On behalf of the Healthcare Business Management Association (HBMA), we appreciate the opportunity to provide observations and comments about the proposed rules for the Merit-based Incentive Payment System (MIPS) and the requirements for approval as an Advanced Alternative Payment Model as required by the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA).
Ober | Kaler Health Law Alert: 2016 Issue 10
| MEDICARE/MEDICAID ENROLLMENT
New CMS Final Fire Safety Regulations The Centers for Medicare and Medicaid Services has finalized an update to the fire safety regulations that govern Medicare and Medicaid participating health care providers. The updated fire safety rules, which affect a broad range of provider types, incorporate the 2012 editions of the National Fire Protection Association’s Life Safety Code and Health Care Facilities Code, with some specific qualifications. Howard Sollins discusses the application of the updated fire safety regulations and highlights the more notable requirements. Click to continue… EMPLOYMENT The Final Overtime Rule – Is It Really that Simple? The DOL has stated that it has updated the overtime regulations “to simplify the identification of overtime-eligible workers, thus making it easier for employers and workers to understand and apply.” Is it really that simple? Ober|Kaler Employment Group attorneys Donna Glover and Jennifer Curry conducted a webinar to explain the changes in the Final Rule, discuss why it is important to start preparing now, and provide participants with strategies for complying with the Rule. A recording is posted here… NEWS Ober|Kaler has been ranked as a leading law firm in Health Care and Construction by The Legal 500 in its 2016 edition. More… |
| Health Law Alert® is not to be construed as legal or financial advice, and the review of this information does not create an attorney-client relationship.
Ober|Kaler also offers Payment Matters, which focuses on Medicare and Medicaid payment issues. Subscribe here. Copyright© 2016, Ober, Kaler, Grimes & Shriver Ober|Kaler |
Ober | Kaler Health Law Alert – 2016 Issue 9
OCR Clarifies Parameters of Covered Entities’ Fees for PHI Copies In recently released guidance, the Office for Civil Rights (OCR) offers covered entities insight into what fees may be charged to individuals when providing them with copies of their own protected health information (PHI), without hampering any individual’s right to access such PHI. The overarching theme of the OCR guidance is protection against potential barriers to individuals’ PHI access, but, as Emily Wein, Howard Sollins and Hannah Clark discuss, the OCR guidance focuses on a number of specific issues, such as what costs may be passed on to the individual for PHI copies. Further, state law and HIPAA can intersect in this area, which Emily, Howard and Hannah demonstrate in a detailed example. Click to continue… FRAUD AND ABUSE OIG Approves Wholly Owned Group Purchasing Organization In OIG Advisory Opinion 16-06, the OIG approved the restructuring of a group purchasing organization’s ownership such that the GPO would be wholly owned by the same corporate parent as some of the GPO’s health care provider members. Bill Mathias and Christopher Dean summarize the OIG’s review of the proposed arrangement, including its qualifications for protection under the anti-kickback statute’s exceptions and safe harbors for GPOs and for discounts. Click to continue… EMPLOYMENT The Final Overtime Rule – Is It Really that Simple? The DOL has stated that it has updated the overtime regulations “to simplify the identification of overtime-eligible workers, thus making it easier for employers and workers to understand and apply.” Is it really that simple? Ober|Kaler Employment Group attorneys Donna Glover and Jennifer Curry conducted a webinar to explain the changes in the Final Rule, discuss why it is important to start preparing now, and provide participants with strategies for complying with the Rule. A recording is posted here… |
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| Health Law Alert® is not to be construed as legal or financial advice, and the review of this information does not create an attorney-client relationship.
Ober|Kaler also offers Payment Matters, which focuses on Medicare and Medicaid payment issues. Subscribe here. Copyright© 2016, Ober, Kaler, Grimes & Shriver Ober|Kaler |
HBMA Washington Report – May Issue
Washington Report – May, 2016
(Covers activity between 5/1/16 and 5/31/16)
Bill Finerfrock, Matt Reiter, Nathan Baugh, Alex Ehat and Carolyn Bounds
- HBMA GR Committee Preparing Comments on MACRA Proposed Rule
- House Ways and Means Committee Passes Bill Tweaking Several Hospital Payment Policies
- Misery Loves Company – Push to Expand RAC Program Gaining Steam
- HHS Wants to Make Medical Bills Easier for Patients to Understand
- Insurers Submit 2017 Health Exchange Premium Rate Proposals
- HHS Clarifies Rules on Charging Patients for Medical Records
- DOL Increases Threshold for Overtime Payment Eligibility for Salaried Employees
- CMS Releases Interim Final Rule in Effort to Save Remaining CO-OPs, Addresses SEPs
- HHS Regulatory Agenda Allows CMS to Delay Part B Drug Reimbursement Proposal
- Aetna and Humana Remain Confident About Merger Despite New Challenges
- House Committee Holds Hearing on Medicare and Medicaid Program Integrity
- Congress Working to Pass Opioid Addiction and Abuse Legislation
- ONC Publishes Data on Hospital EHR Utilization and Interoperability
- Congress Divided on How to Address Zika Virus
- CMS Transmittals
Dear Doctor, We Don’t Care If You Don’t Get Paid Promptly
By Holly Louie, RN, CHBME
The story that I am going to relate could borrow a line from the movie When Harry Met Sally. Sally is sobbing and says she is going to be 4o. When Harry asks when, Sally responds, “Some day!” And that is our punch line to this story.
There has been so much talk about how smoothly ICD-10 has gone. No big surprises, no significant increase in claims denials, cash flow not significantly disrupted. But wait! Let’s talk about the forthcoming CMS announcement about just one National Coverage Decision absolute disaster. This is not an isolated problem, but the best example I know of how bad it can get, how quickly it can snowball and how long providers are expected to just wait for payments.
On February 5, 2015, CMS issued a National Coverage Determination (NCD) for screening for lung cancer with low dose computed tomography (LDCT). There is no doubt this was a very good decision. However, at that time, CMS did not provide any instructions regarding CPT, HCPCS or diagnosis codes that would be covered under this policy, or any methodology to bill for the services. That would be released, “some day”. In spite of pressure from numerous organizations, the HCPCS code was not released until the 2016 fee schedule was published in the final quarter of 2015. The date providers could begin billing the code was January 1, 2016. It was bad enough to wait almost a full year to bill for all the legitimate, medically necessary services provided to Medicare beneficiaries, but the other shoe was about to drop.
For those not in the radiology space, the policy covers people who smoked in the past or who are current smokers, as long as other specified criteria are met. When the covered diagnosis codes in ICD-9 and ICD-10 were published in October, it was immediately obvious that CMS had completely omitted the diagnosis codes for current smokers. (See MM9246) In spite of the fact that this error was brought to the attention of CMS, and they agreed there was a significant omission, they responded that it would be addressed at their earliest convenience. This omission was incorporated in the applicable Medicare manuals, NCD and other transmittals and instructions.
Communications with CMS over the past week have resulted in the promise of a forthcoming transmittal that will explain how and when corrections will be made. Because NCDs are only updated quarterly and because CMS was already working on the quarterly updates well into 2016, the earliest we can expect corrections for claims is in the July 2016 publication, possibly to be implemented in October. Ladies and Gentlemen, that is 1 full year plus either 5 or 8 months before any correct adjudication will begin. Will claims need to be resubmitted or will they be reprocessed? There will need to be overrides for timely filing and other operational realities. Will the providers also have to bear that burden?
No one expected CMS to implement the myriad changes required by ICD-10 error free. Mistakes happen. But this system is broken and it needs to be fixed. Once a coverage decision has been made, the mechanism for submitting claims and receiving correct payment should be in place before issuing notices. Holding claims for 11 months is not ok. Correction of egregious, or even minor errors, should certainly not take 6 months or longer. Prompt interim instructions should be implemented to allow claims submission and correct adjudication and payment as soon as the error is known.
It seems to me we have a double standard. When a Medicare contractor wants something there is a very short time line to respond or suffer the consequences. When CMS has errors, there is apparently no clock for resolution or concern for the providers who cannot get paid for treating Medicare beneficiaries. In this case, we can expect payment, “some day.”
Holly Louie, RN, CHBME, is the compliance officer for Practice Management Inc. and the 2016 HBMA president.