|
Hello,
In
this issue
MGMA expresses serious concern over latest
“meaningful use of EHR” definition
The
Medical Group Management Association (MGMA) expressed serious concern to
the Office of the National Coordinator for Health Information Technology
(ONC) over the latest draft set of criteria that eligible professionals
will have to meet in order to qualify for the Medicare and Medicaid
electronic health record (EHR) incentive programs.
The
American Recovery and Reinvestment Act of 2009 (ARRA) stipulates that 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. ONC recommended a series of increasingly stringent meaningful use
requirements between 2011, the first “payment year” of the subsidy program,
and 2015. In 2015, eligible professionals who are not meaningful EHR users
will face decreased Medicare payments.
In its
letter, MGMA highlighted concerns regarding:
- The need for
practice administrators and others with “real-world” EHR experience to
be formally consulted by ONC during the process of defining
meaningful use;
- The
requirement that practices use computerized patient order entry (CPOE)
for all orders;
- The
inclusion of inappropriate administrative measures;
- The overly
burdensome, escalating criteria in 2013 and 2015;
- The lack of
specialty-specific quality measures; and
- The
requirement that forces physician practices to rely on patient actions
and third-party compliance in order to qualify for the incentives.
MGMA
also recommended that:
- ONC give
physician practices the option of self-certifying that their system
meets the meaningful use criteria; and
- That ONC
name the Certification Commission for Health Information Technology (CCHIT)
the official certification entity.
The
government will finalize the meaningful use definition and outline the
specifics of the EHR incentive program in a regulation that we expect later
this year.
Read the
latest
MGMA letter on the latest meaningful use criteria.
Complete
text of the most
recent draft definition of meaningful use [PDF].
Visit
the ONC
Web site.
OIG
releases coding audit, recommends CMS action
The
Department of Health and Human Services Office of Inspector General (OIG)
released a report of an audit of Medicare Part B claims conducted in 2005
and 2006. The audit focused on services coded as office services but that
occurred on the same date that the same beneficiary received related
outpatient hospital or ambulatory surgical center (ASC) services. Because
physicians receive a higher reimbursement rate for office-based (as opposed
to outpatient hospital or ASC) services, the OIG sought to learn whether
the office was the correct site of service for these claims.
The OIG
identified 857,911 claims and sampled 150 of them. It found that physicians
incorrectly coded 121 of the 150 services listed. Based on these sample
results, the OIG estimates that it overpaid physicians by $20.2 million for
incorrectly coded services. It recommended that:
- The Centers
for Medicare & Medicaid (CMS) review the additional claims
identified but not sampled and attempt to recover any overpayments;
and
- CMS
strengthen its outreach efforts to physicians and work with its
contractors to develop a process to identify services at a high risk
of being miscoded.
In its
response to the OIG report, CMS agreed to attempt to collect overpayments
if it deemed the effort cost-effective. It agreed to implement the OIG’s
other recommendations and provide overcoding information to the Medicare
Recovery Audit Contractors. The contractors will then determine whether
reviews are warranted on claims made on or after Oct. 1, 2007.
Read the
OIG’s
executive summary and report.
CMS
announces J7 MAC
The
Centers for Medicare & Medicaid Services (CMS) recently awarded the J7
Medicare Administrative Contractor (MAC) contract to Trailblazer Health
Enterprises LLC. J7 covers Arkansas, Louisiana and Mississippi. Trailblazer
also serves as the MAC for J4, covering Colorado, New Mexico, Oklahoma and
Texas.
CMS
originally awarded the contract to Pinnacle Business Services in June 2008.
However, a protest was filed with the Government Accountability Office
(GAO) in July 2008. GAO upheld the protest and recommended corrective
actions. CMS then took corrective action regarding certain aspects of the
initial award decision.
More
from CMS on the awarding of the J7
MAC contract [PDF].
More
from MGMA
on Medicare contracting reform.
|
