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Archive for the ‘NATIONAL HEALTHCARE NEWS’ Category
« Older Entries |The New Medicare Physician Fee Schedule
Monday, March 12th, 2012
Posted in MEDICARE UPDATES, NATIONAL HEALTHCARE NEWS | No Comments »
Revised Medicare fee schedule for January 1, to February 29, 2012 is up on-line
Friday, January 6th, 2012
The revised Medicare fee schedule for January 1, to February 29, 2012 is up on-line at:
Please be sure to review your correct NYS payment locality.
Again, as you should know, CONGRESS voted on at least five (5) separate Medicare Physician Fee Schedules for calendar year 2010. This caused the Medicare contractors to reprocess physicians’ claims for the first 5 months of the 2010 year and resulted in some peculiar recovery actions. Please use the following link to locate your elected officials and contact them to urge that 2010 not be repeated: http://www.mssny.org/mssnyip.cfm?c=s&nm=Grassroots_Action The Medicare fee schedule needs to be properly addressed. Fixing the flawed Medicare payment system and protecting Medicare beneficiaries’ access to doctors is vital. Congress must pass legislation permanently reforming the SGR and address this issue once and for all. The pattern of threatened SGR cuts and last-minute Congressional rescues is in itself not a sustainable solution and must be remedied.
Regina
Regina McNally, VP
Division of Socio-Medical Economics
Medical Society of the State of New York
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Agreement Ends Stalemate on SGR Cuts
Tuesday, December 27th, 2011
Below is a press statement issued by House Speaker Boehner, announcing that the House and Senate have reached agreement on a two month extension of important policies that expire on January 1, including a reprieve from the 27.4 percent Medicare physician payment cut that is scheduled to take effect. Legislators plan to approve this proposal before Christmas, and a House-Senate conference committee will convene in January to work on a longer-term agreement. At a press conference, Speaker Boehner said the goal is to extend all the expiring programs for a full year, except for the physician payment cut reprieve which is to be extended for two years.
In a press statement released today, the AMA urged Congress to use this time constructively and develop the permanent solution to the sustainable growth rate formula that all agree is needed.
WASHINGTON, DC – House Speaker John Boehner (R-OH) today issued the following statement:
“Senator Reid and I have reached an agreement that will ensure taxes do not increase for working families on January 1 while ensuring that a complex new reporting burden is not unintentionally imposed on small business job creators. Under the terms of our agreement, a new bill will be approved by the House that reflects the bipartisan agreement in the Senate along with new language that allows job creators to process and withhold payroll taxation under the same accounting structure that is currently in place. The Senate will join the House in immediately appointing conferees, with instructions to reach agreement in the weeks ahead on a full-year payroll tax extension. We will ask the House and Senate to approve this agreement by unanimous consent before Christmas. I thank our Members – particularly those who have remained here in the Capitol with the holidays approaching – for their efforts to enact a full-year extension of the payroll tax cut for working families.”
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Posted in MEDICARE UPDATES, NATIONAL HEALTHCARE NEWS | No Comments »
Update on the SGR and 2012 Medicare Physician Payments
Wednesday, December 21st, 2011
Dateline : December 20, 2012,
The House of Representatives held a series of votes regarding H.R. 3630, legislation that would extend an expiring payroll tax reduction and unemployment insurance benefits, as well as stop a 27.4 percent Medicare physician payment cut that is scheduled to take effect on January 1. The net result was to leave the status of 2012 payment rates in limbo.
Votes on H.R. 3690: As originally passed by the House on December 13 by a vote of 234-193, the legislation would have provided Medicare physician payment updates of 1 percent a year for two years, followed by a return to the current negative trend line produced by the sustainable growth rate (SGR) formula. But, due to disagreements over financial offsets and other policy issues unrelated to the SGR, the legislation could not attract a sufficient number of votes to pass the Senate.
On December 17, the Senate voted 89-10 to pass an amended version of the bill that would extend all the expiring policies, including current Medicare physician payment rates, for two months. The rationale for the short-term extension was to avoid disruptions on January 1 and provide time for further negotiations on financing longer-term extensions.
House action on December 20: Following the Senate’s action, a significant number of House Republicans expressed strong opposition to the two-month extension, and several relevant votes were scheduled for today. Most important of these, the House approved a resolution by a vote of 229-193 to disagree with the Senate and appoint members to a House-Senate conference committee, which would be charged with working out differences between the two versions of the bill.
Prior to the House votes today, the Senate leadership announced that the Senate would not reconvene over the holidays to engage in further negotiations and votes. In addition, members of the House are departing this evening for the holidays, after being informed that they could be called back to Washington on short notice. At this time, it does not appear likely that the outstanding issues will be resolved before January 1.
Outlook for January: On December 19, the Centers for Medicare and Medicaid Services announced that it would hold claims for 2012 physician services for 10 business days, until January 17, to avoid processing payments at the lower rate. After that date claims will be processed on a first in, first paid basis at the reduced rates until the situation is resolved.
The House is currently scheduled to return to Washington on January 17, while the Senate is scheduled to return on January 23. However, there are reports that the House, at least, may move up the date of its return to January 3.
AMA views: The AMA issued strong statements following the House and Senate votes reaffirming its opposition to any short-term patches to the SGR formula, denouncing the political brinkmanship that left the issue unresolved until Congress was adjourning, and calling for a bipartisan effort to repeal flawed and disruptive formula once and for all.
Throughout the year, the AMA has been pursuing a strategy for repealing the SGR that was developed in consultation with state medical societies and national medical specialty societies. We continued to oppose short-term remedies that serve to make future cuts deeper and the cost of permanent payment reform increasingly steep. And, throughout the year, bicameral and bipartisan support has been expressed in Congress for permanently addressing the Medicare physician payment crisis. Nonetheless, physicians and their patients once again find themselves confronting uncertainty and instability. It is long past time for Congress to act decisively and protect access to care for senior citizens and military families that rely on TRICARE—they and their physicians deserve better.
The AMA will provide additional updates on the status of the 2012 payment rates as events unfold. With the expectation that Congress will be in recess, we will defer any new grassroots messaging between now and the New Year. New grassroots messages will be available after January 1 or if Congress decides to return to Washington between the holidays. The AMA’s latest grassroots messages can always be viewed at www.ama-assn.org/go/grassroots, and physicians can reach their federal legislators by telephone using our toll-free physician’ grassroots hotline number: 1-800-833-6354.
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New Incentives for Providers to Work Together Through Accountable Care Organizations
Monday, October 24th, 2011
HHS Announces New Incentives When Caring for People With Medicare
New tools help doctors and other healthcare providers improve quality of care
Thu Oct 20 – People with Medicare will be able to benefit from a new program designed to encourage primary care doctors, specialists, hospitals, and other healthcare providers to coordinate their care under a final regulation issued today by the Department of Health and Human Services (HHS). Created by the Affordable Care Act, these final rules on Accountable Care Organizations add to the menu of options for providers looking to better coordinate care for patients and will make it easier for providers to deliver high quality care and use healthcare dollars more wisely.
The initiatives announced today are just two of several efforts made possible by the Affordable Care Act to help bring better health, better care and lower costs not just to Medicare beneficiaries, but to all Americans. For example, the Bundled Payments for Care Improvement Initiative and Comprehensive Primary Care Initiative offer alternatives to coordinate and improve healthcare.
The two initiatives launched today – the Medicare Shared Savings Program and the Advance Payment model – will help providers form Accountable Care Organizations and reflect the significant input provided by stakeholders as well as lessons learned by innovators in care coordination in the private sector.
- The Medicare Shared Savings Program will provide incentives for participating healthcare providers who agree to work together and become accountable for coordinating care for patients. Providers who band together through this model and who meet certain quality standards based upon, among other measures, patient outcomes and care coordination among the provider team, may share in savings they achieve for the Medicare program. The higher the quality of care providers deliver, the more shared savings the providers may keep.
- The Advance Payment model will provide additional support to physician-owned and rural providers participating in the Medicare Shared Savings Program who also would benefit from additional start-up resources to build the necessary infrastructure, such as new staff or information technology systems. The advanced payments would be recovered from any future shared savings achieved by the Accountable Care Organization.
The Shared Savings Program final rule is posted at: http://www.ofr.gov/OFRUpload/OFRData/2011-27461_PI.pdf.
The CMS press release is available at: http://www.cms.gov/apps/media/press/release.asp?Counter=4132.
The Advanced Payment solicitation is posted at: http://innovations.CMS.gov/areas-of-focus/seamless-and-coordinated-care-models/advance-payment/.
For more information, fact sheets are posted at: http://www.HealthCare.gov/news/factsheets/2011/10/accountable-care10202011a.html and http://www.CMS.gov/ACO/.
The joint CMS and HHS Office of Inspector General (OIG) Interim Final Rule with Comment Period addressing waivers of certain fraud and abuse laws in connection with the Shared Savings Program is posted at: www.OFR.gov/inspection.aspx.
The Antitrust Policy Statement is posted at: www.FTC.gov/opp/aco/ and http://www.justice.gov/atr/public/health_care/aco.html.
The Internal Revenue Service (IRS) Fact Sheet, Tax-Exempt Organizations Participating in the Medicare Shared Savings Program through Accountable Care (FS-2001-11), will be posted at: http://www.IRS.gov.
For additional information you may view the CMS Fact Sheets (10/20) posted at: https://www.CMS.gov/apps/media/fact_sheets.asp
Federal Register Links:
ACOs: http://www.ofr.gov/OFRUpload/OFRData/2011-27461_PI.pdf
Stark Waivers: http://www.ofr.gov/OFRUpload/OFRData/2011-27460_PI.pdf
Advanced Payment: http://www.ofr.gov/OFRUpload/OFRData/2011-27458_PI.pdf
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Problem with September 2011 Influenza Vaccine Pricing
Thursday, October 20th, 2011
Description of the Problem
For dates of service in September 2011, influenza vaccinations are being priced using the 2010-2011 influenza season rates.
What This Means to You
Providers are receiving incorrect payment for influenza vaccination claims. If you identify influenza vaccinations where you were paid incorrectly, please hold your appeal requests. As soon as the pricing files are updated you will be notified and you may request an adjustment of your claims. Until the new pricing files are uploaded National Government Services cannot reprocess any claims. If you have not already submitted your influenza vaccinations for September, please consider holding your claims until the new pricing files are in effect.
Current Status
10/20/2011: National Government Services is aware of this issue and is working in collaboration with the Centers for Medicare & Medicaid Services (CMS) in order to rectify the pricing disparity as soon as possible. Thank you for your patience.
National Government Services, Inc.
Corporate Communications
Posted in FLU/IMMUNIZATION UPDATES, MEDICARE UPDATES, NATIONAL HEALTHCARE NEWS | No Comments »
URGENT NOTICE – Compliance deadline Jan.1, 2012
Thursday, October 20th, 2011
2011 Version of Advance Beneficiary Notice of Noncoverage Must Be Used Beginning Sun Jan 1, 2012
Only 10% of the NGS’ Medicare provider volume has tested their HIPAA Version 5010 claims on an individual basis. If you bill electronically, please be sure that you or your billing vendor, clearinghouse or service provider has successfully tested your claims submission before the January 1, 2012 deadline (i.e. the first two weeks of December). Please make sure, by asking them, if you have not asked them, already. Not doing so will have serious negative cash flow implications – your claims will not be paid. If you do not have an Administrative Simplification Compliance Act (ASCA) waiver, you will not be permitted to default to paper claim filing.
In May 2011, CMS released an updated version of the Advance Beneficiary Notice of Noncoverage (ABN) (form CMS-R-131), which will replace the 2008 version of this form. The 2011 version contains no substantive changes from the 2008 version of the notice and was approved by the Office of Management and Budget. The 2008 and 2011 ABN notices are identical except that the release date of “3/11” is printed in the lower left hand corner of the new version. The ABN is used by all providers, practitioners, and suppliers paid under Medicare Part B, as well as hospice providers and religious non-medical healthcare institutions (RNHCIs) paid exclusively under Part A.
When the 2011 ABN was posted to the CMS website on Mon May 16, CMS announced a mandatory use date of Thu Sep 1 and permitted providers and suppliers to begin using the new form immediately. Subsequently, we received requests from the industry to extend this deadline in order to permit providers and suppliers with pre-printed stockpiles of ABNs time to exhaust their supplies.
Providers and suppliers are allowed to use either the 2008 or 2011 version of the ABN through the end of this year; beginning Sun Jan 1, 2012, they must begin using the 2011 version. ABNs issued after Sun Jan 1 that are prepared using the 2008 version of the notice will be considered invalid by Medicare contractors. 2008 versions of the ABN that were issued prior to Sun Jan 1 as long-term notification for repetitive services delivered for up to one year will remain effective for the length of time specified on the notice.
Information and a copy of the 2011 version of the ABN (form CMS-R-131) can be found online at http://www.CMS.gov/BNI, under the “FFS Revised ABN” link.
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Responding to EMTALA as a Member of the Medical Staff
Tuesday, October 18th, 2011
Considerations for Medical Staff Bylaws
Professional Discipline • Litigation and Arbitration • Contracts and Business Transactions • White Collar Crime Regulatory Compliance • Practice Formation • Mergers and Acquisitions • Asset Protection and Estate Planning Medical Financial Audits
The Emergency Medical Treatment and Labor Act (EMTALA) requires hospitals with emergency departments (and Critical Access Hospitals) to provide a medical screening examination to any individual who comes to the emergency department and requests such an examination, and prohibits hospitals with emergency departments from refusing to examine or treat individuals with an emergency medical condition (EMC). The provisions of EMTALA apply to all individuals (not just Medicare beneficiaries) who attempt to gain access to a hospital for emergency care. The regulations define “hospital with an emergency department” to mean a hospital with a dedicated emergency department (ED) and define “dedicated emergency department” as any department or facility of the hospital that: (1) is licensed by the state as an emergency department; (2) is held out to the public as providing treatment for emergency medical conditions; or (3) on one-third of the visits to the department in the preceding calendar year actually provided treatment for emergency medical conditions on an urgent basis.
Enforcement of EMTALA is complaint driven, i.e., the investigation of a hospital’s policies and procedures, and any subsequent sanctions, are initiated by a complaint. CMS surveyors review the bylaws, rules, and regulations of the medical staff and the ED policies and procedures manual to help determine if a hospital is in compliance with EMTALA requirements. If the results of a complaint investigation indicate that a hospital violated one or more of the anti-dumping provisions of EMTALA, a hospital may be subject to termination of its provider agreement and/or the imposition of civil monetary penalties (CMPs). CMS refers cases it has investigated to the HHS Office of Inspector General (OIG) when CMS finds violations that appear to fall within the OIG’s EMTALA jurisdiction. CMPs may be imposed by the OIG against both the hospital and individual physicians for EMTALA violations. The OIG can also terminate a physician’s provider agreement for gross and flagrant or repeated EMTALA violations. A physician found to have violated EMTALA may also be sanctioned by the state licensing board, payors and other third-party entities, and be sued by the hospital for indemnification.
TO RECEIVE THE COMPLETE 19-PAGE REPORT, Contact the Nassau County Medical Society at nassaumed@verizon.net.
Tags: LEGAL SERVICES AND INFORMATION
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ACO Regulations are Released
Monday, April 11th, 2011
The Administration issued its long awaited Medicare Shared Savings/Accountable Care Organization (ACO) regulation on Mar. 31. The Medicare ACO program is a voluntary, three-year program to further develop the ACO model of health care delivery reform. The Centers for Medicare and Medicaid Services (CMS) issued the proposed regulation and comments are due on June 6. Prior to the release, CMS Administrator Don Berwick, MD, reached out to AMA leadership to emphasize the Administration’s interest in our comments. CMS and the Office of the Inspector General (OIG) also issued a joint solicitation of comments on proposed waivers for Medicare ACOs from the self-referral, anti-kickback, and civil monetary penalties statutes. The Federal Trade Commission (FTC) and the Department of Justice (DOJ) issued a proposed policy statement on antitrust and ACOs, and the Internal Revenue Service (IRS) issued a notice pertaining to tax-exempt entities, as well. All these agencies are providing opportunities for the public to comment. The AMA is reviewing the hundreds of pages of these documents in-depth and will be working with the Federation in developing comments.
The documents can be viewed at:
• CMS proposed rule on ACOs:
http://www.ofr.gov/OFRUpload/OFRData/2011-07880_PI.pdf
• CMS/ OIG notice on waiver designs:
http://www.ofr.gov/OFRUpload/OFRData/2011-07884_PI.pdf
• FTC/ DOJ notice on antitrust enforcement policy and ACOs:
http://www.ftc.gov/os/fedreg/2011/03/110331acofrn.pdf
• IRS notice on ACO participation by tax-exempt organizations:
http://www.irs.gov/pub/irs-drop/n-11-20.pdf
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Supreme Court: Medical Residents NOT Exempt from FICA Taxes
Tuesday, January 18th, 2011
On January 11, the US Supreme Court ruled unanimously that medical residents are not exempt from paying employment taxes under the Federal Insurance Contributions Act (FICA), and that medical residents should be considered employees when it comes to collecting Social Security taxes. This ruling in Mayo Foundation for Medical Education and Research v. United States will have a wide-ranging impact on health care and teaching hospitals and involves an estimated $700 million in employment taxes annually.
“The department certainly did not act irrationally in concluding that these doctors — ‘who work long hours, serve as high skilled professionals, and typically share some or all of the terms of employment of career employees’ — are the kind of workers that Congress intended to both contribute and benefit from the Social Security system,” said Chief Justice John Roberts, who wrote the opinion for the court.
Under the Social Security Act, medical residents were exempt from FICA taxes under an exception carved out for those performing services “in the employ of…a school, college, or university…if such service is performed by a student who is enrolled and regularly attending classes at such school, college or university.” However, Mayo officials argued that residents fall under a Social Security tax exemption for student employees whose work is part of their education. The Treasury Department took away that exemption in 2004 for medical students who work more than 40 hours per week. Mayo Clinic officials wanted the court to overturn a federal appeals court ruling and restore the student exemption for medical residents. It also wanted a refund of the money it had withheld and paid to the IRS on its residents’ stipends during the second quarter of 2005.
In arguments before the Supreme Court, Mayo’s lawyer argued that the IRS’ decision that anyone who works over 40 hours a week at a hospital can no longer be classified as a student was arbitrary and capricious.
The Supreme Court decision is available at http://www.supremecourt.gov/opinions/10pdf/09-837.pdf
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