Final Rule for Meaningful Use of Electronic Health Records Just Released!
Arizona Health-e Connection to Launch Series of In-Depth Meetings Across State on New Rule
On July 13, the Centers for Medicare & Medicaid Services (CMS) issued the Meaningful Use Final Rule for electronic health records (EHRs). The final rule defines the criteria that healthcare providers must meet to reach Meaningful Use and outlines payment methodologies for the Medicare and Medicaid incentive programs.
The Arizona Regional Extension Center, led by Arizona Health-e Connection (AzHeC) in collaboration with key partners (ASU’s Department of Biomedical Informatics, Health Services Advisory Group and the Purchasing & Assistance Collaborative for Electronic Health Records) is part of a $634 million ARRA/HITECH initiative to establish HIT Regional Extension Centers nationwide to assist primary care providers in adopting and becoming Meaningful Users of EHR systems. Arizona’s Regional Extension Center recognizes there are many challenges Arizona providers face and is committed to addressing those challenges when it opens its doors to begin assisting providers in early fall 2010.
In the coming weeks, the Regional Extension Center program will offer a series of statewide regional Meaningful Use meetings to provide in-depth information on the new rule. Meetings will be held in Flagstaff, Phoenix, Tucson and Yuma and are specifically geared toward healthcare providers and other healthcare professionals that will be impacted by Meaningful Use, although anyone is welcome and encouraged to attend. Please look for details soon!
The final rule, along with a number of summary resources on the final rule, are posted on AzHeC’s Website.
Learn More
Visit the AzHeC Website
Read Arizona’s Regional Extension Center: An Opportunity to Make Healthcare Higher in quality and Lower in Costs through Adoption of Electronic Health Records, an AzHeC Issue Paper
Sign-up to receive regular Regional Extension Center updates—please email ehr@azhec.org (subject line: Sign-up for REC updates)
Attend one of the Regional Meaningful Use meetings taking place in Flagstaff, Phoenix, Tucson and Yuma—Look for details soon!
Posted on June 25, 2010
House Agrees to Six Month Payment Fix Proposed by Senate
On Thursday, June 25, the House of Representatives approved a six-month Medicare physician payment bill 417-1. The Senate approved the bill late last week. The short-term fix, which would restore Medicare payment cuts that took effect June 18, was a last-minute addition to the House floor schedule Thursday afternoon. Once enacted by the President, physicians participating in the Medicare program will receive positive payment updates through November 30, 2010.
Posted on June 18, 2010
Senate reaches Medicare physician payment deal, House scheduled to vote next week
The Senate passed legislation on Friday, June 18th via a unanimous consent agreement blocking the 21.3 percent cut to Medicare physician payments until Nov 30. The House of Representatives must also vote on the matter and is expected to do so next week. If this bill becomes law, medical practices will receive a 2.2 percent increase to Medicare physician payment for claims with dates of service of from June 1 through Nov. 30.
Posted on June 16, 2010
Senate Fails to Enact Medicare Payment Fix
The United States Senate has failed to override a budget point of order on HR 4213, the American Jobs and Closing Tax Loopholes Act (HR 4213). This legislation would have helped preserve access to physicians for millions of Americans in Medicare until 2014 by preventing the impending 21.2% Medicare physician payment cut and replacing it with at least 1% positive updates until a permanent fix to the Sustainable Growth Rate formula could be found. With the Senate's failure to override the point of order, the bill will be scaled back dramatically, including rolling back the Medicare physician payment provisions. The American Osteopathic Association (AOA) now anticipate that the Senate will seek a freeze for six to seven months. We will keep AOMA members apprised of further developments.
CMS Delays Implementation of 21.3% Cut
Claims will continue to be held through June 17th
The Centers for Medicare and Medicaid Services has released the statement below regarding the Medicare physician fee schedule. Please note that the date for processing claims reflecting the 21% cut is now Friday, June 18.
The 2010 Medicare Physician Fee Schedule
The Continuing Extension Act of 2010, enacted on April 15, 2010, extended the zero percent (0%) update to the 2010 Medicare Physician Fee Schedule (MPFS) through May 31, 2010. At this time, Congress is debating the elimination of the negative update that took effect June 1, 2010. The Centers for Medicare & Medicaid Services (CMS) is hopeful that Congressional action will be taken within the next several days to avert the negative update.
To avoid disruption in the delivery of health care services to beneficiaries and payment of claims for physicians, non-physician practitioners, and other providers paid under the MPFS, CMS had instructed its contractors on May 27th to hold claims for services paid under the MPFS for the first 10 business days of June (i.e., through June 14, 2010). This hold only affects MPFS claims with dates of service of June 1, 2010, and later.
Given the possibility of Congressional action in the very near future, CMS is now directing its contractors to continue holding June 1 and later claims through Thursday, June 17, lifting the hold on Friday, June 18.
This action will facilitate accurate claims processing at the outset and minimize the need for claims reprocessing if Congressional action changes the negative update. It also should minimize the provider and beneficiary burdens and costs associated with reprocessing claims.
We understand that the delayed processing of Medicare claims may present cash flow problems for some Medicare providers. However, we expect that the delay, if any, beyond the normal processing period will be only a few days. Be on the alert for more information regarding the 2010 Medicare Physician Fee Schedule Update.
FTC extends deadline for Red Flags Rule
The American Osteopathic Association (AOA), the American Medical Association (AMA) and the Medical Society of the District of Columbia (MSDC) filed a lawsuit in federal court last week seeking to prevent the Federal Trade Commission (FTC) from extending identity theft regulations to physicians.
The complaint, prepared by the Litigation Center of the AMA and State Medical Societies, targets the contentious "Red Flags" Rule, which requires creditors to implement safeguards against identity theft. The medical societies charge that the FTC's rule exceeds the powers delegated to it by Congress and that its application to physicians is "arbitrary, capricious and contrary to the law."
At the request of Congress, the FTC has now delayed the enforcement of the "Red Flags" rule until December 31, 2010; the Red Flags rule was scheduled to go into effect on June 1. For more information on the delay, visit the FTC website.http://www.ftc.gov/opa/2010/05/redflags.shtm
Congress Adjourns without Ensuring SGR Cut is Prevented
The U.S. House of Representatives has approved the "American Jobs and Closing Tax Loopholes Act" (H.R. 4213), which includes Medicare physician payment provisions. The House considered the Medicare physician payment policy as an amendment to the underlying bill. The SGR amendment was approved 245-271. Fifteen Republicans voted for the amendment and 15 Democrats voted against the amendment. The vote on the complete package was 215-206.
The Medicare physician payment provisions provide a 2.2% positive payment update for 2010 and a 1% positive payment update for 2011. The formula would revert to current law in 2012.
Since the Senate has adjourned for the Memorial Day recess, they will not consider the bill until June 7 at the earliest. This means that the 21% cut will be implemented on June 1. The Centers for Medicare and Medicaid Services (CMS) has announced that they will - as allowed under current law - hold all claims for 10 business days. This affords the Senate additional time to enact H.R. 4213 and prevent the payment of claims reflecting the 21% cut.
Health Care Reform Enacted
On Sunday, March 21, 2010, the U.S. House of Representatives approved by a vote of 219 – 212 the Patient Protection and Affordable Care Act (PPAC) (H.R. 3590). President Obama signed the bill into law on Tuesday, March 23, 3010
The Senate approved the Health Care and Education Affordability Reconciliation Act of 2010 (H.R. 4872) by a vote of 56 – 43 on March 25, 2010 by a vote of 56-43.
Changes for patients:
Health care coverage will be extended to an additional 32 million Americans which dramatically increases access to care.
Health insurance plans will be required to offer dependent coverage for adult children through the age of 26 years.
If children have been accepted for coverage, or are already covered, the insurer cannot exclude payment for treating a particular illness. The full protection for children and adults with preexisting conditions will begin in 2014. (This is new information).
Medicare beneficiaries will receive $ 250 to cover expenses for medications to close the gap or donut hole whereby the beneficiaries previously had to pay their own drug costs.
Congress will address the sustainable growth rate formula in separate legislation this summer. Currently, physician payments are frozen at 2009 levels through March 31.
Primary Care Bonus Payments
All primary care physicians will be eligible for a 10% bonus in Medicare payments. To qualify, at least 60% of the physicians total Medicare charges must be comprised of office, nursing home, and home care visits.
2011 - 2016
General Surgery Bonus
Payments
General surgeons who perform major procedures in a health professional shortage
area will be eligible for a 10% bonus payment for those services. Major procedure is
defined as any service with a 10 or 90 day global payment.
2011 - 2016
Medicaid Payments
Raises Medicaid payments for evaluation and management (E&M) services to at least 100% of Medicare payment rates.
2013 - 2014
Geographic Payment
Adjustments
Establishes the “floor” on the work geographic practice cost indice (GPCI) at 1.0 for all localities for 2010. Medicare will begin making a separate adjustment for the practice expense portion of physician payments in 2010 and 2011. Increases the practice expense GPCI adjustment for physicians in North Dakota, Montana, South Dakota, Utah and Wyoming to the national average beginning in 2011.
2010
Medical Liability Reform
The Secretary of Health and Human Services (HHS) is authorized to award five-year demonstration grants to states to develop, implement and evaluate alternative medical liability reform initiatives, such as health courts and early offer programs. Medical liability protections under the Federal Tort Claims Act (FTCA) are extended to officers, governing board members, employees, and contractors of free health clinics.
2011
Community Health Centers
Funding for Community Health Centers increases by $11 billion to assist in providing care to uninsured and underinsured individuals.
2011
Prevention and Wellness
Medicaid will be required to cover tobacco cessation services for pregnant women beginning in 2010. Cost-sharing for preventive services is eliminated in Medicare and Medicaid programs beginning in 2011. Medicare payments for these preventive services will be increased to 100 percent of payment schedule rates. Health plans are required to provide a minimum level of coverage without cost-sharing for preventive services beginning in 2010.
2010
Mental Health Incentive
Payments
Medicare will increase payments for psychotherapy services by 5%.
2010
Administrative Simplification
National rules will be implemented to standardize and streamline health insurance claims processing requirements.
2013 - 2016
Insurance Reforms
Insurers are prohibited from denying coverage to children who have pre-existing conditions. Insurers are prohibited from placing lifetime limits on how much they pay out to individual policyholders and from rescinding coverage except in the case
of fraud. Adult dependent children up to the age of 26 are eligible for coverage under their parents or legal guardians’ insurance policies.
2010
Medicare Prescription Drug
Coverage
Medicare beneficiaries whose prescription expenses reach the so-called Medicare Part D coverage "doughnut hole" ($2,700 to $6,150) in 2010 will receive a $250 rebate.
2010
Coverage Mandates – Employers
Employers with more than 50 employees, with a minimum of one full-time employee, which receives a premium tax credit, are required to offer health insurance coverage to their employees or face penalties. Employers with 50 employees or less are exempt from this requirement.
2014
Coverage Mandate – Individuals
Most individuals are required to either purchase health care coverage or demonstrate
coverage through their employer or other program or face penalties.
2014
Medicaid Expansion
Low-income individuals under the age of 65 and at or below 133% of the federal
poverty level ($29,327 for family of four) are eligible for Medicaid coverage.
2014
Banner Health CEO Comments on Health Cuts
Peter Fine, CEO of Banner Health wrote a commentary published recently in the Arizona Republic. Mr. Fine discusses his concerns about the dramatic impact that the proposed cuts to the state budget for health entities will have. Click here to read the article.
Senate Approves Delaying Physician Pay Cut Until October 1
The Senate voted on March 11, 2010 to delay a 21.2% physician pay cut in Medicare reimbursement until October 1. Overall, the Senate approved a $138 billion package of legislation, including tax extenders and unemployment aid that the White House said is critically important to the country's economic recovery. The vote was 62 to 36.
On Tuesday, the Senate voted to limit the bill's debate, with President Obama saying he was "grateful to members of both parties that helped move forward on this bill, " said White House Press Secretary Robert Gibbs. The Senate included an amendment by Senate Finance Committee Chairman Max Baucus, D-MT, to the American Workers, State and Business Relief Act that would delay the Medicare payment cut for physicians—that was supposed to go into effect March 1— until October 1.
Congress Extends 2009 Medicare Pay Rates by 30 Days
The United States Senate has approved H.R. 4691, legislation that extends current Medicare physician payment policy until Mach 31. The vote on passage was 78-19. The bill was approved by the House of Representatives on February 26. The Senate vote ensures that the 21 percent cut in Medicare physician payments is averted for 30 additional days.
AOA President-elect Nichols testifies before House Doctors Caucus
AOA President-elect Karen J. Nichols, DO, participated in a Jan. 21 health care reform briefing hosted by the House of Representatives’ Doctors Caucus. After providing background information on the osteopathic medical profession, Dr. Nichols focused her testimony on physician work force, graduate medical education issues and student debt concerns. She urged lawmakers to maintain provisions in health care reform legislation that will create new training opportunities and clarify existing regulations governing non-hospital training. Click here to read her full testimony.
Arizona Osteopathic Medical Association
5150 N.16th St., Ste. A-122
Phoenix, AZ 85016
Phone: (602) 266-6699 Fax: (602) 266-1393 Contact Us
AOA President-elect Karen J. Nichols, DO, participated in a Jan. 21 health care reform briefing hosted by the House of Representatives’ Doctors Caucus. After providing background information on the osteopathic medical profession, Dr. Nichols focused her testimony on physician work force, graduate medical education issues and student debt concerns. She urged lawmakers to maintain provisions in health care reform legislation that will create new training opportunities and clarify existing regulations governing non-hospital training.