Washington - Medicare's fiscal caretakers warn that the already dismal view they have of the entitlement program's long-term financing is probably overly optimistic given that it relies in large part on reduced payments and increased efficiency-of-care assumptions for health professionals that might never become a reality.

Read the full article HERE.

Landing in their e-mail inboxes were links to reports from Medicare showing the amount their patients cost on average as well as the quality of the care they provided.  The reports also showed how Medicare spending on each doctor's patients compared with their peers in Kansas, Iowa, Missouri and Nebraska.

The "resource use" reports, which Medicare plans to eventually provide to doctors nationwide, are one of the most visible phases of the government's effort to figure out how to enact a complex, delicate and little-noticed provision of the 2010 health-care law: paying more to doctors who provide quality care at lower cost to Medicare, and reducing payments to physicians who run up Medicare's costs without better results.

Read the rest of this interesting article HERE.

When physicians need to borrow money for new equipment or real estate or even to buy out a practice partner, most of the time bank approval is the easy part.

Experts say physicians run into trouble not in qualifying for loans, but in shopping for the best terms and the best service, and paying attention to the details associated with borrowing.  Those details - whose name is on a loan, what is listed as collateral, whether a repayment schedule is based on realistic assumptions - can prove crucial to a practice's success.

Read the full article HERE

Washington - Earning bonuses and avoiding payment cuts during stage 2 of the multibillion-dollar federal electronic medical record incentive program would require using technology that meets tougher quality objectives and that helps coordinate patient care, according to a proposed rule released on Feb. 23.

Read the full article from the American Medical News: HERE.

The Centers for Medicare and Medicaid Services (CMS) proposes a rule that would require Medicare providers to report and return Medicare overpayments within a sixty-day period

On February 16, 2012, CMS published a proposed rule in the Federal Register (77 Red. Reg. 9179) that, in accordance with Patient Protection and Affordable Care Act provisions, would require Medicare providers and suppliers to identify, report, and return Medicare overpayments by the later of sixty days after (i) the date on which the overpayment was identified or (ii) the date that any corresponding cost report is due.  The proposed rule defines an overpayment to be "identified" when a provider has actual knowledge of the overpayment or acts in reckless disregard or deliberate ignorance of the overpayment.  Under the proposed rule, if a Medicare provider fails to identify, report, and return the overpayment within the sixty day period, the provider will be deemed to have made a false claim under the False Claims Act, which could subject the provider to penalties, including exclusion from participating in federal healthcare programs.

Comments on the proposed rule may be submitted to: CMS, Department of Health and Human Services, Attention: CMS-6037-P, Mail Stop C4-26-05, 7500 Security Boulevard, Baltimore, MD 21244-1850.  Comments must be received by 5 p.m. E.S.T. on April 16, 2012.

Read the full article from The Washington Post HERE.

The Center for Medicare & Medicaid Services' Office of Clinical Standards and Quality announced the establishment of a two-tier appeals process for physicians who were deemed ineligible for Medicare meaningful use incentive pay, or who thought their pay was too low. 

Read the full article from the American Medical News HERE.

Physicians who participate in Medicare can consider 2012 to be the last year to practice reporting quality measures to the government before the exercise truly becomes real.  Doctors who have not mastered the Medicare physician quality reporting system by the end of this year might find themselves locked into a lower Medicare pay rate a few years down the road.

Read the full article from the American Medical News HERE.

In light of the ongoing disagreement, the Centers for Medicare and Medicaid Services (CMS) has released the following announcement:

The negative update under current law for the 2012 Medicare Physician Fee Schedule is scheduled to take effect on Sun Jan 1, 2012, eight business days from today. Consequently, as on numerous occasions in the past, CMS will instruct its Medicare claims administration contractors to hold claims containing 2012 services paid under the Medicare Physician Fee Schedule for the first 10 business days of January 2012 (i.e., Sun Jan 1 through Tue Jan 17). The hold should have minimal impact on provider cash flow because, under current law, clean electronic claims are not paid sooner than 14 calendar days (29 days for paper claims) after the date of receipt.

Medicare Physician Fee Schedule claims for services rendered on or before Sat Dec 31 are unaffected by the 2012 claims hold and will be processed and paid under normal procedures and time frames.

CMS will notify you on or before Wed Jan 11, 2012, with more information about the status of Congressional action to avert the negative update and next steps regarding the claims hold.

The agency also is moving ahead with rules on noncompliance penalties for electronic prescribing and quality reporting.

Read the full article from amednews.com HERE.

Although the technology may result in faster and better communication, physicians who text other doctors could be exposing themselves to privacy and security violations of the Health Insurance Portability and Accountability Act.

Read the full article from amednews.com HERE.

One-third of health care organizations, including physician practices, insurers and pharmacies, have reported catching a patient using the identity of someone else to obtain services, according to a report from the professional services firm PwC.

The report, "Old Data Learns New Tricks," by PwC's Health Research Institute, said the problem -- and consequences -- of medical identity theft could get worse as electronic sharing of patient data increases.  Physicians unwittingly could end up using information obtained during a visit with an identity thief in deciding how to treat a patient, for example. 

Read the full article HERE.

Washington -- A commission advising Congress on Medicare payment issues recommended pay cuts to specialiists and a 10-year freeze to primary care physicians in a package to overhaul the Medicare fee-for-service system. 

The recommendations by the Medicare Payment Advisory Commission on Oct. 6 offer Congress a way to eliminate the sustainable growth rate formula used to set Medicare payments.  Physician organizations, and a few MedPAC members, while supporting the elimination of SGR, were critical of the plan.

Read the full article HERE.

An estimated 100,000 physicians and other health professionals at risk for being hit with Medicare electronic prescribing program penalties next year have until Nov. 1 to report a hardship exemption and give the Medicare agency a reason why they should not have their pay reduced in 2012.

Read the full article from amednews.com HERE

Sixty-five precent of established physicians and 49% of physicians hired out of residency or fellowship in a recent 12-month period were placed in hospital-owned practices, according to a Medical Group Management Assn. physician placement report issued in June 2010.

Read the full article from the amednews.com HERE.

A controversial provision of the Affordable Care Act (ACA) that has been highlighted recently in the media calls for establishing an Independent Payment Advisory Board (IPAB).  The purpose of this 15-member panel would be to extend Medicare program solvency through the use of a spending target system and an expedited congressional process for approving Medicare cost savings.

Read the full article - HSRI Opposition to the IPAB.pdf

Read the full email with more of the provisions of the proposed rule HERE.

Read the full article published by Medscape Medical News HERE.

On June 17, 2011, CMS announced that it will begin to use predictive modeling technology to prevent Medicare fraud.  The program is designed to stop fraudulent claims before they are paid.  CMS stated that the technology is similar to the technology used by credit card companies, which uses real-time data to spot suspect charges.  CMS will begin this program on July 1, 2011.

Read the full article published by FierceHealth IT HERE.

The AMA continually stressed to CMS that the agency's sudden decision in November 2010 to require physicians to meet these criteria by June 30 of this year in order to avoid 2012 penalties was unreasonable.

Read the full article from the AMA Health System Reform Insight HERE.

Read the full article from the American Medical News here.

Is your practice reporting on PQRS measures?  NBP can walk you through the steps to successfully report on PQRS measures so your practice can receive incentive payments. 

For more information contact Amanda Bailey: abailey@mybillingpartner.com.

On Jan. 1, 2012, if physicians' practice management systems are not up to new standards, they will risk not getting electronic payments from private insurers and Medicare.

Read the full article from the American Medical News here.

Read the full article from American Medical News here.

Read the full article from the American Medical News here.

Read the full article from the American Medical News here.

Read the full article from the American Medical News here.

Read the full article from American Medical News.com here.

As required by Congress, each March MedPAC reviews Medicare payment policies and makes recommendations to Congress. The 2011 report includes a payment policy recommendation for a 1 percent increase in physician reimbursements for 2012. The commission has previously stated its opposition to physician payment cuts, and determined the 1 percent increase for 2012 to be fiscally disciplined while preserving beneficiaries’ access to physician and health professional services.

MGMA and 130 other state and medical specialty societies sent letters to House and Senate leaders calling on Congress to establish a bipartisan solution to this unreasonable situation. We urge MGMA members and their practices' staff to do the same by accessing the MGMA Advocacy Center and contacting their congressional representatives.