The ISMS Division of Health Policy Research and Advocacy assists members by decoding the myriad rules and regulations that apply to the medical profession.
Our Issue Briefs, published here and available for print out, is for members only and aims to equip physicians with practical information and resources to help them run their practices.
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Physician Quality Reporting System
Failure to successfully report or failure to report at all during 2013 reporting periods will mean not only a loss of the potential 0.05% incentive bonus for reporting Physician Quality Reporting System (PQRS) data in the 2013 reporting periods, it could also mean the imposition of a 1.5% reduction in the Medicare-allowable physician fee schedule payments beginning in 2015. The fee reduction goes up to 2.0% in subsequent years for non-reporters of quality data. If you are a non-participating physician, your Medicare Part B fee for service is already reduced by 5% pursuant to federal law. Thus, failure to report quality data going forward may have significant impact on reimbursements for services you provide your patients. HTML | PDF
Home Healthcare and Durable Medical Equipment
Prosthetic and Orthotic Suppliers
Discerning the Legitimacy of Requests and Understanding Order Completion Requirements
The Illinois State Medical Society routinely receives inquiries from physicians on the requirements for completion of orders from home healthcare and durable medical equipment prosthetic and orthotic suppliers (DMEPOS). To understand what’s required of physicians, one must be familiar with the regulations pertinent to the requests, the agencies responsible for vetting the suppliers, and limitations placed on physicians via the Health Insurance Portability & Accountability Act (HIPAA). Armed with this knowledge, physicians will be able to better assess the legitimacy of the requests. HTML | PDF
Medicare Quality Reporting
This paper will summarize the recent history of Medicare quality reporting initiatives and explain the imminent impact on reimbursement for physician practices that choose to be successful reporters of quality measures for the applicable services they provide to Medicare beneficiaries. It will also address the impact on physician practices that choose not to report. HTML | PDF
A Guide for Physician Interaction with Recovery Audit Contractors
Up until now, Recovery Audit Contractor (RAC) issues have largely focused on inpatient hospital billing issues. However, the RAC for Illinois has begun to creep into issues that directly impact physicians. Anyone who submits even a single claim to a Medicare fee-for-service program is subject to claim review, audit and now RAC review. Therefore, ISMS has prepared this guide to help members. HTML | PDF
Implementing the ICD-10-CM Diagnosis Code Data Set
On Oct. 1, 2013, physicians and their practices will be required to use the ICD-10-CM diagnosis code data set. The new data set was adopted by the Centers for Medicare & Medicaid Services (CMS) and complements initiatives of the American Recovery & Reinvestment Act of 2009. Adoption of ICD-10-CM is mandatory. HTML | PDF
Is Your Practice Ready for HIPAA 5010?
It is suggested that practices perform a phased-in approach to HIPAA 5010 compliance culminating with the adoption of the ICD-10 diagnosis code data set. Level II (external) testing should take place in 2011, as mandated use of X12 Version 5010 begins Jan. 1, 2012. HTML | PDF
Prevent Claims Rejections for Referred Services – Update PECOS Enrollment Records
The Centers for Medicare and Medicaid Services (CMS) published in the May 5, 2010, Federal Register its mandate that all ordering/referring providers of services for Medicare beneficiaries have current enrollment records in the Provider Enrollment Chain and Ownership System (PECOS). HTML | PDF
BONUS guide, for ISMS members only
Provider Enrollment: From Start to Not So Finished – Resource for ISMS members who use either internet-based PECOS or paper-based Medicare enrollment methods. Provides general overview of processes involved with provider enrollment and periodic maintenance of the enrollment record.
Medicaid Claims Database and the Primary Care Case Management Program
In April 2010 the ISMS House of Delegates adopted Substitute Resolution 32 (A-10), directing ISMS to educate members about the availability of the Medicaid Claims History Database, how it can be accessed and how it may be of help to physicians treating Medicaid patients. HTML | PDF
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