Primary care providers will get additional revenue opportunities soon thanks to new Medicare coverage determinations for alcohol misuse and depression, CMS announced in a press release Oct. 14. Medicare will cover screening for alcohol misuse and behavioral counseling for those found to be misusing alcohol. Depression screening will be covered for primary care practices that have “staff resources to follow up” with treatments and referrals, the agency said.

Medicare has started adjusting claims for counseling to prevent tobacco use submitted between Jan. 1 and April 4, Trailblazer reports in its Oct. 12 notice.            

NOTE: The problem that caused claims to be incorrectly processed only affected Part A claims and was corrected in May and any claims held as a result were released.  

Which claims are affected: Any claims submitted during the first quarter of the year that included HCPCS code G0436 and/or G0437; revenue codes 0942, 096X, 097X or 098X; diagnosis codes 305.1 or V15.82; and where occurrence code 32 is not present were not processed correctly and will be automatically adjusted, CMS says.

Get ready for an influx of new Medicare beneficiaries as the Medicare Open Enrollment Period starts. This year, the period begins earlier on Oct. 15 and will last seven weeks, through Dec. 7. A major new wrinkle this year are CMS-published star ratings for Medicare Advantage (MA) plans. “This year CMS is highlighting plans that have achieved an overall quality rating of 5 stars with a high performer or ‘gold star’ icon so people with Medicare can easily find high quality plans,” the agency said in an Oct. 12 press release.

It’s official—CMS’s final rule on accountable care organizations (ACOs) has entered the final stages of approval and should be released very soon.

The much-anticipated rule was sent to the Office of Management and Budgeton Oct. 5 as one of the last legislative step before being released in the Federal Register. If history proves true, the rule should be released within a week of reaching the OMB as it was with the latest e-Prescribing final rule.

We report in the current issue of Part B News that you could get a revalidation notice from CMS this year, even for providers who already have recordsin the agency’s Provider Enrollment Chain Ownership System (PECOS).

Remember: CMS had previously said no providers with existing PECOS records would get revalidation notices until January 2012, when a big “wave” of notices would be sent out. The culprits are active provider transaction account numbers (PTANs), which cause the revalidations to be sent when they are on file with a Medicare contractor but not listed in a provider’s PECOS record, CMS has said. Now the agency has answered some questions about the PTAN and revalidation issue.