[Provider] Payment Method for Hospital-Based Physicians

[Provider Notification]

ATTENTION: Hospitals that receive Prospective Interim Payments (PIPs)
from MaineCare 

 

The recently enacted State Supplemental Budget (for fiscal year ending
June 30, 2009), changes MaineCare's payment method for hospital-based
physicians.  Effective February 1, 2009 MaineCare will pay
hospital-based physicians a percentage of cost that equates to 70% of
the 2008 Medicare fee.  

 

Beginning July 1, the CMS1500 claim form will be required for
hospital-based physicians and other professionals.  A new CMS rule
requires this change.  These professionals (see list below) will need to
enroll as MaineCare Servicing/Rendering providers, and to bill for
services on the CMS1500 claim form.  

 

To accomplish these changes an emergency rule will be effective February
1, 2009.  A new rule will then be proposed to require the use of the CMS
1500 form effective July 1, 2009. 

 

Enrolling Servicing Providers 

 

Enrolling your Servicing Providers is a big project for you and your
staff, as it is for MaineCare.  MaineCare encourages you to get a head
start.  You can start enrolling Servicing Providers now and avoid
holding back claims or re-doing claims later.  (Note: This enrollment
will be for the current claims management system; enrollment for the new
system will occur later in 2009.)  

 

If you would like to start enrolling your professionals or have
questions, please contact Cheryl Rood at 287-5735.    

 

List of hospital-based professionals who will need to enroll as
MaineCare Servicing Providers 

*        All hospital-based physicians who are MDs or DOs, including
hospitalists, emergency department physicians, locum tenens physicians,
radiologists, pathologists, anesthesiologists, etc. 

*        psychiatrists 

*        advance practice registered nurses,

*        certified registered nurse anesthetists,

*        licensed certified midwives,   

*        physician assistants.

 

Implementation of the Payment Change 

 

To pay for physician services on a fee schedule, your hospital-based
professionals need to enroll as MaineCare Servicing Providers and bill
claims for those services on a CMS1500 form.  To allow time for these
changes to occur, an interim approach will be followed:

 

February 1, 2009 through June 30, 2009

 

During these five months, MaineCare's cost settlement will recognize a
percentage of costs for physician services.  Instead of using 100% of
allowable costs for inpatient and emergency department physician
services, MaineCare will recognize 78.51%.   For outpatient services,
the percentage will go from 89.7% to 70.42% of allowable costs.  These
percentages equate to reimbursing at 70% of Medicare rates.     

 

Your PIP will be adjusted for the change from cost-based to fee schedule
reimbursement for physician services. The settlement's handling of
claims paid from 1500 forms will not change.  

 

Starting July 1, 2009

 

MaineCare will reimburse claims at 70% of the 2008 Medicare rate.  Also,
all physician/professional charges must be billed on the CMS1500 forms.
These claims will be excluded from your cost settlement, the same way
1500 form claims are excluded now.  Your PIP may be adjusted again on
July 1, since more of your billing will come from 1500 form claims.    

 

Questions?

 

For questions about enrolling your Servicing Providers, please contact
Cheryl Rood at 287-5735. 

 

For questions about your PIPs, please contact Michael Ballard at
287-4254.  

 

For general questions about billing and rates, contact your Provider
Relations Specialist or MaineCare's Billing & Information line at
1-800-321-5557, Option 8.  

Is your mailing address up to date with MaineCare?  Please keep
MaineCare up to date so your Remittance Statements and checks arrive on
time.  Call Provider Enrollment at 1-800-321-5557 Option #6.  

 

If you would rather not get these e-mails, visit MaineCare's List Serve
Subscription
<http://www.maine.gov/dhhs/bms/member/innerthird/listserv.shtml>  page
to unsubscribe.

 

This is a one-way communication.  Do not reply to this e-mail.  Your
e-mail will not receive response.  If you have questions, please call
1-800-321-5557.  

 

 

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