The demand for both primary and specialty care physicians will exceed the number of such physicians available to meet those needs by 2025, according to a new Health Affairs study.

The Centers for Medicare & Medicaid Services (CMS) has posted feedback reports for providers who submitted Physician Quality Reporting System (PQRS) data for dates of service between Jan. 1 – Dec 31, 2012.

CMS is continuing to assess the impact of the government shutdown on 2014 Medicare fee for service payment regulations. CMS has announced that it will publish the calendar year 2014 Outpatient Prospective Payment System (OPPS) and Medicare Physician Fee Schedule (MPFS) on or before November 27, 2013. 

On October 1, 2014 providers are required to transition from ICD-9 to ICD-10 coding. While this deadline has been extended numerous times over the past few years, the Department of Health and Human Services (HHS) is adamant that the 2014 date is final. 

The AASM was recently notified that UnitedHealthcare (United) has dropped a number of physician providers from its Medicare Advantage plans.  United notified physicians of this change by letter. Contract termination is effective in early 2014.

Continuous positive airway pressure (CPAP) and bilevel positive airway pressure (BiPAP) supplies had an improper payment rate of 56 percent and a projected improper payment amount of approximately $356 million during the 2012 report period, according to the Medicare Fee-for-Service (FFS) 2012 Improper Payments Report. Most of the improper payments were due to insufficient documentation to support the medical necessity of the devices. The AASM continues to advocate for a Stark Law exception that will bring continuity of care to Medicare by allowing board certified sleep medicine physicians to provide PAP therapy for Medicare patients with OSA.

Earlier this month the Office of Inspector General (OIG) released its report on Questionable Billing for Polysomnography Services, finding that Medicare made $16.8 million in inappropriate payments for polysomnography services in 2011. About $16 million of these payments were related to claims with inappropriate diagnosis codes. CMS plans to investigate and attempt to recover the payments that did not meet Medicare requirements.

On October 1, the AASM hosted a live webinar with PQRSwizard staff to educate members about the importance of 2013 reporting and the ease if reporting using the PQRSwizard. 

In response to provisions of the Affordable Care Act (ACA), the Centers for Medicare & Medicaid Services (CMS) intends to apply a 1 percent Value- Based Modifier (VBM) penalty to the Medicare payments of physicians in groups of 100 or more that did not engage in group participation in the Physician Quality Reporting System (PQRS) in 2013. To avoid these penalties, physicians in groups of 100 or more should ensure that their group is registered for one of the PQRS group participation options by Oct. 15.