HPI News

HHS Announces Intent to Delay ICD-10 Compliance Date

2012-02-16T14:21:00.001-05:00

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.”

ICD-10 codes provide more robust and specific data that will help improve patient care and enable the exchange of our health care data with that of the rest of the world that has long been using ICD-10. Entities covered under the Health Insurance Portability and Accountability Act of 1996 (HIPAA) will be required to use the ICD-10 diagnostic and procedure codes.

Original Article Here.

New Resources On Avoiding E-Prescribing Penalties

2012-02-16T10:47:00.002-05:00

The Centers for Medicare and Medicaid Services (CMS) released the new CMS E-prescribing Future Payment Adjustment Factsheet Medicare e-prescribing penalties increase to 1.5 percent in 2013 and to 2.0 percent in 2014 and action is required in 2012 to prevent physicians from being penalized. It is imperative that practices understand how to avoid these penalties as the criteria for 2013 and 2014 are different from those for the 2012 penalty. Eligible professionals can avoid the 2013 penalty by submitting 10 e-prescribing instances during the first six months of 2012, using claims-based reporting. These e-prescribing instances do not have to be associated with any specific eligible visits or “denominator codes,” but the e-prescribing G-code must be submitted on a claim with other payable Medicare services.

CMS Answers to eRx Questions

Medicare Pay Cut of 27% Averted; Next Deadline For Action is March 1.

2012-01-23T11:09:00.002-05:00

The threat of an across-the board Medicare doctor pay cut was defused with over a week to spare. But the congressional agreement only maintains rates for an additional two months before Congress must act again to avoid a steep reduction. The House and Senate on Dec. 23, 2011, approved a two-month payroll tax cut extension package that included a two-month doctor pay freeze. That means physicians will continue to receive 2011 rates for Medicare services they provide through the end of February. Lawmakers will need to agree on a longer-term patch if they are to prevent the 27.4% cut from taking effect on March 1.

For Full Article See:
Full Article (PDF)

From January 9th, 2012 edition of American Medical News, Volume 55, Number 1
American Medical News

Top 10 government issues for practice executives to watch in 2012

2012-01-12T11:00:00.004-05:00

As 2012 gets underway, here are the top government issues that will impact medical groups this year.

Medicare payments remain in flux
Congress left Washington late last year after only passing a two month fix for the flawed sustainable growth rate (SGR) formula, despite the fact that they had a full year to address the 2012 cuts. Congress’s inability to avert the 27.4 percent cut for a full year exacerbates uncertainty for physician payment in 2012.

Version 5010 transition
Jan. 1 was the compliance deadline to use Version 5010 standards for electronic claims and other HIPAA transactions. MGMA research indicated that some practice trading partners, including practice management system vendors and health plans, were not able to meet the deadline.

E-prescribing penalties begin in 2012
A 1 percent penalty will be levied in 2012 for physicians who are eligible for the Medicare e-prescribing program and did not successfully e-prescribe in 2011 or have a hardship exemption request approved by the Centers for Medicare & Medicaid Services (CMS). E-prescribing penalties increase to 1.5 percent in 2013 and to 2.0 percent in 2014.

Countdown to ICD-10
The healthcare industry has been focused on transitioning to HIPAA Version 5010 electronic transaction standards, but 5010 is only a stepping stone to implement ICD-10, the new diagnosis code set. The industry must transition from ICD-9 to ICD-10 by Oct. 1, 2013. This new code set is vastly more complex.

2012 elections
Campaigns are underway for the 2012 elections, which could change the political landscape for the next four years and have a significant impact on health policy, including repeal or further implementation of healthcare reform.

Continued emphasis on compliance
Both Congress and CMS continue to focus on curbing fraud, waste and abuse in public health programs, such as Medicare and Medicaid. Medicare recovers more than $7 for every $1 spent on fraud investigations, according to government data. Group practices should be prepared for new compliance initiatives.

The Supreme Court hearing on ACA
Justices will hear challenges to the constitutionality of the 2010 healthcare reform bill, the Patient Protection and Affordable Care Act (ACA).

CMS explores alternative payment models
The Center for Medicare & Medicaid Innovation (CMMI) and CMS continue to explore payment models that move away from the current fee-for-service reimbursement method.

Focus on site of service payment differentials
The Medicare Payment Advisory Commission and Congress are taking a closer look at payment differences for identical services across delivery settings, including the difference between payments made to hospitals and physician practices.

EHR meaningful use incentives continue
The second year of the Medicare EHR incentive program is important because 2012 is the last year that physicians can start participating and earn the maximum amount of $44,000 over five years per eligible professional.

For full article go here. (MGMA Membership Required)

Practices should continue HIPAA Version 5010 implementation efforts

2012-01-05T11:10:00.002-05:00

Despite the contingency plan issued by the Centers for Medicare & Medicaid Services in late December, physician practices still risk claims payment disruption if they do not completely convert to HIPAA Version 5010. Practices and others were required to transition to the latest version of the HIPAA electronic transaction standards by Jan. 1. Due to the lack of testing between providers and Medicare Administrative Contractors (MACs) on Version 5010 electronic transactions, CMS announced a contingency plan that included:

Practices and clearinghouses that have tested with their MAC and have been approved for Version 5010 will be notified that they have 30 days to cutover to Version 5010.

Practices and clearinghouses that have not yet tested were to be notified in December 2011 that they must submit their transition plan (including compliance timeline) to their MAC within 30 days of the notification. Those who submit a transition plan by the deadline will have until April 1, 2012 to complete their transition to the 5010 formats.

Covered entities are afforded a 90-day enforcement delay at the discretion of the agency.

Practices should:

Work with their trading partners (practice management system vendors, clearinghouses and health plans) to ensure that you are able to generate Version 5010 transactions as quickly as possible.

Check with their clearinghouses to determine if they will be submitting the required “transition plan” (Notification will come from the MACs, with clearinghouses having the responsibility to notify the providers they service.

Review the notification letter sent by the MAC to the practice that submit claims directly to a MAC and submit the required transition plan (Note: While there is no specific format required for the transition plan, submitters should outline the steps they have taken and the steps they still need to take to successfully achieve compliance with the updated version of the transactions.)

Determine if their commercial health plans will continue accepting Version 4010 transactions and if so, for how long (If they will not, identify a clearinghouse or other contingency plan to ensure there is no disruption in cash flow.)
Remember that despite CMS’ discretionary enforcement delay, the compliance date for these new standards remains Jan. 1, 2012.

For more information visit the CMS Web site.

CMS releases revised fee schedule RVU files and conversion factor

2012-01-05T11:08:00.000-05:00

The Centers for Medicare & Medicaid Services (CMS) released revisions to the 2012 Medicare physician fee schedule relative value units (RVUs) files. The revised payment files are based on current law, including the Temporary Payroll Tax Cut Continuation Act of 2011, which provides for an “update” of zero percent for claims with dates of service from Jan. 1, 2012, through Feb. 29, 2012 instead of a 27.4 percent cut. To make 2012 RVU changes budget neutral, CMS adjusted the conversion factor. In the revised RVU file, CMS sets the 2012 conversion factor at $34.0376. This is a slight increase from last year’s conversion factor of $33.9764.

To view the updated files, visit the CMS Web site.

Recovery Audit Program (RAC) demand letters now coming from Medicare Administrative Contractors (MACs)

2012-01-05T11:01:00.001-05:00

Beginning Jan. 3, the Centers for Medicare & Medicaid Services (CMS) shifted responsibility for issuing Recovery Audit Program (RAC) demand letters from the Recovery Audit Contractors (RACs) to the Medicare Administrative Contractors (MACs). The change, announced last summer, is an attempt to reduce delays in issuing demand letters, which can count against a provider's time to rebut a finding.

The model demand letter from CMS, which references the Recovery Audit Program in the second paragraph and uses a “Letter Number” beginning with an “R” to indicate the finding is coming from a RAC. While CMS originally stated that the demand letters would include contact information for the RAC, they do not currently contain that information. Contact information for each of the four RACs can be found on the CMS Web site.

This process change comes as CMS reports that the RAC program identified $939.4M in overpayments and underpayments in FY 2011, up from $92.3M in FY 2010.

Early EMR adopters get a break; tougher criteria delayed to 2014

2012-01-03T15:13:00.000-05:00

Physicians who didn't wait until 2012 to get their first meaningful use bonus will have an extra year to meet more rigorous reporting thresholds.

Physicians meeting criteria in 2011 to earn federal electronic medical record incentives will have more time before the Dept. of Health and Human Services requires them to satisfy tougher standards for attaining additional bonuses. The move is being viewed by physicians and health policy observers as a goodwill gesture by the Obama administration toward EMR early adopters. Doctors and hospitals who currently meet stage 1 meaningful use criteria would be able to vie for bonuses for an extra year under the same requirements, HHS Secretary Kathleen Sebelius announced on Nov. 30. These bonus recipients would not need to upgrade their EMR systems to comply with stage 2 standards until 2014, instead of 2013 under the initial plan.

The delay of stage 2 affects only physicians and hospitals who met stage 1 criteria in 2011. Doctors who will report meeting stage 1 requirements for the first time in 2012 will still be expected to meet stage 2 requirements starting in 2014. Before the new policy change, those who waited until 2012 to adopt would have had a later upgrade deadline but still would have been eligible to receive the same total bonus amounts as the early adopters.
Oct. 3 was the last day a physician could begin a 90-day reporting period for 2011, according to the Centers for Medicare & Medicaid Services. Physicians who met the requirements will have until Feb. 29, 2012, to register and attest to receive a bonus for 2011. Physicians can earn up to $44,000 over five years from the Medicare program or up to $63,750 over six years from Medicaid.

The full article may be accessed at American Medical News: http://www.ama-assn.org/amednews/2011/12/12/gvl11212.htm

Reminder: providers must use new Medicare ABN forms by Jan. 1, 2012

2011-12-22T11:02:00.001-05:00

The Centers for Medicare & Medicaid Services is requiring providers to use new Advanced Beneficiary Notice of Non-coverage (ABN) forms beginning Jan. 1. The instructions and latest version of the ABN (with the release date of 3/2011 printed in the lower left hand corner) are available for immediate use http://www.cms.gov/BNI/02_ABN.asp. Providers may use the new forms prior to January, and all ABNs with the release date of 3/2008 that are issued on or after Jan. 1 will be considered invalid.

Meaningful use & 5010 claims

2011-12-01T12:31:00.000-05:00

HHS delays Stage 2 of Meaningful Use until 2014

The Department of Health and Human Services (HHS) announced that Stage 2 of the Medicare EHR incentive program (Meaningful Use) would be delayed until 2014. Under the current requirements, eligible professionals (EPs) that begin participating in the meaningful use incentive program this year would have to meet new and more challenging standards for the program in 2013. If an EP did not participate in the meaningful use program until 2012, they could wait to meet these new standards until 2014 and still be eligible for the same incentive payment. In an effort to encourage faster adoption, EPs are permitted to adopt an EHR this year, without meeting the new standards until 2014.

5010 claims deadline still Jan. 1 despite enforcement delay

The compliance date to replace the current Version 4010 with Version 5010 of the standards for electronic claims and other HIPAA transactions is Sunday, Jan. 1. Although the Centers for Medicare & Medicaid Services recently issued a 90-day enforcement delay, practices are still required to comply with the Jan. 1 date to send claims using the new standard. In its announcement, CMS indicated that it would exercise its enforcement discretion with respect to any HIPAA covered entity (provider, clearinghouse or health plan) that had a complaint filed against it for violation of compliance with Version 5010 standards.

Note that some health plans have announced that they will stop accepting claims submitted in Version 4010 on Friday, Dec. 31.

Practices that do not make the transition to Version 5010 risk cash flow disruption. If you have not heard from your practice management system or billing system software vendor, billing service, clearinghouse, or health plans regarding the Version 5010 transition, contact them to discuss their Version 5010 readiness plan.

ICD & 5010 Implementation Timeline

2011-10-10T14:21:00.000-04:00

Below is a downloadable graphic for ICD-10 & 5010 Timelines.

The reference image was here.

CMS corrects e-prescribing hardship exemptions Web site

2011-10-06T14:04:00.002-04:00

CMS has corrected a problem many have encountered when applying for hardship exemptions from the Centers for Medicare and Medicaid Services (CMS) e-prescribing incentive program penalties through the CMS-designated Web site here. Last week, the Web site did not permit applicants to enter the full 15 digit “certification” number. After this issue was raised, CMS instructed eligible professionals (EPs) to include the complete certification number in the written “justification” text box. The Web site has now been fixed and EPs can resubmit their request in this category and include the 15-digit certification number in the correct box. Read CMS tips for using the site here.

EPs who were unable to meet the program requirements will need to submit a request for a hardship exemption by Nov. 1, 2011 in order to avoid the 1 percent penalty in 2012.

EPs can request an exemption based on one of the following:

Inability to electronically prescribe due to local, state, or federal law or regulation

Limited prescribing activity

Insufficient opportunities to report the electronic prescribing measure

Practice in a rural area without sufficient high speed internet access

Practice in an area without sufficient available pharmacies for electronic prescribing

Registered to participate in the Medicare or Medicaid EHR Incentive Programs for 2011 and have adopted Certified EHR technology

On that same Web site CMS offers the ability to download Physician Quality Reporting System and E-prescribing Incentive Program feedback reports. In addition, EPs can check if they successfully submitted the minimum number of G-codes on claims from Jan. 1, 2011 to June 30, 2011 to avoid the 2012 penalty by requesting the “E-prescribing Payment Adjustment Feedback Report.” While these reports are not yet available, CMS has indicated they will be released sometime in October.

It is recommended that EPs submit their hardship request as soon as possible. CMS has stated that the 1 percent penalty will be applied to all Medicare payments for exemptions that were not approved before Jan. 1, 2012. Once the exemption is approved, these claims would have to be reprocessed.

CMS releases final 2012 e-prescribing penalty exemptions

2011-09-01T10:25:00.002-04:00

On August 31st the Centers for Medicare & Medicaid Services (CMS) released a final rule detailing additional exemptions from the 2012 e-prescribing penalty for providers unable to comply with the current requirements. CMS finalized all exemption categories that were included in a proposed rule released in June of this year. Eligible professionals must submit hardship exemption requests by Nov. 1.The finalized 2012 e-prescribing penalty exemption categories include:

The practice is located in a rural area without high speed internet access.

The practice is located in an area without sufficient available pharmacies for electronic prescribing.

Registration to participate in the Medicare or Medicaid EHR Incentive Program and adoption of Certified EHR Technology.

Inability to electronically prescribe due to local, State or Federal law or regulation.

Limited prescribing activity.

Insufficient opportunities to report the e-prescribing measure due to limitations of the measure's denominator.

CMS released a fact sheet (attached pdf file) with links to the rule and additional information.

2012 E-Prescribing Exemptions Final Rule Fact Sheet (PDF)

It's Coding Class Time in Tennessee!

2011-08-17T14:21:00.003-04:00

A Coding class has been scheduled for September 20th, 2011 in Kingsport, TN. See the link below for location, and registration information, as well as Information about CEUs.

September 20th, 2011 Coding Class

U.S. Department of Health and Human Services announces proposal to revise substantially the human research subject protection regulations

2011-08-17T14:01:00.002-04:00

On 26 July, the U.S. Department of Health and Human Services (HHS) published an Advance Notice of Proposed Rulemaking to modernize and enhance regulations that govern research on human subjects. 76 Fed. Reg. 44512 (26 July 2011). The current regulations, often referred to as the Common Rule, 45 CFR Part 46, have been in place since 1991. HHS requests comments by 26 September 2011.

The proposal would substantially change, in several respects, the regulatory framework with which hospitals and academic medical centers have had years of experience. For example, if an institution receives federal funding for human subjects research, all human subjects research at that institution would be covered by the regulations; and informed consent, IRB review, and data protection standards would be significantly changed for biospecimen and data research. The proposal aims to reduce IRB workload. It also implicates such questions as how institutions may ensure adequate protection of human subjects and manage liability risk in multi-site studies if such studies are to be reviewed, as the proposal suggests, by a single IRB. We highlight here selected aspects of the ANPRM. Our summary presupposes familiarity with basic Common Rule terms.

HHS offers two broad motivations to update the Common Rule:
(1) the research landscape has changed dramatically over the past two decades; and (2) in light of the current research environment, the effectiveness and efficiency of the Common Rule must be improved. HHS will reconsider several elements of the Common Rule, as follows.

Extension of the Common Rule to all human subjects research. HHS proposes to extend the Common Rule to research that is not federally funded, but which is conducted at a domestic institution that receives some funding for human subjects research from a Common Rule federal agency. Already, many institutions voluntarily extend the Common Rule to all nonfederal research via election on the OHRP-approved Federal Wide Assurance (FWA), but not all institutions make this election.

Level of IRB review required. HHS would refine the regulations to ensure that the level of review is commensurate with the level of risk to human subjects. For example, changes under consideration include these:
- Elimination of continuing review for all minimal risk studies that undergo expedited IRB review;
- Regular updates to the categories of research eligible for expedited review, thereby creating a presumption that such studies are indeed minimal risk;
- Expansion of the categories of research exempt from IRB review, commencement of such studies upon filing a brief form with the IRB, elimination of routine IRB review of such studies, and a requirement for random audits of a sample of exempt studies;
- Establishment of data security standards for identifiable information and for de-identified information, consistent with the level of risk entailed;
- Requirement for a brief written consent for research use of any biospecimens collected for clinical purposes.
IRB review of multi-site studies. HHS proposes a requirement for all domestic sites in a multi-site study to rely upon a single IRB as the central IRB of record. Changes to the HHS Office for Human Research Protections (OHRP) enforcement procedures would hold an external IRB directly accountable for compliance. Issues under consideration include, among others, how a central IRB would be selected, whether the IRB would have adequate knowledge of each site, and whether a central IRB arrangement could adequately address liability concerns at each institution involved in a study.

Informed consent. HHS proposes to enhance the informed consent process in various ways. Modifications under consideration include new consent form requirements that would (1) specify appropriate consent form content; (2) proscribe certain content; (3) limit consent form length; (4) specify how information is presented; (5) reduce institutional "boilerplate" language; and (6) make available standardized consent forms that satisfy applicable regulations. In addition, HHS seeks to clarify criteria for waivers of informed consent and for verbal consent, and HHS would clarify the circumstances under which future research use of data would or would not require informed consent. For example, changes under consideration would require institutions to provide the research subject an opportunity to choose how their biological specimens may be used in the future.

Data security and information protections. HHS proposes that the Common Rule incorporate HIPAA standards to define individually identifiable information and de-identified information, but HHS may reevaluate and supplement these definitions. Specific data protection standards, modeled on the HIPAA Security Rule,1 would include administrative, physical, and technical safeguards, as well as data breach notification procedures.

Event reporting. HHS proposes to simplify and consolidate reports on unanticipated problems or adverse events, through (1) using standardized but flexible data elements for safety reporting; (2) implementing a web-based, Federal-wide portal for reporting; and (3) harmonizing terminology and reporting timelines across all agencies.

Consistency across federal agencies. HHS proposes to examine the extent to which regulatory uniformity across federal agencies and departments is desirable, appropriate, and feasible to address human subjects protections in diverse research populations and contexts, and in view of differing agency mandates and objectives.

RAC demand letters to come from MACs

2011-08-17T14:00:00.001-04:00

Beginning on Jan. 3, 2012, Medicare Administrative Contractors (MACs) will begin issuing demand letters to collect overpayments identified by the Recovery Audit Contractors (RACs). The RAC will report the overpayment to the MAC, which will issue automated demand letters following the same process used to recover other overpayments from providers. This change was made to avoid delays in issuing demand letters, a problem with the current RAC process.

Providers will be able to contact their MACs with any administrative questions about the demand, including timeframes and the appeals process but will continue to contact RACs with specific questions relating to the audits.

Providers must use new Medicare ABN forms by Nov. 1

2011-08-17T13:59:00.000-04:00

The Centers for Medicare and Medicaid Services (CMS) is encouraging providers to use a new Advanced Beneficiary Notice of Noncoverage (ABN) form now, and the new forms must be used beginning Nov. 1, 2011. The instructions and latest version of the ABN (with the release date of 3/2011 printed in the lower left hand corner) are available for immediate use and may be found at http://www.cms.gov/BNI/02_ABN.asp. All ABNs with the release date of 3/2008 that are issued on or after Nov. 1 will be considered invalid.

CMS releases article on the Medicare 2013 enrollment revalidation initiative

2011-08-17T13:56:00.001-04:00

The Centers for Medicare and Medicaid Services (CMS) recently issued a Medicare Learning Network Matters release on Medicare enrollment revalidation. The agency is moving forward with a requirement that all Medicare providers must revalidate their enrollment information by March 2013. The only providers exempt from this requirement are those who enrolled or revalidated on or after March 25, 2011.

Medicare providers are typically required to revalidate enrollment information every five years, but the new initiative will require many providers to revalidate sooner. It is important to note that any healthcare provider who receives a revalidation request from their Medicare contractor is required to furnish all necessary information within 60 calendar days of the request. CMS specifies that providers must wait to receive a revalidation notice from their Medicare contractor and should not revalidate until they receive such notice. Failure to submit the enrollment forms as requested may result in the deactivation of Medicare billing privileges.

CDC Infection Prevention Recommendations for Outpatient/Ambulatory Settings

2011-07-27T15:57:00.002-04:00

CDC Infection Prevention Recommendations for Outpatient/Ambulatory Settings

CMS to host call on ICD-10 implementation

2011-07-14T09:20:00.002-04:00

The Centers for Medicare & Medicaid Services (CMS) will host a National Provider Call entitled "ICD-10 Implementation Strategies for Physicians" on Wednesday, August 3, 2011 from 1-3 pm ET. The call is part of the agency’s ongoing efforts to prepare the physician community for the upcoming transition to the ICD-10 code set scheduled to take effect Oct. 1, 2013.

Participants must register for this call by Aug. 2 or before available space has been filled.

Members can find more information about the transition to ICD-10 on the CMS Web site.

E-Prescribing Frequently Asked Questions

2011-06-29T16:21:00.002-04:00

ERxFAQ.pdf

Medicare to offer more waivers from e-prescribing penalty

2011-06-29T11:08:00.003-04:00

Washington -- Physicians who see Medicare patients would have more opportunities to avoid being penalized for failing to prescribe medications electronically by a June 30 deadline under a proposed rule from the Centers for Medicare & Medicaid Services.

The proposed revisions would provide relief to eligible physicians who do not expect to report at least 10 paperless drug orders to CMS by June 30. Medicare will penalize doctors for failing to meet 2011 e-prescribing requirements by reducing payments by 1% in 2012. On May 26, the Medicare agency said it would give doctors a second chance to avoid the penalty after the deadline. It would allow physicians who did not meet the minimum reporting requirements to claim one of several hardship exemptions through a special website by October 1st, 2011.

The proposed rule also would apply to physician practices that already have adopted certified electronic medical record systems in an effort to earn Medicare or Medicaid meaningful use bonuses. Those practices could use those systems to satisfy the e-prescribing requirements as well. Under the current program, practices that use certified EMRs to send paperless drug orders will satisfy the e-prescribing requirement as long as the system meets four specific functionalities. If the proposed rule is finalized later this year, certified EMRs will be acceptable for e-prescribing in future reporting years even if they don't technically meet the four specific functionalities.

In addition to the expanded hardship exemptions, the revised language on the certified EMRs was a change requested by members of organized medicine, including the American Medical Association. Physicians complained that because the requirements for the e-prescribing incentive program and the EMR meaningful use incentive program were different, some paperless practices were concerned that they would need to buy and use a stand-alone e-prescribing system to avoid the 1% reduction in 2012.

"Eliminating unreasonable penalties and burdensome requirements, and providing physicians with more flexibility through an exemption process, will help ensure more physicians are able to successfully participate in the e-prescribing incentive program," said AMA President Cecil B. Wilson, MD. "The AMA has continually stressed to CMS that these changes were essential and is pleased to see them become a reality in a rule that will be finalized later this summer."

The Medical Group Management Assn. also was pleased with the proposed rule. However, some practices already had taken special steps earlier this year just to avoid the penalty -- actions that now have become unnecessary, said Anders Gilberg, MGMA's vice president of public and private economic affairs.

Some groups used temporary e-prescribing software, independent of their EMRs, and discarded the systems after reporting the minimum 10 e-prescribing encounters per physician. Others, such as some surgery practices, struggled to find ways to prescribe medications during office visits just so they would not be penalized in 2012.

"It's unfortunate it took until almost June for the proposed rule to come out," Gilberg said.

Expanded hardship exemptions

Approximately 109,000 to 209,000 physicians and other health care professionals could be eligible to file for hardship exemptions to the e-prescribing penalty by Oct. 1, CMS said in the proposed rule. The Medicare agency has proposed developing a special website for doctors and others to claim one of several hardships. CMS would approve the claims on a case-by-case basis, said Michael Rapp, MD, director of the CMS Quality Measurement and Health Assessment Group.

The initial rules had provided only two hardship exemption categories -- for physicians who practiced in rural areas with limited high-speed Internet access or for those who worked in areas with a limited number of pharmacies that accept electronic drug orders. CMS had required one of these exemptions to be reported before June 30.

The proposed rule would allow doctors to choose from these two hardships as well as four new exemptions on the website by the October deadline. The site would go live sometime after the rule is finalized in August, Dr. Rapp said.

The expanded list of hardship exemptions would include:

Physicians who register to participate in the Medicare or Medicaid EMR incentive program, and adopt and use certified EMR technology by the 2011 deadline.

Physicians who cannot prescribe enough drug orders electronically due to local, state or federal laws, such as those prohibiting paperless orders for narcotics.

Physicians with limited prescribing activity.

Physicians with insufficient opportunities to report the e-prescribing measures because the types of patient visits they claim are not eligible under the program.

"There will be an opportunity for physicians to indicate that they feel that they fit, and are requesting to be classified, in one of these hardship categories," Dr. Rapp said. "Then those individuals would be taken off the list to be 'subject to the negative payment adjustment.' "

Those who report that they e-prescribed 10 times before June 30 automatically would not be subject to the 2012 penalty, Dr. Rapp added. Of that subset, those physicians who report 25 e-prescribing encounters by Dec. 31 would receive a 1% bonus in 2012, assuming they do not opt instead for a Medicare bonus for meaningful EMR use in 2011.

More regulatory relief on the way?

The softening of the e-prescribing requirements is part of the Obama administration's initiative to provide regulatory relief across the federal government. Dept. of Health and Human Services officials are considering revising several of its regulations over the next two years. CMS also will identify and address conflicting requirements between the Medicare and Medicaid programs.

An initial review of the rules has determined that some regulations appear to be redundant and unhelpful, said Jack Lew, director of the White House Office of Management and Budget.

"It will be asked if some of these actually benefit patients or are they a matter of bureaucratic, anachronistic rules," Lew said.

The Medicare agency already has gathered input on revising potentially burdensome rules identified by the AMA and other members of organized medicine. They include:

Requirements to provide translators for Medicare and Medicaid patients with hearing impairments or limited English proficiency.

Misaligned incentive programs, such as EMR meaningful use and the physician quality reporting system.

Overlapping claims reviews by auditors, such as Medicare administrative contractors and recovery audit contractors.

Various Medicare documentation requirements.

The prohibition on the use of Medicare consultation codes.

Burdensome Medicare enrollment requirements.

ADDITIONAL INFORMATION:

Are you already exempt?

Only certain physicians and other health professionals are eligible to earn Medicare electronic prescribing bonuses. For those eligible, failure to e-prescribe in 2011 will trigger a 1% payment reduction in 2012, unless they also obtain special hardship waivers. Medicare defines an eligible professional as meeting all three of the following criteria:

Is a physician, nurse or therapist with prescribing privileges as of June 30.

Has at least 100 instances of eligible patient encounters for e-prescribing, such as an office evaluation and management visit, between Jan. 1 and June 30.

Has at least 10% of total Medicare charges associated with eligible patient encounters.

How to comment

The Centers for Medicare & Medicaid Services will accept comments on the proposed changes to the Medicare electronic prescribing incentive program until July 25. Comments can be submitted:

Online by following the instructions for submitting comments (www.regulations.gov). Enter keyword CMS-3248-P for the document file code.

By regular mail addressed to Centers for Medicare & Medicaid Services, Dept. of Health and Human Services, Attn: CMS-3248-P, P.O. Box 8013, Baltimore, MD 21244-8013.

For the full text of this article in it's original context click HERE

Avoiding the 2012 Medicare e-prescribing penalties

2011-06-16T08:29:00.003-04:00

As the 2012 e-prescribing deadline looms, we continue to receive member questions on how to avoid the penalties by submitting the necessary 10 e-prescriptions per eligible provider for Medicare patients by the June 30th deadline. As practices prepare to accomplish this goal, keep in mind the following:

Refills- Do they count?

The Centers for Medicare & Medicaid Services (CMS) recently clarified that refills that are submitted electronically for an eligible patient visit (see the CMS list of eligible cases) in association with a unique face-to-face patient encounter will count for the purposes of the e-prescribing program reporting requirements.

Are there any exclusions related to the 2012 penalties?

Providers may be excluded from the penalties if one of the following situations applies:
• A provider was new to Medicare prior to June 30th
• Less than 10% of your Medicare charges for services rendered Jan. 1- June 30, 2011 are associated with one or more of the eligible patient visits
• A provider has billed Medicare for less than 100 instances associated with one or more of the eligible patient visits for services rendered Jan. 1-June 30, 2011
Do e-prescriptions for over the counter drugs count?

CMS recently posted an FAQ stating that e-prescriptions for over the counter drugs that are medically necessary will count for the purposes of the e-prescribing program reporting requirements.

Do we need to enroll to participate and/or report?

No! Simply start reporting the G-code (G8553) in association with an eligible patient visit on CMS 1500 claim forms for Medicare patients. Remember, to avoid the 2012 penalty each eligible provider will need to report at least 10 e-prescriptions for Medicare patients by June 30, 2011 on claims associated with an eligible patient visit.

ACO White Paper-Provider Education

2011-06-02T13:52:00.003-04:00

ACO White Paper-Provider Education (PDF)

HPI Comments On ACO Draft Regulations

2011-06-02T13:31:00.005-04:00

Click below to read HPI's response the CMS ACO draft regulations.

HPI Comments on ACO Draft Regulations (PDF)