Active Reduced Fee Licensees—Status Issue with CMS

The Centers for Medicare & Medicaid Service’s (CMS), Medicare Administrative Contractor (Highmark Medicare Services, now Novitas Solutions, Inc.) considers the “active reduced fee” license to be a retired or inactive status. This status is sometimes referred to in the state’s licensee database as “retired-paid.” Consequently, Novitas Solutions has taken the position that these licensees are no longer authorized to practice and to bill Medicare for services rendered. CMS/Novitas Solutions has sent Notices of Revocation of Medicare Billing Privileges to active reduced fee licensees. Any Medicare billing revocation may include serious consequences for the physician.

There is concern that the Federal Government is misinterpreting the special license status and has requested that the New Jersey Board of Medical Examiners clarify any ambiguity so that these physicians may continue to treat our seniors and submit claims to Medicare. We are also in discussions with Novitas Solutions about what we believe to be a misinterpretation of the license status.

Medicare patients who have come to rely on treatment from this group of semi-retired, but licensed, physicians may be facing access to and continuity of care issues.

Members in the “active reduced fee” category who have received any notice about their status or a “Notice of Revocation of Medicare Billing Privileges” are urged to email info@msnj.org. Write “Active Reduced Fee License Status” in the subject line.

CMS to Delay Enforcement of HIPAA Version 5010 Until July 1st

The Centers for Medicare & Medicaid Services (CMS) has announced an extension of the grace period through June.
Physicians, payers and other entities using electronic health care transactions were required to use only the version 5010 transactions beginning Jan. 1, but CMS issued a 90-day grace period that was to expire March 30. However, serious claims processing issues have caused payment delays and other issues for many physicians.
CMS announced March 15 that it will extend the grace period until July 1 to allow additional time to resolve these ongoing claims processing issues.
Physicians who continue to experience claims processing difficulties should complete a complaint form.

To find the complaint form - log onto www.BCMSNJ.org