Healthcare Legal
Meaningful Use Incentive Payments Due To Begin In May 2011
Aug 12th
The Centers for Medicare and Medicaid Services (CMS) will begin issuing the first of the “meaningful use” incentive payments available under the HITECH Act in May 2011, according to a senior CMS official.
Karen Trudel, Deputy Director for CMS’ Office of E-Health Standards & Services, told Healthcare IT News that registration will open in January 2011. From then on, healthcare providers will be required to demonstrate “meaningful use” for a period of 90 days in order to be eligible for the incentive bonuses offered under the Act.
Due to the required 90-day demonstration period, “no one will be able to attest before April,” said Ms. Trudel at July 28 meeting of the federal advisory Health IT Standards Committee. “The first payments will go out in the middle of May.”
In order to receive the incentive payments, hospitals and physicians are required to have a National Provider Identifier (NPI) and must also be enrolled in CMS’ PECOS (Provider Enrollment, Chain and Ownership System). A majority of providers will also be required to register with the National Plan and Provider Enumeration System (NPPES).
Any questions regarding the incentive program can be directed to CMS and ONC. For more information, please click here
Medicare Part D ‘Donut Hole’ To Be Closed By 2020
Aug 12th
Under the current Medicare regime, seniors enrolled in the Medicare Part D drug plan for 2010 are not only required to pay a $310 deductible, they must also pay 25% of their drug costs until the total reaches $2,830 for the year. After that, Medicare recipients are liable for drug costs until their yearly out-of-pocket expenses exceed $4,550. At that point, the coverage gap ends and recipients are only responsible for the higher of a designated copay amount ($2.40 for generic drugs and $6.00 for other drugs) or 5% of their drug costs. This Medicare coverage gap is also referred to as the “donut hole.”
The healthcare reforms issued by President Obama’s administration include provisions for closing the donut hole. Pursuant to these reforms, seniors in the coverage gap will receive a $250 rebate from Medicare in 2010. In 2011, seniors in the donut hole will be given a 50% discount on brand name prescription drugs and a 7% discount on generic prescription drugs.
Those numbers will steadily rise in the next few years until they reach 75%. By 2020, the Medicare Part D coverage gap will effectively end, making Medicare recipients responsible for only 25% of the costs.
The closing of the Medicare donut hole is one of the first significant accomplishments of the Obama administration’s healthcare reforms. According to the Department of Health and Human Services, an estimated 4 million seniors will receive $250 rebates this year.
For more information, please click here.
DEA Establishes Final Rule on E-Prescribing of Controlled Drugs
Aug 12th
The Drug Enforcement Administration (DEA) has announced its interim final rule for electronic prescribing of controlled substances. The rule became effective on June 1, 2010, and it may be amended in the future depending on public comment.
Pharmacy organizations have been working with the DEA for more than a decade to draft rules for electronic prescriptions of controlled substances. According to the American Pharmacists Association (APhA), e-prescribing for controlled substances will likely not happen for at least another year. Nonetheless, the proposed rules are practical for pharmacists, prescribers and the DEA.
The DEA’s new rule manages electronic prescribing for both controlled and non-controlled pharmaceutical products, whereas before pharmacies were required to keep a paper-and-fax workflow for prescribing controlled substances. The rule also reduces the electronic record-keeping requirement from 5 years to 2 years and eases verification procedures.
Prior to the release of the DEA’s final rule, federal regulations prohibited the use of e-prescribing for controlled substances due to abuse and security concerns. The rule takes the first step in alleviating what many saw as a substantial impediment to the adoption of e-prescribing. Accordingly, the rule is expected to increase the number of providers adopting healthcare IT systems.
Some obstacles that will have to be overcome in e-prescribing for controlled substances are verifying digital signatures, standardizing procedures to change the strength (or any element) of a prescription and standardizing procedures to transfer prescriptions. The DEA will also need to establish whether it will standardize identifiers that prescribers use to write prescriptions for controlled substances.
For more detailed information on the DEA’s new rule, please click here.
CMS Determined To Simplify Collections Of “Meaningful Use” Incentives For Providers
Aug 11th
The Centers for Medicare and Medicaid Services (CMS) has announced the expansion of its Medicare Provider Enrollment system. The expansion will make it easier for physicians and medical practices to register for Medicare and take advantage of the “meaningful use” incentives offered under the Health Information Technology for Economic and Clinical Health Act (HITECH Act).
Under the HITECH Act, providers that can demonstrate “meaningful use” of a certified EHR will become eligible for substantial bonuses (in excess of $44,000). To qualify for the bonuses, providers must satisfy 15 core requirements and an additional 5 requirements that they can choose from a “menu” of 10. Hospitals must comply with 14 core requirements and an additional 5 “menu” requirements in order to qualify.
CMS has provided a $1.6 million contract to CGI Federal, Inc. to develop the necessary supplementary functions for its Internet-based Provider Enrollment, Chain and Ownership System (PECOS), which manages, tracks, and validates the enrollment of providers and suppliers in the Medicare program. The Internet-based PECOS replaces the CMS paper enrollment application and enables providers to view or change enrollment information,
track enrollment applications through the web submission process, add or change a reassignment of benefits, submit changes to existing Medicare enrollment information, reactivate an existing enrollment record and withdraw from the Medicare Program. According to the Federal Business Opportunities website, the modification of the PECOS system will take about 10 months.
The U.S. Department of Health and Human Services issued the final rule on what constitutes “meaningful use” of an EHR in mid-July. To view the final rule, click here.
To view MTBC’s free webinar on the final “meaningful use” requirements, or to obtain more information on this topic, please click here.
Physicians May Legally Waive Coinsurance Relative To 2.2% Medicare Pay Increase
Jul 15th
The recently enacted law that temporarily replaces a 21.3% cut in Medicare reimbursement rates with a 2.2% increase also retroactively increases what patients owe in coinsurance. However, according to the Office of Inspector General (OIG), physicians can legally waive the additional amount owed under the increased rate. The 2.2% raise came into effect on June 25th but retroactively covers any Medicare services rendered on or after June 1st.
According to Medicare policies, it is mandatory for physicians to collect the entire 20% coinsurance amount from Medicare patients. Physicians who fail to collect the full amount owed risk violating federal fraud and abuse laws. The OIG’s waiver of this requirement with respect to the 2.2% increase provides relief for physicians who do not have the time or resources to go through the trouble of collecting the extra coinsurance amount due under the new rate. In many instances, the administrative cost associated with billing the patient exceeds the cost of the additional coinsurance amount.
According to the policy statement issued by the OIG, providers “will not be subject to OIG administrative sanctions if they waive retroactive beneficiary liability.” However, the statement also contains several conditions applicable to the waiver:
- Physicians waiving the additional coinsurance amount should offer the waiver to all of their affected Medicare patients;
- Physicians should not offer the waiver as part of any advertisement or solicitation; and
- Physicians should calculate and collect coinsurance based on the new payment rates going forward.
The OIG policy statement does not apply to waivers of beneficiary cost-sharing amounts that were calculated using the prior lower payment rates, nor does it apply if the waivers are conditioned in any manner on the provision of items, supplies or services.
Questions regarding the new policy statement can be directed to James Cannatti III, Senior Counsel in the Office of Counsel to the Inspector General, at (202) 619-0335.