As part of the settlement, the Blue Cross Blue Shield Settling Parties have agreed to make a settlement payment of $131,209,507 which, together with accrued interest from June 30, 2007, will be distributed to physicians who file a claim form in a timely manner and are Class Members (i.e., physician, physician group, or physician organization who provided covered services to any individual enrolled in or covered by BCBS plans at any time between May 22, 1999 and May 31, 2007). If you have not received your mailed notice, please visit www.hmosettlements.com to download the mailed notice, as well as the claim form and instructions. Be sure to submit a completed claim form by October 19, 2007. One form can be prepared for an entire practice, however, a list of every physician and the number of shares each physician is entitled to should be attached. Questions about the settlement may be addressed to the Settlement Administrator through email submissions at www.hmosettlements.com  or by telephone at 877.893.2643. You may also obtain information regarding this and other settlements at www.ama-assn.org/go/settlements.

2008 Renewal Fee
Great news!  Effective January 2008, the physician license renewal fee has been reduced to $360 (plus the unlicensed activity fee and the background check fee).  The FMA was instrumental in ensuring that this reduction became a reality. Be on the lookout for the renewal notices, which will be sent on October 4, 2007 for those licenses expiring on January 31, 2008.

Important Information For Medicare Providers
Starting September 3, 2007, Medicare Carriers will begin transitioning their systems to reject claims when the NPI and Legacy Provider Identifier cannot be found on the Medicare Crosswalk. Between September 3, 2007 and October 29, 2007, all Part B carriers will begin to turn on edits to validate the NPI/Legacy pairs submitted on claims. If the pair is not found on the Medicare NPI crosswalk, the claim will reject. Contractors have been instructed to inform providers a minimum of 7 days prior to turning on the edits to validate the NPI/Legacy pairs against the Crosswalk. If you are receiving informational edits today, Medicare strongly urges you to validate that the NPPES has ALL of the NPI and legacy numbers you intend to use on claims and for billing purposes. If NPPES is correct, and you continue to receive information edits, you should ask your contractor to validate the provider information in their system. If the contractor information is not correct, you may be instructed to submit an enrollment form or CMS-855. Please include ALL of your NPI/Legacy numbers in NPPES AND all of your NPIs that are to be used in place of your legacy on the CMS-855. If the information is different in the two systems, there is a good chance your claim will reject. NPPES data may be verified at https://nppes.cms.hhs.gov.

Medicare Efforts To Minimize Rejections And Suspensions
CMS CR5649, Transmittal number 1262 dated June 8, 2007, instructed Medicare Contractors to identify providers with the highest volume of rejections (or potential rejections/informational edits) due to invalid NPI information. They were also instructed to identify providers who are not submitting their NPI. Contractors have begun calling providers that fit these categories. If you are contacted, you may be asked to validate your NPPES information or confirm that the information in the Contractor's Provider file is correct. If you are not submitting your NPI at this time, your Contractor will ask: why you are not submitting it, the date you plan to submit it, and will ask you to send a small batch of claims using your NPI only if possible. Additionally, all Medicare providers could receive phone calls and/or letters from their contractors in the event that a claim suspends due to problems with mapping a provider's NPI to a legacy provider identifier. This could happen in the instance where one NPI is tied to several legacy identifiers. If it is determined that the claim suspended due to incorrect data in the Contractors provider file or NPPES, the provider will be requested to either update their information in NPPES and/or submit an updated CMS-855 form. If the provider does not respond within 14 calendar days to this communication, the Contractor will return the claim as unprocessable. Conversely, if the provider does respond, it may furnish the Legacy number over the phone; however, the Contractor will ensure that it is in compliance with the Medicare Program Integrity Manual (Publication 100-08), chapter 10, section 17.2 regarding the release of information.

National Plan And Provider Enumeration System (NPPES) FOIA-Disclosable Data
National Plan and Provider Enumeration System (NPPES) FOIA-Disclosable Data to be Available on September 4, 2007--NPPES health care provider data that are disclosable under the Freedom of Information Act (FOIA) will be disclosed to the public by the Centers for Medicare & Medicaid Services (CMS). In accordance with the e-FOIA Amendments, CMS will be disclosing these data via the Internet. Data will be available in two forms:
1. A query-only database, known as the NPI Registry.
2. A downloadable file.
CMS has extended the period of time in which enumerated health care providers can view their FOIA-disclosable NPPES data and make any edits they feel are necessary prior to our initial disclosure of the data. CMS will be making FOIA-disclosable NPPES health care provider data available beginning Tuesday, September 4, 2007. The NPI Registry will become operational on September 4 and the downloadable file will be ready approximately one week later. CMS has posted several documents to help providers understand what the downloadable file will look like, including a "Read Me" file, Header File, and Code Value document for the downloadable file on the CMS NPI web page at http://www.cms.hhs.gov/NationalProvIdentStand/06a_DataDissemination.asp.
 

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