Health Care Compliance Watch : New York Health Care Compliance Lawyer & Attorney : Ilana Sable : NY Physician Representation Law

Primary care practices (including family medicine, pediatrics, internal medicine and OB/GYN) located in under-served NYC communities may be eligible to receive a $4,000.00 grant toward an eClinicalWorks EHR software package.  The grant is administered by the New York Department of Health and Mental Hygiene in support of its Primary Care Information Project ("PCIP").

PCIP is a New York City grant program that was developed to promote "prevention-oriented EHR's" among providers who care for NYC's under-served and vulnerable populations.  Primary care practices that are eligible for, and receive, the EHR grant will be required to participate in certain quality improvement efforts, including quality reporting and linkage to public health information systems.

While the $4,000.00 grant money will not cover the entire cost of running an EHR based practice, it is enough to cover the initial conversion costs ( including eClinicalWorks EHR licensing, staff training and 2 years of maintenance and support).  In addition, by converting to EHR, primary care practices may become eligible for the financial incentives available under other government programs, including the ARRA.

eClinicalWorks EHR has recieved 2008 CCHIT certification (the most current certification offered by CCHIT) and, as with all other EHR software, it remains to be seen whether it will receive the upcoming CCHIT ARRA certification.

• Email This
• Print
• Comments
• Trackbacks

The Certification Commission for Health Information Technology ("CCHIT"), a non-profit organization that independently certifies health information technology, has put together a preliminary ARRA certification criteria for EHR (pdf) that it believes will meet the requirements for receiving EHR financial incentives available under the ARRA.

Currently, CCHIT is the only Department of Health and Human Services ("HHS") recognized certifying body.  As such, it will likely determine which EHR software will enable providers to make  "meaningful use" of their EHR when HHS publishes the final definition of  "meaningful use." When the definition is published, certification will be necessary for providers to receive the financial incentives available under the ARRA. 

The preliminary guide focuses on Ambulatory and In Patient EHR, and promises ongoing updates as more information becomes available. 

• Email This
• Print
• Comments
• Trackbacks

As an update on the progress that Health and Human Services (“HHS”), in conjunction with the Centers for Medicare and Medicaid Services (“CMS”) and the National Coordinator for Health Information, is making toward defining “meaningful use," HHS is reporting that the proposed rule (defining “meaningful use”), is targeted for publication in late 2009.
 

On a related issue, recently, I have been receiving an increasing number of questions from readers wondering whether their practices will be among those eligible for incentive payments under the ARRA.  My response has always been, and remains, that these questions can not be answered until the exact definition of "meaningful use" is fleshed out.  However, in the interim, HHS has defined "eligible professional" in the following ways:

For the Medicare Incentives:

A physician as defined in section 1861(r) of the Social Security Act, which includes the following five types of professional:

1. Doctor of medicine or osteopathy
2.  Doctor of dental surgery or medicine
3. Doctor of podiatric medicine
4. Doctor of optometry
5. Chiropractor

For the Medicaid Incentives:

• Physicians
• Dentists
• Certified nurse-midwives
• Nurse Practitioners
• Physician Assistants who are participating in Federally Qualified Health Centers or Rural Health Clinics led by physician assistants.

I hope that helps to clear up some of the confusion.

• Email This
• Print
• Comments
• Trackbacks

While it is difficult to pinpoint the exact areas that Recovery Audit Contractors ("RACs") will look to recover improper payments, it is worthwhile to review the current CMS Approved Audit Issues and use them as guidance for internal reviews and self-auditing.

Diversified Collection Services, covering Region A (including New York and New Jersey), lists:

• Pharmacy Supply and Dispensing Fees
• Wheelchair Bundling
• Urological Bundling

as the CMS Approved Audit Issues for Region A, and providers billing the codes that accompany these audit issues between October 1, 2007 - present may undergo an automated review (where no medical record is involved in the review) for overpayments.

The CMS Approved Audit Issues for the other three regions are as follows:

Although the audit issues vary among each region, the overall focus of CMS is important to study because it explains the manner of billing that providers must avoid.  Where, in the past, billing errors may have gone unnoticed, the advent of RACs will force providers to diligently research and review their billing and coding prior to submission for payment.    

• Email This
• Print
• Comments
• Trackbacks

After reading a recent article posted by Angela Boynton, a frequent and informative writer with the American Academy of Professional Coders, titled "The Cost of ICD-10 Implementation," I am left wondering who will, realistically, finance the cost of conversion to ICD-10.  In the article, Angela cites a study conducted by the The Medical Group Management Association which predicts astronomical ICD-10 implementations costs.  The study found that, on average, it would cost :

• $84,000.00 for the average small physician practice to upgrade to ICD-10;
• $3,000,000.00 for large practice implementation;
• $500,000.00 - $14,000,000.00 for health plans, depending on size.

While the article does not go into details regarding the scope and time frame for the projected costs (i.e. Are these "lifetime" costs or one-time conversion costs?  Do these costs include new equipment, software, technical support, training and so forth?), it is clear that the health care industry will be addressing more than the burden associated with training and education.

However, I am not sure that these figures are accurate, nor that they will be paid by the health care providers.  For instance, if a small physician practice is currently leasing billing software, or working with a medical billing company, wouldn't these service providers absorb most of the conversion costs?  

My assumption is that current ICD-9 billing and coding software can easily be converted to, or updated for, ICD-10 functionality and compatibility.  And even if my "easily converted" assumption is wrong, isn't it in the service providers' best interest to keep the costs to the end users - like small physician practices - as low as possible so that they can retain  their client base?

As for those practices that use in-house billing and coding software that they own, it is probably best to hold off and buy a comprehensive software that incorporates ICD-10 billing and coding, and a certified electronic health records system ("EHR").  Most practices will be expending money for the EHR software no matter what happens with ICD-10, so waiting for one unified system will likely be the most cost effective approach.  The problem for these practices is that they will be pressed to purchase the EHR software much sooner than ICD-10 will be in use.

• Email This
• Print
• Comments
• Trackbacks

In an effort to identify improper Medicare payments and fight fraud, waste and abuse in the Medicare program,  The Centers for Medicare & Medicaid Services ("CMS") awarded contracts to four permanent Recovery Audit Contractors ("RAC's").  The national RAC program is the outgrowth of a successful demonstration program that used RAC's to identify Medicare overpayments and underpayments to health care providers and suppliers in California , Florida , New York , Massachusetts , South Carolina and Arizona . The demonstration resulted in over $900 million in overpayments being returned to the Medicare Trust Fund between 2005 and 2008, and nearly $38 million in underpayments returned to health care providers. 

• Overpayments can occur when health care providers submit claims that do not meet            Medicare’s coding or medical necessity policies.
• Underpayments can occur when health care providers submit claims for a simple procedure but the medical record reveals that a more complicated procedure was actually performed.

Health care providers that will be reviewed for overpayments and underpayments include: hospitals, physician practices, nursing homes, home health agencies, durable medical equipment suppliers, and any other provider or supplier that bills Medicare Parts A and B.

On October 6, 2008, CMS announced the names of the new national RACs. The new RACs are:

• Diversified Collection Services, in Region A, initially working in Maine, New Hampshire, Vermont,  Massachusetts, Rhode Island and New York. 
• CGI Technologies and Solutions, in Region B, initially working in Michigan, Indiana and Minnesota.
• Connolly Consulting Associates, in Region C, initially working in South Carolina, Florida, Colorado and New Mexico.
• HealthDataInsights, in Region D, initially working in Montana, Wyoming, North Dakota, South Dakota, Utah and Arizona.

Additional states will be added to each RAC region in 2009.

The RACs will be paid on a contingency fee basis on both the overpayments and underpayments they find. Contingency Fees are as follows:

• Region A - 12.45%
• Region B - 12.50%
• Region C -   9.00%
• Region D -   9.49%

• Email This
• Print
• Comments
• Trackbacks

On July 29, 2009, the Federal Trade Commission ("FTC") announced that it would redouble its efforts to educate small business (including most health care providers) about compliance with the "Red Flags" Rule by providing additional resources and guidance to clarify whether businesses are covered by the Rule, and what they must do to comply. In the spirit of this effort, the FTC has decided to further delay enforcement of the Rule until November 1, 2009.   

I suspect that many health care providers subject to the Red Flag's Rule would not have been in compliance on the original August 1, 2009 enforcement date, and therefore still need to put together a compliance program.  The good news is that compliance is relatively easy and will take very little time to complete.  I recommend reviewing the FTC's newly added Red Flag's Rule: "Frequently Asked Questions" section to determine if your business is subject to compliance under the Rule.  If so, see the FTC's compliance template (pdf) for businesses at low risk for identity theft.  It is short, straightforward and simple to use.

• Email This
• Print
• Comments
• Trackbacks

Under the Office-Based Surgery Law, enacted in 2007, all New York State medical practices that perform invasive procedures and surgery requiring more than mild sedation were required to obtain accreditation by a nationally recognized body designated by the Commissioner of Health no later than July 14, 2009.

Currently, accreditation is available through the following agencies:
• Accreditation Association for Ambulatory Health Care (AAAHC)
• American Association for Accreditation of Ambulatory Surgery Facilities, Inc. (AAAASF)
• The Joint Commission (TJC)

For those practices that did not receive accreditation by the July 14, 2009 deadline (even if an accreditation application was filed prior to the deadline), procedures involving moderate or deep sedation or liposuction involving the removal of 500 cc of fat or more cannot be performed until the accrediting agency has conducted an inspection and found the practice to be in compliance with the accrediting agencies office-based surgery standards.  Unaccredited medical practices that perform office-based surgeries falling under the scope of the Office-Based Surgery Law after July 14, 2009 should bear in mind that they are at risk of being found guilty of professional misconduct.

For an up-to-date list of accredited Office-Based Surgery practices in New York State, please visit the NYS Department of Health website.
 

• Email This
• Print
• Comments
• Trackbacks (1)

The FTC has posted a compliance template (pdf) for businesses at low risk for identity theft, such as most health care providers.  The template allows business owners to design their own Identity Theft Prevention Program in accordance with the FTC Red Flags Rule, and consists of two relatively easy to use parts. 

Part A helps users determine if their business is at low risk, and Part B helps users design a written Identity Theft Prevention Program if their business is in a low risk category.

However, like any other compliance regulation, the purpose of the Red Flags Rule is not to inflict more paperwork on affected businesses; its purpose is to foster meaningful use of effective identity theft prevention programs.  At minimum, health care providers must actually adhere to the programs that they develop, and train their employees accordingly.

Remember, the implementation date for the Red Flags Rule is August 1, 2009!
 

• Email This
• Print
• Comments
• Trackbacks