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Hello,
CMS warns
medical practices: Beware of faxed requests for practice account
information
The
Centers for Medicare & Medicaid Services (CMS) has warned medical
practices to be on alert for a fax scam. Individuals posing as Medicare
carriers or Medicare Administrative Contractors send faxes to medical
groups instructing them to provide account information update within 48
hours to prevent a gap in Medicare payments. The faxes may bear the CMS
logo and/or the contractor logo to enhance the appearance of authenticity.
CMS
warns all providers to be wary of such fax requests. If your organization
receives one, contact your contractor before submitting any information.
Your group should only send account information to Medicare
contractors using the information in the download section of CMS.gov:
www.cms.hhs.gov/MLNGenInfo/
or www.cms.hhs.gov/MedicareProviderSupEnroll.
Government
takes first step in defining meaningful-use requirement for EHR incentives
The
Health Information Technology Policy Committee (HITPC) work groups and the
Office of the National Coordinator for Health Information Technology (ONC)
announced the first set of draft criteria that eligible professionals will
have to meet to qualify for the electronic health record (EHR) incentives
included in the American Recovery and Reinvestment Act of 2009
(ARRA). To qualify for up to $44,000 in Medicare incentives or up to
$63,750 in Medicaid incentives, eligible professionals must be “meaningful
users” of an EHR.
The
HITPC committee mandated that providers meeting meaningful-use goals
for 2011 must:
- Provide
access to comprehensive patient health data for the patient’s health
care team
- Use
evidence-based order sets and computerized patient order entry (CPOE)
- Apply
clinical decision support at the point of care
- Generate
lists of patients who need care and use them to reach out to patients
(e.g., reminders, care instructions)
- Report to
patient registries for quality improvement, public reporting, etc.
- Provide
patients and their families with data needed to manage care
- Ensure
privacy and security protection
The
committee also proposed more stringent requirements for 2013 and 2015. An
official from the Centers for Medicare & Medicaid Services (CMS)
indicated that to continue qualifying for the incentives, eligible
professionals must have EHRs that comply with the escalating requirements.
CMS will issue specifics on the incentive programs — including the final
definition of meaningful use — through a formal rule-making process. The
agency should issue regulations before the end of the year.
Read
a complete list of the draft meaningful-use recommendations.
Visit
the ONC Web site.
Urge
Congress to repeal the Medicare physician payment formula right now!
Providers
treating Medicare patients will see their Medicare reimbursement cut an
estimated 21.5 percent in 2010 unless Congress intercedes. The Medical
Group Management Association (MGMA) needs you to contact your members of
Congress today and tell them to finally repeal the flawed Medicare
physician payment policy before Congress uses it as the basis for health
care reform. Use the MGMA
Advocacy Center and tell Congress to instead use a method that accurately
reimburses physician practices for the costs of providing quality care to
Medicare beneficiaries.
Congress
is currently considering various reform proposals. E-mail
your senators and representative today to ensure they repeal the flawed
sustainable growth rate formula.
Find
current information at the MGMA
Health Care Reform Resource Center.
CMS
makes two PQRI announcements
The
Centers for Medicare & Medicaid Services (CMS) recently announced that 74
clinical registries qualified to participate in Medicare’s 2009
Physician Quality Reporting Initiative (PQRI), an impressive increase
compared with the 2008 PQRI, which had 32 qualified registries. Registries
indicated their interest in the 2009 PQRI by sending a self-nominating
letter to CMS. The agency then subjected the registries to a vetting
process. Registries are required to send CMS all PQRI information no later
than Feb. 28, 2010.
In a
separate announcement, CMS indicated that it will archive the 2007 PQRI
feedback reports on June 30. Originally posted in July 2008 on www.qualitynet.org/pqri,
the 2007 archived reports will not be available to 2007 PQRI participants.
Remember,
your practice may begin participating in the 2009 PQRI on July 1 via
one of these reporting options:
- Claims-based
– Report on one measures group for 80 percent of applicable Medicare
Part B patients for each eligible professional (including a minimum of
15 patients during the reporting period)
- Registry-based
– Report on at least three PQRI measures for at least 80 percent of
applicable Medicare Part B patients
- Registry-based
– Report on one measures group for 80 percent of applicable Medicare
Part B patients of each eligible professional (including a minimum of
15 patients during the reporting period)
FTC
settles complaint against failed “messenger model” IPA
The
Federal Trade Commission (FTC) reached a proposed settlement agreement with
a California multispecialty independent practice association (IPA) for
price-fixing, collective bargaining and having its member physicians
refrain from individual negotiations with payers. The charges stem from
negotiations that the IPA entered into on behalf of its member physicians
with health plans for fee-for-service medical care.
While
IPAs and their physician members may legally adopt a “messenger model” in
which the IPA acts as a conduit between physician members and health plans,
the FTC claims the California IPA’s actions did not conform to this model.
Instead, the IPA engaged in collective bargaining, making proposals and
counterproposals and accepting or rejecting offers without consulting its
physician members, and without transmitting payers’ offers to its physician
members. The FTC maintained that the physicians were competitors because
they were not clinically integrated and did not engage in financial
risk-sharing. As a result, the actions of the IPA violated federal
antitrust laws because they restrained prices and other forms of
competition in the area. The complaint also alleged that the IPA tried to
impede competition by one of its major competitors by refusing to serve its
fee-for-service patients.
The
settlement, in the form of a proposed consent order, is open for public
comment until July 6. The FTC will review public comments before the
settlement is finalized.
Read the
proposed
consent order (with instructions on submitting comments).
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