Posts tagged CMS
Almost $90m paid out to providers as MU incentives!
Oct 13th
The Centers for Medicare and Medicaid Services Office of E-Health Standards and Services announced yesterday that almost $90 million have been paid out to eligible practices and hospitals under the Meaningful Use EHR incentive program this past September. Robert Anthony, who made the announcement, said that $25 million of the total was paid out to 1400 medical providers and $61 million was paid out to 30 hospitals.
Last month, almost 17,000 eligible providers joined the list of 114,000 – including both hospitals and providers – that have registered for the Meaningful Use program, since its inception on Jan. 1, 2011. Since the program began, CMS has paid over $870 million in incentives, a total which likely reach “$1 billion by the end of this year,” Anthony said.
A number of MTBC’s clients have successfully received their Meaningful Use bonuses with more on the path to doing so. Utilizing MTBC’s state-of-the-art software, providers are able to keep track of their progress in fulfilling MU requirements.
While these figures from CMS are noted by Anthony to be the “earliest of the earliest” data, they do definitely provide proof of the ongoing success of the incentive program. All the thresholds have exceeded what CMS expected would happen this year, Anthony added. All in all, it’s a good sign that the healthcare community is embracing Meaningful Use.
Saad Sawar, Marketing & Communications Lead
Mr. Sawar joined MTBC in the summer of 2011 upon graduation from the University of Michigan. He and his team focus on the promotion of MTBC’s products and services in addition to augmenting MTBC’s nation-wide presence in the Healthcare IT industry.
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.
ICD-10 Info Series – Part 1
Aug 3rd
An old saying goes that “laws are like sausages, it is better not to see them being made.” The decision to transition from ICD-9 to ICD-10 by the Center for Medicare and Medicaid Services (CMS) is no exception to this saying and most likely the finished product will not be appetizing to most healthcare providers either.
To first comply with this regulation you must first know what it actually means to your practice. ICD-10’s goal is to assist providers in adapting to the changing and more detailed world of modern disease diagnosis. To accomplish this feat, ICD-10 will include almost 69,000 diagnosis codes compared to 13,000 ICD-9 codes. Many of these new codes reflect changes in medical diagnosis but the majority attempt to provide a more specific and in depth classification of existing aliments.
This transition will inevitably mean more cost to healthcare providers who must now find the regulation, understand it and implement a training regime so that their practices are in compliance. This burden is especially heavy on smaller practices that do not have the administrative infrastructure that larger practices and hospitals currently have in place.
Now you may believe that your practice is not subject to the new 1CD-10 codes or that you are immune because you receive reimbursement from only commercial insurance payers. Denial is always present when uncomfortable change is developing. Please take heed though, that all “covered entities” under HIPAA are subject to ICD-10. This includes healthcare providers, all payers (commercial and governmental) and other entities such as software vendors and billing companies. Denial is a necessary step to acceptance and eventually compliance.
CMS has set several deadlines for providers to comply with the new regulation. First, all electronic claims must conform to HIPAA transaction 5010 standards by January 1, 2012. This change establishes the technical groundwork for the use of ICD-10 codes, which become mandatory on October 1, 2013. If you are not a big believer in bureaucratic efficiency and believe that these dates will inevitably be extended (as they already were extended for 2 years in 2009), please note that CMS is adamant that there will be no further extensions to these deadlines.
To further buttress this point, CMS has even begun sponsoring training events such as the sardonically named Code-a-thon in April of 2011. CMS is also providing national provider conference calls and training materials to attempt a smooth transition from ICD-9. All evidence is pointing to CMS’s seriousness in this transition. Developing a plan for your practice now will blunt any of the hardships that will arise once full implementation of ICD-10 occurs in October of 2013. Because as with anything coming out of Washington, the devil is always in the details.
This is just Part 1 of my discussion on ICD-10 implementation.
Be sure to read my next blog post in which I will discuss the steps your practice can take to comply with 1CD-10.