From the Brown/McCarroll Health Law E-Alert:

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.

MIAMI - Federal authorities say they recovered $4.1 billion in health care fraud judgments last year, a record high which officials on Monday credited to new tools for cracking down on deceitful Medicare claims.

Read the full article from The Washington Post HERE.

Physicians who believe they were given an incorrect bonus can file for reconsideration. 

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.

The Medicare physician quality reporting system will use participation in 2013 to determine who will be penalized starting in 2015.

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.

As of 12/19, the House and Senate appear unable to reach agreement on a "fix" to the SGR cut scheduled to take effect on January 1. Each respective body has enacted legislation postponing the cut but they are in disagreement on the length of the postponement, as well as how to pay for the short-term fix.

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.

CMS says its hands are tied on the payment formula but agrees to scale back additional pay reductions planned for interpreting imaging scans.

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.

After years of using pagers, and constantly waiting on return calls, physicians now consider texting to be an efficient and fast way to connect with colleagues.

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.

With 1.5 million victims in the U.S., physicians can take a few simple steps to ensure that patients aren't using someone else's name to get care. 

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.

The AMA and others in organized medicine are speaking out against the recommendations. 

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.

Physicians facing a 2012 pay reduction will not receive any more time to report paperless prescription activity. 

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

The number of small, privately owned practices continues to shrink as economic pressures and long hours take their toll on the owner-physician. 

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.

From the AMA's Health System Reform Insight:

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

The Centers for Medicare & Medicaid Services (CMS) released the Medicare proposed physician fee schedule for 2012 late Friday afternoon.  In the proposed rule, CMS estimates the 2012 conversion factor to be $23.9635, which represents a 29.5 percent cut to Medicare physician payments unless Congress intervenes.  CMS will accept public comments on the rule until Aug. 30th, and intends to issue the final rule by Nov. 1. 

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

June 21, 2011 - Almost 1 in 5 claims physicians file with commercial health insurers have a processing error that often mistakenly delays payments or rejects them entirely, according to the American Medical Association's (AMA's) 2011 National Health Insurer Report Card.

Read the full article published by Medscape Medical News HERE.

From the BROWN/MCCARROLL Health Law E-Alert:

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.

A recent MGMA survery of physician practices makes clear that a large percentage will have trouble meeting the Jan. 1, 2012 deadline for using the HIPAA 5010 transaction set.

Read the full article published by FierceHealth IT HERE.

Under the Centers for Medicare & Medicaid Services (CMS) ePrescribing rule, physicians must issue at least 10 electronic scripts (e-scripts) by June 30, 2011, to avoid an ePrescribing penalty that amounts to a 1% reduction from their total Medicare Part B allowable charges in 2012.

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.

Total payouts were up in the third year, but only one in five eligible professionals participated in the voluntary program. 

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.

Physicians still have time to change from the HIPAA 4010 standards for electronic claims submissions to the 5010 set.

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.

Doctor privacy advocates defend a 30-year ban on releasing data from challenges on Capitol Hill and in the courts.

Read the full article from American Medical News here.

The first contact most patients have with your practice is by telephone.  Here's how to make that initial conversation work for you.

Read the full article from the American Medical News here.

Many workplaces, including medical practices, tried to accomplish more with less during the recent economic recession.  Employees were laid off.  Open positions went unfilled. 

Read the full article from the American Medical News here.

Practicing medicine will present new challenges and opportunities after new rules are implemented -- for you and for your patients.

Read the full article from the American Medical News here.

Mishandling patient information, whether paper or electronic, can cost millions in fines even if no harm is intended.

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

The House voted 271-158 on March 14 to keep the government funded through April 8. The Senate is expected to pass the legislation, which includes $6 billion in cuts to the federal budget, before the end of the week. The White House indicated that the president will sign the extension before the current continuing resolution (CR) expires on Friday, March 18. The cuts in the legislation include funding rescissions, reductions, and program terminations. The bill also eliminates earmark accounts within the Agriculture, Commerce/Justice/Science, Financial Services/General Government, and Interior subcommittee jurisdictions.

In a letter to the Medicare Payment Advisory Commission (MedPAC), the Centers for Medicare & Medicaid Services (CMS) estimated that Medicare physician payments will be cut by 29.5 percent in 2012, unless Congress intervenes.

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.

Many express concern about rising costs, declining reimbursements and health system reform.

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

Social media has become an undeniable force, and its rapid, informal communication style represents both possibility and liability for healthcare organizations. Good policies and training help organizations pursue the benefits and mitigate the risks.

Read the full article from AHIMA here.

Healthcare providers need to do a better job of engaging their patients in Meaningful Use initiatives and aligning their efforts to meet patients' needs in order to truly have success going into Stage 2 and beyond, according to a survey released by PricewaterhouseCoopers during HIMSS11 last week.

Read the full article from FierceHealthIT here.

There are several aspects to running a successful orthopedic practice beyond delivering great outcomes and high patient satisfaction.

Read the full article from Becker's Orthopedic & Spine here.

Call Nancy Moore @ 512-331-1600 to discuss how the 2011 changes will effect your practice.

MedicarePhysicianPaymentRates2011.pdf