Friday, July 30, 2010
AHA Responds to Recent CMS Telemedicine Expansion: "We Believe the Proposed Changes Do Not Go Far Enough"
Click here to read the letter in it's entirety.
Thursday, July 29, 2010
H.R. 5044, sponsored by Reps. Ron Klein (D-Fla.) and Ileana Ros-Lehtinen (R-Fla.), would increase penalties for Medicare fraud, such as doubling monetary fines and doubling jail time.
Kevin G. McAnaney, an attorney with the Law Offices of Kevin G. McAnaney, Washington told BNA July 28 that the bill was a mixed bag, with some positive provisions, such as the penalties for selling Medicare beneficiary numbers, but several questionable sections.
“The bill would substantially expand the definition of ‘items and services' for purposes of civil monetary penalties from ‘medical care or services and items' to include ‘without limitation, any medical, social, management, administrative, or other item or service used in connection with or directly or indirectly related to a federal program',” McAnaney said.
H.R. 5546 would create a pre-payment review prevention system that would review Medicare claims, identifying high-risk claims using predictive modeling technology. All flagged claims would be fully reviewed by the HHS secretary, who would have the final say as to whether the claim was paid or denied. The system would work by assessing the risk level of all Medicare transactions on a near real-time basis and would identify suspicious patterns that increased the likelihood of fraud.
“I think this bill simply provides for a robust pre-payment review of claims akin to what the credit card companies do. I don't know if it will work, but it is certainly something they should be trying,” McAnaney said.
It should be made aware that these pieces of legislation highlight the fact that the House and Senate are continuously watching the Medicare program and taking measures to prevent fraud and abuse.
Swann, James. "AARP Pledges Support for Two House, One Senate Medicare Fraud-Fighting Bills." BNA Health Care Daily Report. 29 July 2010. Web. 29 July 2010. http://news.bna.com/hdln/HDLNWB/split_display.adp?fedfid=17565311&vname=hcenotallissues&fn=17565311&jd=a0c3w0p2a1&split=0
Tuesday, July 27, 2010
The PPACA and deficit reduction will be funded through new taxes, fees, and penalties on individuals, businesses, and the health care industry. This alert will touch upon the biggest changes individuals, businesses, and the health care industry will experience in the next few years.
Individual tax payers will contribute to the PPACA funding through an additional Medicare tax imposed on wages and investment income, penalties for failure to maintain health care coverage, a higher threshold for itemized medical expense deductions, a tax on indoor tanning, and an additional tax on distributions from health and medical savings accounts.
The health care industry will be a large source of the PPACA’s funding through fees on health insurance providers and pharmaceutical manufacturers and importers, excise taxes on medical devices and high cost employer sponsored health coverage, and a limitation on remuneration paid by health insurance providers.
Beginning this year, the deduction for employee remuneration paid by health insurance providers will be limited. The amount health insurance providers will be able deduct in applicable employee remuneration will decrease from $1 million to $500,000. The limit will apply to all officers, employees, directors, and other workers or services providers performing services for or on behalf of a health insurance provider.
Non-health care industry businesses will also face changes and penalties as part of the PPACA funding. Effective in 2010, the PPACA eliminated the cellulosic biofuel producer credit. Paper companies will now be barred from claiming $1.01 per gallon cellulosic biofuel producer credit for black liquor, a by-product of paper making. This change is estimated to raise $23.6 billion over the next ten years.
Hoffman, Larkin, Bruce Douglas and Kelly Burke. "Patient Protection and Affordable Care Act - How It Will be Funded." Lexology. 13 July 2010. Web. 27 July 2010.
Small business owners speaking at a Chamber of Commerce forum July 26 said they will pay fines imposed under the new health reform law rather than purchase health care coverage for their employees.
“We're going to have to live with it for awhile, and we're going to have to deal with it,” Johnson said. He and small business owners spoke at a forum in Washington, Behind the Curtain: the Health Care Law's Impact on Small Business, sponsored by the chamber, the National Federation of Independent Business, and the American Action Network. The Chamber of Commerce strongly opposed the new law.
“We'll absolutely be paying the penalty,” said Scott Womack, president of Womack Restaurants in Terra Haute, Ind. “There's no way we can buy the health insurance,” Womack said. Under PPACA employers with at least 50 employees must offer coverage to workers beginning in 2014 or pay penalties, which are not tax-deductible, of $2,000 per employee.
The "big picture" impact of Health Care Reform should be noted as it will inherently affect all medical personnel, including MSPs.
Hansard, Sara. "Small Businesses will Pay Fines Rather than Health Insurance." BNA's Health Care Daily Report. 27 July 2010. Web. 27 July 2010.
Tuesday, July 20, 2010
The survey indicates that the approximately 5,500 physicians who completed the survey have been forced to take a number of cost-cutting steps to offset revenue losses associated with the elimination of these codes.
After analyzing survey data, representatives of these specialties and the AMA identified several technical improvements that would make the policy more equitable. They joined with 16 other organizations in a letter outlining their concerns and asking the Centers for Medicare and Medicaid Services (CMS) to review and modify its current policy to prevent further deterioration of care coordination between physicians.
For more information on the survey results, the organization letter, and survey participants, please visit the American Medical Association website.
American Medical Association. "New Physician Survey Find Medicare Payment Change Hurts Care Coordination Efforts: Medical OrganizationsCall on CMS to Review Consultation Code Policy."
AMA. July 16, 2010. Web. July 201, 2010.
Monday, July 19, 2010
The U.S. District Court for the District of Colorado said the state law did not bar Dr. Michael Ryskin from seeking documents from the Sterling Regional MedCenter credentialing committee because he provided sufficient allegations that the hospital failed to follow provisions of professional review and fair hearing plans that guaranteed him certain due process rights in the event of adverse actions affecting medical staff privileges.
Of greater importance, the court said, was the fact that the hospital did not appear to have followed its applicable practices for professional review and credentialing activities in Ryskin's case. Because compliance with the statutory procedural requirements is a prerequisite to asserting the privileges, they were not available.
Although the hospital argued that Ryskin may have been entitled to some due process rights if the credentialing committee had made an adverse recommendation against his medical privileges, and although it also argued that no adverse determination was ever made, the court rejected those arguments
The court concluded that, while the state law privileges are designed primarily to shield peer review materials from production in medical malpractice cases, Ryskin's action was not concerned with quality of care issues but was, rather, focused on determining the motives behind his termination.
In a conclusive decision from the court: “Plaintiff seeks not the conclusions of the relevant committees, but their motives. To shield the documents in this lawsuit would be to frustrate the search for truth."
Source: BNA's Health Care Daily 7/19/2010: Federal Court Says Credentialing Documents
Not Covered by Colorado Statutory Privilege
Monday, July 12, 2010
ABIM has also settled its lawsuit with doctors Rajender Arora, M.D., and Anise Kachadourian, M.D., barring them from sitting for the ABIM for several years, and barring employees and representatives of the Arora Board Review from accessing, copying, or distributing ABIM materials.
Names of the 139 doctors who were sanctioned in connection with the incident have not been released. However, their status has been updated in the ABIM's online database.
Source: Modern Healthcare
Wednesday, July 7, 2010
In Spradling v. SSM Health Care St. Louis, Mo., a patient was suing Dr. William Sprich, alleging that he was negligent when performing a verteboplasty. Section 538.225.1 of the Missouri Code requires that a plaintiff bringing medical negligence charge must file an affidavit stating that he or she "has obtained the opinion of a 'legally qualified health care provider'" backing the claim of negligence. Section 538.225.2 defines the above term as "a health care provider license in this state or any other state in the same profession as the defendant and either actively practicing or within five years of retirement from actively practicing substantially the same specialty as the defendant."
The defense claimed that the plaintiff's expert witness was not qualified under this definition because his board specialty was in radiology, not neurosurgery. The court ruled that because the witness, Dr. John Mathis, had performed over 3,000 vertebroplasties and had written articles and presented lectures on the procedure, he was "practicing substantially the same specialty" as the defendant. Therefore, he was qualified to testify on the procedure, even though he was of a different specialty as the defendant.
Thursday, July 1, 2010
By July 6, 2010, physicians who order or refer for covered Part B services must revalidate their enrollment in PECOS online. Several providers have reported issues in completing the application and revalidation process and called on CMS to delay the rule until problems with the system were worked out. This rule will still be effective by July 6; only the automatic rejection of claims will be delayed until January 2011.
Many hospitals are putting the responsibility on MSPs responsible for credentialing to verify enrollment in Medicare as part of the initial credentialing process. NAMSS will monitor this carefully during the next year. Best practice credentialing procedures include MSPs reviewing the OIG and/or the Medicare/Medicaid Exclusion List. Enforcement guidelines for the PECOS database will likely be developed over the remainder of the year.