Where GOP Presidential Hopefuls Stand On Health Care
Sep 13th
Kaiser Health News has assembled a helpful chart detailing where five of the declared candidates for the Republican presidential nomination – Bachmann, Hutsman, Paul, Perry and Romney – currently stand on major health care issues. The chart is sorted by issue and will be updated as the candidates continue to develop their platform. Definitely worth a look.
http://www.kaiserhealthnews.org/Stories/2011/August/26/GOP-candidate-health-care-platforms.aspx
Christine Salimbene, Vice President & General Counsel
Ms. Salimbene joined MTBC in 2009 as General Counsel, Vice President and Company Secretary. She and her team focus on mitigating business risk and ensuring compliance with all legal requirements.
New EHR-sharing plan introduced by Highmark
Aug 22nd
The Pittsburgh Tribune-Review (8/20, Nixon) reports that Pennslyvania’s largest health insurer, Highmark Inc., “is developing its own network to allow doctors and hospitals across Pennsylvania to easily share electronic health records.”
Although Highmark “is not ready to release details of the network, known as a health information exchange, such as cost or the hospital systems or software provider involved” a spokesman for the insurer said the network “is planned to be available to hospitals and doctors across the state.”
Highmark is Pennsylvania’s largest health insurer with more than 4 million members in the state.
As discussed in a previous post, the federal government is pushing exchanges and electronic medical records as ways to reduce medical errors, prevent duplicative treatment and reduce costs. The Tribune- Review reports that the anticipated interoperability of the exchanges with electronic medical records are “envisioned as being analogous to the world’s banking system, in which bank transactions are performed electronically and easily occur between different institutions.” Additionally, “[a]n exchange would allow a doctor to quickly pull medical records for a patient he or she is treating, no matter where that patient may have been treated in the past.”
For more information:
http://www.pittsburghlive.com/x/pittsburghtrib/business/s_752483.html#ixzz1VmhYvU00
Christine Salimbene, Vice President & General Counsel
Ms. Salimbene joined MTBC in 2009 as General Counsel, Vice President and Company Secretary. She and her team focus on mitigating business risk and ensuring compliance with all legal requirements.
Affordable Care Act Rules to Prevent Fraud: How Increased Vigilance Will Affect Your Practice
Aug 17th
If you are wondering how the new healthcare law – the Affordable Care Act – will affect your practice, you are not alone. Providers across the country are trying to understand the implications that this new law will have on reimbursements and the practice of medicine. Well, because the public is clamoring for my opinion on this matter, I will embark on a series of blog posts dedicated solely to the different provisions of the Affordable Care Act. You’re welcome.
One of the most important features of the Affordable Care Act is the increased measures designed to weed out fraud and abuse in the healthcare system. Whatever your opinion on this new law is, we can all agree that prosecuting and preventing healthcare fraud is a noble goal. In keeping with the spirit of preventive care in the Affordable Care Act, the anti-fraud measures of the law focuses on the prevention of fraud by identifying and remedying the sources of abuse. We have yet to see the law in full action but a reading of the statute appears to combat fraud with a broad stroke. For example, the law includes the following:
More detailed credentialing process- CMS will be scrutinizing Medicare, Medicaid and the new Children’s Health Insurance Program (“CHIP”) provider applications a little more closely to prevent fraud from even occurring. To this end, CMS states that certain types of providers (read- DMEs and “Pain Management”) will receive special attention.
New enrollment process for Medicaid and CHIP- Each individual State will be responsible for screening providers for enrollment in Medicaid and CHIP. The States will be on the lookout for providers who have been excluded from Medicare or another State’s Medicaid program. If this evidence is discovered, the provider will be barred from enrollment in Medicaid and CHIP in any State.
Temporary stop of enrollment if patterns of fraud are detected- Medicare will be borrowing new strategies from the credit card industry to identify patterns of fraud. If a pattern is discovered, all provider enrollment will be stopped until the fraud is remedied. Providers can be affected due to their geographic location or type of practice.
Payments stopped during investigation- If there is a “credible allegation of fraud”, CMS will stop all payments to a provider during the investigation process. The investigation process could take several months and would be a disaster for a practice alleged to have committed fraud.
Although these features of the new healthcare law are designed to prevent wide scale abuse of the healthcare system, they are broad and aggressive enough to potentially affect honest providers. Remember that laws are like cobwebs, which may catch small flies, but let wasps and hornets break through. Therefore, it is wise for your practice to understand these new anti-fraud countermeasures and how they could potentially affect your practice.
Thanks for reading and be sure to continue to follow my posts on the Affordable Care Act.
If you would like more information, check out CMS’s website at http://www.hhs.gov/news/press/2011pres/01/20110124a.html.
Brendan P. Harney, Associate General Counsel
Mr. Harney joined MTBC in 2010 as an Associate General Counsel. His practice mainly focuses on healthcare compliance regulations including HIPAA and state privacy laws.