Medicare Updates
Providers are often faced with uncertainty when it comes to keeping up with changes in Medicare policy. It is our goal to provide you with timely information that will help you keep abreast of changes in policy that affect your practice. For more detailed information, visit the CMS Physician Center
- Click here to read the CMS Final Rule Summary of the 2008 Medicare Physician Payment Schedule
- Click here for Medicare participation options for physicians
- Click here to access the AMA Medicare Physician Payment Action Toolkit
- Click here to view Medicare payment cuts for physician services by state
- Click here to view Medicare payment updates for physicians -vs- other providers and also to view the negative impacts these cuts will have on South Dakota physicians
- Click here to view the Medicare Equity and Accessibility Act of 2007 and to view how South Dakota stacks up against the national averages for reimbursement
Recently, several bills have been introduced in Congress to "fix" the current Medicare dilemma:
- Click here to read S 2786, the Medicare Rural Health Access Improvement Act of 2008 (MRHAIA), introduced by Sen. Grassley, from Iowa.
- Click here to read a summary of the MRHAIA
- Click here to read S 2785, the Save Medicare Act, a bill proposed by Senator Debbie Stabenow (D-Michigan) that provides an 18-month fix to the SGR. Senators Johnson and Thune from South Dakota have agreed to co-sponsor this bill.
- Click here to read HR 4736, balance-billing legislation.
Tamper-Proof Prescription Pad Information
- Click here to read the latest details on Tamper-Resistant Rx Pads
- Click here to read a letter sent on February 12, 2008, to all Medicaid clinics and providers regarding two federal mandates that will take effect on April 1, 2008. The letter contains important information on tamper-resistant prescriptions for Medicaid recipients.
- Click here for a list of important bullet points regarding this issue
Recently passed legislation is making it mandatory for physicians to use tamper-resistant precription pads for all handwritten Medicaid prescriptions as of October 1. However, thanks to a successful, collaborative effort among organizations (including SDSMA) with an interest in the continuity of medication therapy for Medicaid patients, a letter was sent to Mike Leavitt, secretary of the U.S. Department of Health and Human Services, addressing the need for a 6-12 month extension of the October 1 deadline. Click here to read the letter. A Congressional support letter (signed by 78 Congressional representatives) was also drafted addressing the early implementation date and sent to CMS Director Dennis Smith. Click here to read the letter.
The CMS recently released a letter detailing guidelines and exemptions to the tamper-proof prescription pad requirement. Click here to view the guidance letter.
It was recently decided in South Dakota that tamper-resistant gel pens meet the compliance criteria, and the Department of Social Services (DSS) is sending a letter to physicians and providers informing them of the new mandate and their guidance to use gel pens for writing Medicaid prescriptions. Click here to read the letter.
On Saturday, September 29, President Bush signed House Resolution 3668 that provides for an exstension of the implementation date of the temper-proof requirements. The extension provides for a new implementation date of April 1, 2008. Click here to read more.
Health Information Technology
The AMA provides information that clearly explains the world of health information technology, including the benefits, risks, challenages and costs to physicians should consider when making decisions about these new tools.
Medicaid Updates
In February 2008, a letter from the DSS was sent to all Medicaid providers and clinics regarding two federal mandates on prescription drugs that will take effect on April 1, 2008.
- Click here to view the letter, which also includes important information on tamper-resistant prescriptions for Medicaid Recipients
National Provider Identifier (NPI)
The NPI is a Health Insurance Portability and Accountability (HIPAA) requirement; therefore, physicians who transmit claims and other HIPAA transactions electronically, will be required to use an NPI starting May 23, 2007. Click here for more information on NPI.
The SDSMA is alerting physicians that Medicare must be able to match a physician's appropriate PIN to his or her correct National Provider Identifier (NPI) and may reject claims if a match cannot be made. Click here for more information.
Physician Assistant Scope of Practice (Revised 9/11/2007)
A workgroup has been appointed by the South Dakota Board of Medical and Osteopathic Examiners (SDBMOE) to draft rules to implement the scope of practice law for physician assistants that was passed by the 2007 State Legislature. Click here for more information on the new statute.
Physician Quality Reporting Initiative (PQRI)
On December 20, 2006 the President signed the Tax Relief and Health Care Act of 2006 (TRHCA). Section 101 under Title I authorizes the establishment of a physician quality reporting system by CMS. CMS has titled the statutory program the Physician Quality Reporting Initiative (PQRI). PQRI establishes a financial incentive for eligible professionals to participate in a voluntary quality reporting program. Click here for more information and resources for PQRI.
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