Anesthesia Billing and Practice Management | Anesthesia Resources » CMS

HIPAA Mega-rule Due June 2012

Robert Cox — Mon, 07 May 2012 17:01:29 +0000

The HIPAA mega-rule has reached its final hurdle and is expected to be released in June 2012.

The mega-rule will include:

Changes to privacy and security rules the HITECH Act mandates
Requirements for new enforcement and higher penalties
Final regulations of HITECH Act’s breach notification rule
Changes to HIPAA to incorporate Genetic Information Nondiscrimination Act

Just as you will have to adjust to the new provisions in the final rule, you will be under increased scrutiny to comply with them. The government is intensifying its enforcement to protect patients’ confidential health information due in large part to the increased number of security breaches that have resulted from the lack of staff training. Practices will have an arduous task incorporating all of the changes to avoid those HIPAA headaches and potential fines. The most proactive practices have begun to update privacy & security policies as well as re-train employees.

EHR Incentives Still Out of Reach of Anesthesia & Pain Providers

Robert Cox — Tue, 06 Mar 2012 14:29:10 +0000

The EHR incentive program is targeted at office-based practices. Indeed, the original version of the program would have excluded anesthesiologists explicitly. The July 28, 2010 final rule however, restricted the definition of “hospital-based” so that it only covered physicians who provide 90 percent or more of their services on an inpatient basis or in the emergency department. Most anesthesiologists do more than 10 percent of their cases on an outpatient basis, so they are not disqualified on the grounds that they are hospital-based. Nevertheless, they will be ineligible for the bonus because fewer than 50 percent of their Medicare allowables will be generated in facilities with certified EHR systems and/or because fewer than 80 percent of their patients will have records in a certified EHR system.

Then there are the meaningful use standards. Stage 1 requires the eligible professional to meet or qualify for an exclusion from each of 15 core objective functionalities (e.g., drug interaction checks) plus five out of a possible ten “menu set” measures. The EHR must allow the eligible professional to report at least six clinical quality measures, three of which are mandatory and three of which must be selected from a group of 38 measures. The majority of these objectives and clinical quality measures do not apply to anesthesiology or pain medicine practice. So the chances of quailifying for the EHR incentives are slim for anesthesia and pain professional, as the law is currently written.

HHS Announces Intent to Delay ICD-10 Compliance Date

Robert Cox — Mon, 20 Feb 2012 18:19:08 +0000

As part of President Obama’s commitment to reducing regulatory burden, Health and Human Services Secretary Kathleen G. Sebelius today announced that HHS will initiate a process to postpone the date by which certain health care entities have to comply with International Classification of Diseases, 10th Edition diagnosis and procedure codes (ICD-10).

The final rule adopting ICD-10 as a standard was published in January 2009 and set a compliance date of October 1, 2013 – a delay of two years from the compliance date initially specified in the 2008 proposed rule. HHS will announce a new compliance date moving forward.

”ICD-10 codes are important to many positive improvements in our health care system,” said HHS Secretary Kathleen Sebelius. “We have heard from many in the provider community who have concerns about the administrative burdens they face in the years ahead. We are committing to work with the provider community to reexamine the pace at which HHS and the nation implement these important improvements to our health care system.”

Congress passes fee fix, avoids 27% physician pay cut

Robert Cox — Mon, 20 Feb 2012 14:55:40 +0000

Physicians are safe from the impending 27.4% cut to their Medicare payments set to hit March 1 thanks to Congress passing a temporary ‘doc fix’ Friday through the end of 2012.

The vote to extend the payroll tax holiday bill and keep the current $34.0376 conversion rate through Dec. 31 comes on the heels of intense debate among Congress members as to whether preventing the pay cut was fiscally sound. The $150 billion bill failed to include deeper cuts requested by GOP Congress members but remained largely budget neutral.

Congress originally approved a two-month fix that was set to expire Feb. 29. Once signed into law, the new fee fix will be good through Dec. 31.

ACO Resources now available from CMS

Robert Cox — Fri, 11 Nov 2011 16:09:23 +0000

The Centers for Medicare & Medicaid Services’ Medicare Learning Network
is offering several resources for providers looking for information on accountable care organizations and the Medicare Shared Savings Program.

Several electronic fact sheets that address topics are now available, including how to participate in an ACO and improve quality of care and information on the advanced payment model for ACOs. New fact sheets are also available detailing final rule provisions for ACOs under the shared savings program and fact sheets provide information on the methodology for determining shared savings and losses under the program.

ACO Rules Revised to Entice Greater Participation

Robert Cox — Fri, 21 Oct 2011 19:39:12 +0000

The latest ACO rules revision; requires half the number of performance measurements, removes the electronic health records requirement and eliminates financial risks for some groups. CMS also relaxed the timetable for the launch of the ACOs with groups allowing them to apply throughout 2012. To entice providers, CMS said it will make $170 million available starting next year to physician-owned and rural providers to start ACOs (Gold and Galewitz, 10/20).

ASA Urges MedPAC to Reject SGR Draft Plans to Cut 18%

Robert Cox — Thu, 06 Oct 2011 20:23:18 +0000

On October 5 and 6, 2011, the Medicare Payment Advisory Commission (MedPAC), the commission tasked with advising Congress on Medicare payment issues, will meet to review a draft recommendation that would help cover the costs of SGR repeal by cutting payments to specialty physicians, such as anesthesiologists, by nearly 18 percent over three years.

In a letter written to MedPAC in response to the proposed plan, ASA President Mark A. Warner, M.D., expresses strong opposition to the commission’s draft recommendation. Dr. Warner writes, “While we support permanently fixing the SGR, we believe cutting payment for anesthesia by 5.9 percent each year over the next three years, followed by a freeze in payment would harm patient access to care and does not take into account that Medicare currently pays anesthesiologists only 33 percent of the average commercial insurance payment for the same service.”

The proposed 10 year plan would differentiate specialty physicians from primary care physicians in regards to Medicare payments. For specialty physicians, the draft recommendation would reduce payments 5.9 percent annually in years 2012, 2013 and 2014, followed by payment freezes for the final seven years. Payments for primary care specialties would be exempt from the payment reductions and would instead be frozen at current 2011 levels for the entirety of the 10-year period.

ASA will continue to update members on the latest MedPAC developments.

Click here to read the letter ASA sent to MedPAC.

Anesthesiologists as ACO Leaders

Robert Cox — Wed, 07 Sep 2011 16:44:15 +0000

As hospitals, Ambulatory Surgery Centers (ASCs), and physician providers formulate the transparent partnerships the new rules require to participate in an ACO, it is important to be reminded that anesthesiologists are integral providers to achieve the goals of this new ACO concept. Anesthesiologists have been critical players in the initial assessment and on-going management of patient’s care throughout the perioperative and obstetrical arenas. In addition, Anesthesiology has been a champion for patient safety and has contributed data to the Anesthesia Quality Institute (AQI), for years.

Recent professional editorials have talked about creating a “surgical home” or an Accountable Anesthesia Organization as concepts where anesthesiologists would lead a team dedicated to the goals of an ACO. A recent article published in the Journal of the American Medical Association addressed the potential mistakes in implementing ACOs, particularly in failing to recognize interdependencies (http://jama.ama-assn.org/content/306/7/758.full).

It will be interesting to see the CMS response to the final rules for ACOs when they are made available.

Medicare Requires Revalidation of Physician Provider Enrollment Data

Robert Cox — Tue, 16 Aug 2011 13:34:39 +0000

Medicare is requiring all physician providers who were enrolled prior to March 25, 2011 to revalidate their enrollment data. Between now and March 2013, Medicare fiscal intermediaries will be sending notices to these physician providers, requesting that they revalidate their provider enrollment information contained in the PECOS system. Upon receipt of the revalidation request, physician providers will have 60 days from the date of the letter to submit completed enrollment forms. Failure to submit the enrollment forms as requested may result in the deactivation of your Medicare billing privileges. Providers can now utilize the Internet-based PECOS (Provider Enrollment, Chain, and Ownership System at https://pecos.CMS.hhs.gov.) to revalidate their provider information.

Physician providers who fail to revalidate their data timely could suffer financial hardship due to the interuption in Medicare payments until the revalidations is completed.

2012 Medicare Payment Rate Changes for Physician Fee Schedule

Robert Cox — Thu, 14 Jul 2011 13:00:30 +0000

On July 1, CMS (Center for Medicare & Medicaid) issued a proposed rule that represents a 29.5% cut to Medicare physician payments unless Congress steps in to correct it.

See the CMS press release at http://go.cms.gov/kssRvx

Dr. Donald Berwick, head of CMS was quoted in the press release saying, “This payment cut would have serious consequences, and we cannot and will not allow it to happen,” said Dr. Donald M. Berwick, CMS administrator, in a statement. “We need a permanent SGR fix to solve this problem once and for all. That’s why the President’s budget and his fiscal framework call for averting these cuts and why we are determined to pass and implement a permanent and sustainable fix.” Physicians groups have clamored for the SGR (Sustainable Growth Rate) formula to be overhauled as part of the deficit reduction process, but that would also come with a $300BB price tag.

Some provisions of the proposed rule include:

Physician Quality Reporting System (PQRS) – adding 26 new measures
Value-based modifier-CY 2013 as the initial performance year
Meaningful use
Misvalued code Initiative
Payment for certain Part B drugs
2012 e-prescribing incentive
Multiple procedure payment reduction (MPPR)
Physician payment during 3-day payment window

Comments are due back to CMS before August 30th. The final rule is expected by November 1st.