.

Psychiatrists furnishing services in mental health HPSAs are eligible to receive bonus payments for all professional services they provide in mental health HPSAs.

Effective July 1, 2004, carriers and FIs began making HPSA bonus payments to psychiatrists furnishing services in mental health HPSAs. Some carriers and FIs may have interpreted Medicare’s instructions in such a way that they limited bonus payments in the mental health HPSAs to services they determined were mental health services and may have initiated overpayment recovery actions for bonuses they determined to be paid incorrectly. CMS has determined that these actions are incorrect.

CR 3736 clarifies the language in the Medicare Claims Processing Manual (Pub. 100-04), Chapter 12, Section 90.4.5c to indicate that the bonus is payable for all professional services provided by psychiatrists in a mental health HPSA that they are licensed to provide. It also instructs carriers and FIs to review any overpayment actions taken on mental health HPSAs, cancel any overpayment recovery actions that have been initiated and are in process, and return any overpayments already collected.

Additional Information

These bonus payments were also addressed in Medlearn Matters articles MM3108 and MM3336. To view the details on the payments, you may retrieve these articles, respectively, at:

http://www.cms.hhs.gov/medlearn/matters/mmarticles/2004/MM3108.pdf

and

http://www.cms.hhs.gov/medlearn/matters/mmarticles/2004/MM3336.pdf

The official instruction issued to your carrier/intermediary regarding this change may be found at:

http://www.cms.hhs.gov/manuals/transmittals/comm_date_dsc.asp

From that web page, look for CR 3736 in the CR NUM column on the right, and then click on the file for that CR. If you have questions regarding this issue, contact your carrier/intermediary on their toll free number, which is available at:

http://www.cms.hhs.gov/medlearn/tollnums.asp

Tsunami Relief Effort
FMA President's Report - January 3, 2005

President’s Report

Dennis S. Agliano, M.D.

January 3, 2005

Information on Tsunami Relief Efforts

We are very saddened by the devastating tsunami catastrophe during the holidays. This event has truly shattered the lives of thousands in South Asia. As of today, the death toll across 12 nations has reached over 137,000, and the International Red Cross has warned that the toll could eventually surpass 150,000. Health officials predict that an outbreak of diseases, from cholera to dysentery, could bring another wave of fatalities. Already, reports of measles and diarrhea have emerged in Sri Lanka.

FMA EVP/CEO Sandra Mortham on the FMA’s behalf contacted Dr. Yank Coble with the World Medical Association to determine how best to assist with the relief efforts. She also contacted Governor Jeb Bush prior to his aid mission to Sri Lanka. After these discussions, Dr. Coble forwarded some information obtained through the American Public Health Association regarding where to send contributions and how best to assist the survivors.

Here are some of the local and national organizations accepting donations to help victims of the South Asian tsunami. Most groups recommend that people donate cash rather than supplies. The FMA does not endorse any particular organization, and recommends that you evaluate any donation given. Consumer guidelines for giving can be found on the Web site for the U.S. Federal Trade Commission at www.ftc.gov/bcp/conline/pubs/tmarkg/charity.htm.

n American Red Cross – Donations can be made online by going to http://www.redcross.org and following the instructions on the home page. Donations can also be sent to the International Response Fund, P.O. Box 37243, Washington, D.C. 20013. For more information about donating, please call 800-435-7669. For information about friends or relatives who may have been victims, call 866-438-4636.

n CARE USA – Donations may be made online at https://donate.care.org/05/20130000/?source=170570020000. Contributions may also be made by phone at 800-422-7385 or 800-521-CARE. You may also e-mail info@care.org for more information about donating.

n UNICEF USA – Donations may be made online at www.unicefusa.org. Checks and money orders made payable to the U.S. Fund for UNICEF may be mailed to unicefusa.org, 333 East 38^th Street, New York, NY 10016.

n World Vision – Donations may be made online at www.worldvision.org. Monetary contributions will be used to provide food and family survival kits to Asian countries. Each kit provides things like blankets, tarps for temporary shelter, water purification tablets and cooking supplies.

n United Nations World Food Programme – Donations may be made online at www.wfp.org. Contributions may be mailed to U.S. Friends of the WFP, P.O. Box 11856, Washington, D.C. 20008. Donations by U.S. taxpayers are tax-deductible.

n Oxfam America – Donations may be made online at https://secure.ga3.org/02/asia_earthquake04. Checks payable to Oxfam America may be mailed to Oxfam America, Asia Earthquake Fund, P.O. Box 211, Albert Lea, MN 56007-1211.

n Asia Relief – The Maryland-based nonprofit organization is accepting donations of cash, nonperishable food, clothing and toys for victims in Sri Lanka. Donations should be dropped off or mailed to Asia Relief, 19409 Olive Tree Way, Gaithersburg, MD 20879. Please contact Rizwan Mowlana at 301-672-9355 for more information.

n Association for India’s Development Inc.—The Maryland-based nonprofit organization is accepting cash donations to help relief work in India. Contributions can be made on the Web at www.aidindia.org or mailed to AID Zone 3, P.O. Box 4801, Mountain View, CA 94040-0801, with checks made payable to AID. Contact Priya Ranjan at 301-422-4441 for more information.

n Tsunami Relief Inc. – The Virginia-based nonprofit group has been set up to help victims in Sri Lanka. Donors can call 703-934-6922 or mail checks payable to Tsunami Relief Inc. to 9302 Lee Hwy., Fifth Floor, Fairfax, VA 22031.

n Direct Relief International – Donations can be made online at www.directrelief.org or by phone at 805-964-4767. Checks and money orders may be mailed to Direct Relief International, 27 S. La Patera Lane, Santa Barbara, Calif. 93117.

n B’nai B’rith International – Donations can be made online at www.bnaibrith.org or mailed to B’nai B’rith Disaster Relief Fund, 2020 K St. NW, Seventh Floor, Washington, D.C. 20006.

n Mercy Corps – Donations can be made online at www.mercycorps.org or by phone at 800-852-2100. Donations may also be mailed to Mercy Corps, Dept. W, P.O. Box 2669, Portland, OR 97208.

n Operation USA – The Los Angeles-based international relief agency is accepting donations online at www.opusa.org or by phone at 800-678-7255. Donations may also be mailed to Operation USA, 8320 Melrose Ave., Suite 200, Los Angeles, CA 90069.

n Doctors Without Borders/Medecins Sans Frontieres (MSF) – Donations can be made online at www.doctorswithoutborders.org or contributions can be made by phone at 888-392-0392. MSF is airlifting more than 60 tons of medical, surgical, and water-and-sanitation equipment to Sri Lanka and Indonesia.

More information about donations to humanitarian organizations can be found on the U.S. Agency for International Development’s Web site, www.usaid.gov.

Donors can also call the Center for International Disaster Information at 703-276-1914.

Opting Out of Medicare

Introduction

Since January 1, 1998, physicians have been permitted to opt out of Medicare and enter into private contracts with Medicare beneficiaries that allow them to set their own fees. A physician who opts out of Medicare agrees not to see any Medicare patients (barring emergencies or urgent services), except for those with whom she has entered into private contracts, for a period of two years.

This means that if you work in a situation where you must see Medicare patients as a part of your employment, you cannot opt out of Medicare. It also means that if there is any possibility that your life will change in the next two years, and you may have to see Medicare patients as part of new managed care contracts or new employment, you also should not consider opting out of Medicare.

The rules for opting out are very specific. In order to opt out you must file an opt-out affidavit with your Medicare Carrier, or Medicare Carriers (if you work in more than one Carrier jurisdiction). Opt Out Affidavit document *PDF A template for this affidavit that conforms to Medicare rules follows. A private contracting template also follows, which you can use for entering into private contracts with your Medicare patients once you have opted out. Private Contracting document *PDF These contracts must be kept on file in your office, available to be sent to the Carrier or to the Centers for Medicare and Medicaid Services (CMS), which oversees the Carriers, should they be requested. New affidavits and private contracts must be completed every two years.

NOTICE AND DISCLAIMER: Opting-out has serious implications for your status, rights, and responsibilities as a Medicare provider. This summary and the attached sample affidavit and private contract template are based on sources believed to be reliable. The information contained herein doesn't constitute legal advice nor should it be relied on exclusively. The APA assumes no responsibility for any physician's decision to opt out or reliance on the sample agreements that follow. If you have any questions concerning these materials or opting out in general, please call the Managed Care Help Line (800-343-4671).

Who May Opt Out & When

Non-participating physicians may opt out of Medicare at any time. Their two-year opt-out period begins the date the affidavit is signed, provided it is filed with the Carrier within ten-days after the physician signs his first private contract with a Medicare beneficiary.

Participating physicians must file their affidavits with their Medicare Carrier(s) at least thirty days before the first date of the next calendar quarter, with the affidavit showing an effective date of the first day of that quarter (i.e., 1/1, 4/1, 7/1, 10/1).

Physicians who have never enrolled in Medicare, but want to be able to treat Medicare patients under private contracts, must also file an affidavit with the Carrier that serves their area. The Carrier will provide these physicians with a UPIN (Unique Physician Identification Number), based on the physician tax identification number that must be entered on the affidavit, and maintain their affidavit on file.

Essential Things to Know About Opting Out

	The first time you opt out of Medicare, there is a ninety-day grace period during which you can change your mind about opting out. You just have to notify the Carriers you filed an opt-out affidavit with and refund any money you received from patients with whom you had private contracts that called for fees exceeding the Medicare-approved charges.
	Once you opt out of Medicare, you cannot see any patients under Medicare during the two-year period you have opted out for.
	If you have been seeing Medicare patients, once you have opted out, they will only be able to continue seeing you under a private contract. This means any payments from them to you will be out of pocket. Not only will Medicare not reimburse for your services, neither will any supplemental Medigap policies your patients have.
	If you mistakenly file a claim with Medicare during your opt-out period, or your patient does, and you are contacted by the Carrier with a request for an explanation, you must be certain to respond within the time period allotted. Otherwise, your opt-out status will be rescinded, and you will no longer be able to do private contracting. If this happens, you will once again be tied to the laws of Medicare, but Medicare will not pay for any of your claims that occur during your original opt-out period.
	Patients who reach Medicare age but are still employed and covered by their employers' insurance can choose not to enroll in Medicare Part B and will then not be Medicare beneficiaries for the purpose of their treatment by physicians.
	If a Medicare-eligible patient is covered under her employer’s insurance, but chooses to enroll in Medicare Part B so that Medicare will serve as the secondary payer, you must still have an opt out contract with this patient or you will be bound to the Medicare-allowed fees (even though Medicare is not the primary payer).
	A new affidavit must be filed within thirty days of the date your old affidavit expires if you wish to maintain your opt-out status. New private contracts also need to be signed every two years.
	When a Medicare beneficiary signs a private contract with one physician, it does not mean Medicare will not cover medical services provided to the same beneficiary by others who have not opted out. This means that if an opted out physician refers a patient to a lab to have blood work done, or to another specialist who has not opted out of Medicare, the services the patient receives as a result of the referral will be covered by Medicare (if they are services that Medicare ordinarily covers).

For copies of the Medicate Opt-Out Affidavit and the Medicare Private Contract visit the APA Website http://www.psych.org/members/practpsych/optingoutofmedicare112701.cfm

Medicare Physician Fee Schedule Alert
The 2005 Medicare physician fee schedule (MPFS) was posted to the Medicare provider education Web site on Nov. 18, 2004. On that day, the Centers for Medicare & Medicaid Services (CMS) provided Medicare carriers with a revised 2005 MPFS, which was posted as a revision to the provider education area of the Web site. On Nov. 22, 2004, CMS notified the Medicare carriers that the fee amounts provided on the original 2005 MPFS were correct. If you downloaded the 2005 Medicare physician fee schedule between the time period of 1:00 p.m. Nov. 18, 2004, to 1:00 p.m. Nov. 19, 2004, you need to download the file again to obtain the correct 2005 fee schedule amounts. You can do so by accessing the Medicare provider education website for the corrected fees at www.floridamedicare.com. The CD-ROM that First Coast Service Option, Inc. sent to qualified providers last week contains the correct fees. On behalf of CMS, FCSO apologizes for the inconvenience this may have caused.

Revised Florida Death Certificate Information for Physicians
Dear Local Registrars:

As discussed on the August 9, 2004 Directors Conference call, Vital Statistics will be implementing a new Florida revised death certificate in January 2005.

The State Office of Vital Statistics would also like you to know that we assembled workgroups with representatives from Florida funeral director associations, the Medical Examiner Commission, Board of Funeral Directors, Florida Medical Association, & Florida Hospital Association. Presentations were made to their annual conferences. Associations have agreed to run articles on the revision of the form in their fall publications. All of this has been done with the intent of keeping our partners in death registration informed of the changes that were coming.

We would like some assistance from our Local Registrars, especially those who are members of their local or regional medical societies. A brochure for physicians, outlining some of the changes on the record, has been developed & will be mailed to physicians throughout Florida in early November. The Florida Hospital Association has agreed to run an article in the October issue of their publication as well as to include information in their bi-weekly newsletters later in the fall. If there is any way you can assist with getting the word to physicians within your community about this important news, we would greatly appreciate it. If you can think of any other way to reach this audience, please let us know. It is important that all the players in the death registration process be up to date & informed in order to make a smooth transition from the old to the new.

The following is a brief listing of some of the changes on the revised FLorida Death Certificate:

New Items

¡ Informant’s Relationship to Decedent

¡ License Number of Certifier

¡ Did Tobacco Use Contribute to Death?

¡ If Transportation Injury

Modified Items

¡ Place of Death

¡ Marital Status

¡ Method of Disposition

¡ Certifier Information

¡ Probable manner of death

¡ Time of death and time of injury

Disposition

If you have any questions or suggestions, please contact Sharon Dover at (904) 359-6900, extension 1021.

Thank you for your continued support.

Ken Jones
Deputy State Registrar
Department of Health
Office of Vital Statistics
Post Office Box 210
Jacksonville, Florida 32231

(904) 359-6982
Suncom 826-6982
ken_jones@doh.state.fl.us
Visit our website at http://www.doh.state.fl.us

Mission: To promote and protect the health and safety of all people in Florida through the delivery of quality public health services and promotion of care standards.

St. Johns County Chapter Call-out
A meeting was held in Saint Augustine at 6PM on Wednesday 13 October 2004 for the FPS members interested in forming a St. Johns County Chapter. The meeting was sponsored by GlaxoSmithKline at a restaurant in St. Augustine.

For more information contact:
Eneida Gomez, MD
Child and Adolescent Psychiatrist
Medical Director
Saint Johns County Mental Health Dept.
1955 US-1 South, Suite C-2
St. Augustine, FL 32086

Tel. 904-825-6850 Ext. 240
Fax 904-825-6824
Email egomez@co.st-johns.fl.us

Update of Directory of Psychiatrists Who Work in Schools
An updated APA Directory of Psychiatrists Who Work in Schools is in process and soon will be available on the APA website (Public Info>Families & Children>Schools). This directory will list more than 350 psychiatrists who work with schools. The purpose of the directory is to continue to facilitate networking between these psychiatrists and to serve as a resource for schools interested in exploring consultation arrangements.

If you want to be listed in this directory, please notify Jane Edgerton in the Office of Children's Affairs (jedgerton@psych.org) of your interest. If she has been in touch with you already, your name and address will appear in the 2005 edition of the APA Directory of Psychiatrists Who Work in Schools. At this time, telephone numbers and e-mail addresses will not be included because this directory will be on a publicly available website.

Information on Tsunami Relief Efforts

Phillip W. Cushman, M.D., JAPCO.net, Webmaster Copyright © 1997-2008 [Florida Psychiatric Society]. All rights reserved. Last modified: Wednesday, April 09, 2008

Phillip W. Cushman, M.D., JAPCO.net, Webmaster
Copyright © 1997-2008 [Florida Psychiatric Society]. All rights reserved.
Last modified: Wednesday, April 09, 2008