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Hello,
FTC maintains
stance on "Red Flags" rule
The
Medical Group Management Association (MGMA) and a number of other health
care associations have expressed concerns to the Federal Trade Commission
(FTC) about the application of the agency’s "Red Flags" rule to
health care providers. The Red Flags rule regulates “creditors” and is part
of the FTC’s implementation of the Fair and Accurate Credit Transactions
(FACT) Act of 2003. It requires creditors who maintain “covered accounts”
to implement an identity-theft prevention program that uses Red Flags,
which the FTC defines as indicators of a possible risk of identity theft.
The FTC
said last fall that it considers health care providers to be creditors
within the meaning of the rule if they do not require a patient to make
payment in full at the time of service. This would include, for example,
practices that bill insurance companies before requesting payment from the
patient. While the rule was originally scheduled to take effect on Nov. 1,
2008, advocacy efforts by MGMA and other medical associations resulted in a
six-month delay in enforcement until May 1, 2009.
In a
letter responding to the health care community, the FTC maintained its
stance that health care providers are creditors under the rule. It further
stated that, “iven the risk-based nature of the Rule’s requirements, as a
practical matter, however, we do not believe that the Rule would impose
significant burdens for most providers.” As an example, it stated that in
low-risk practices, an appropriate program might involve checking photo
identification and having policies to deal with the theft of a patient’s
identity (including not trying to collect the debt from the patient and
separating the medical records of the real patient from those of the
identity thief).
MGMA and
99 other associations and medical societies objected to this interpretation
and to the agency’s rulemaking process. Because the FTC notification that
providers are deemed “creditors” came so late, the health care community
was not able to provide meaningful comments on the rule, as would normally
be the case in a rulemaking process.
While we
will continue to pursue these advocacy efforts, we have also prepared
additional guidance, based on the FTC’s rule and subsequent communications
to help explain the rule’s requirements.
Read the
FTC’s
letter to the health care community.
Read the
health care community’s response.
Read MGMA’s
Red Flags guidance based on the FTC’s rule and subsequent
communications (an MGMA member benefit).
Availity
and Emdeon join Humana, UnitedHealth Group in supporting MGMA’s Project
SwipeIT
Availity,
LLC, a leading health information network, and Emdeon, one of the nation’s
largest providers of revenue and payment cycle solutions, announced their
support of the Medical Group Management Association’s (MGMA’s) Project
SwipeIT. The initiative is intended to advance the adoption of standardized
patient identification (ID) cards containing compliant, machine-readable
information by Jan. 1, 2010. MGMA estimates that machine-readable patient
ID cards could save physician offices and hospitals as much as $1 billion a
year by improving administrative efficiencies and reducing the number of
denied claims. Machine-readable patient ID cards are designed to provide
real-time patient information at the point of care. Cards complying with
the standards developed by the Workgroup for Electronic Data
Interchange will ensure uniformity of information, appearance, and
technology.
These
vendors join two of the nation’s largest health plans, Humana and
UnitedHealth Group, which have already signed the pledge to begin offering
their customers standardized, machine-readable patient ID cards. In
addition, America’s Health Insurance Plans (AHIP), the trade association
representing thousands of commercial health insurance companies, and
numerous state MGMA and physician specialty organizations have also signed
the SwipeIT pledge. MGMA encourages all members to go to www.swipeit.org
and join the more than 315 individual medical groups that have pledged
their support for this important administrative simplification
initiative.
CMS
identifies problems with some 2009 PQRI measure codes and posts partial
2008 PQRI aggregate data
Late
last week the Centers for Medicare & Medicaid Services (CMS) made two
announcements pertaining to the Physician Quality Reporting Initiative
(PQRI).
First,
CMS disclosed that some of its claims-processing contractors are not
prepared to recognize 20 quality data codes used for 13 PQRI
measures. This problem affects PQRI claims-based reporting only and
causes some of the PQRI reported information to be rejected. CMS
expects to resolve this issue by April and offers affected providers two
options to minimize any adverse impact on reporting in the 2009 PQRI.
You can
access a detailed list of problematic measures and more information on the CMS
site, but in summary, breast and colorectal cancer, nuclear medicine,
preventative care, rheumatoid arthritis, hepatitis C, endoscopy and
wound-care measures are affected.
Second,
CMS posted a preliminary 2008
PQRI Quality-Data Code Submission Error Report, which is an
aggregate and per-measure report on codes submitted between Jan. 1, 2008,
and Sept. 30, 2008. Those 2009 PQRI participants can use this
information to identify commonly made reporting errors by 2008 PQRI
participants.
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Mar. 3, 2009
- FTC maintains stance on "Red Flags" rule
- Availity and Emdeon join Humana, UnitedHealth Group in
supporting MGMA’s Project SwipeIT
- CMS identifies problems with some 2009 PQRI measure codes
and posts partial 2008 PQRI aggregate data
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