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Hello,
In
this issue
Participate
on a White House conference call on health reform
Tomorrow,
Aug. 25 at 8:30 p.m. Eastern time, the White House will conduct a
conference call on physician healthcare reform issues. To
participate, call 800.230.1096.
You can submit your questions ahead of the call by e-mailing public@who.eop.gov with the subject
line "Physician Health Insurance Reform Call." We will report the
outcome of the call in an upcoming MGMA
Washington Connexion.
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New
HIPAA privacy and security mandates: Enforcement begins in 30 days
The Department of Health
and Human Services released an interim final rule to implement provisions
of the American Recovery and Reinvestment Act (ARRA), also referred to as
the Stimulus Package. Several provisions of ARRA greatly expand the privacy
and security requirements for protected health information (PHI) under the
Health Insurance Portability and Accountability Act (HIPAA).
The newly released
regulations require a HIPAA covered entity to notify patients if their
unsecured PHI is disclosed because of a breach. The regulations detail the
requirements for notifying patients of a breach, including what constitutes
a breach, who must be contacted and how. These provisions take effect Sept.
23.
The breach notification
requirements set forth in the interim final rule are just one aspect of the
new privacy and security provisions set to go into effect. Other
provisions:
- Expand federal and state
enforcement authority;
- Increase penalties for
HIPAA violations;
- Add requirements for
business associates; and
- Broaden patients'
ability to restrict the disclosure of PHI and to receive accountings for
disclosures.
MGMA will update you on
these changes. We offer a Webinar to help you navigate these new
requirements:
"Are you ready for
the new HIPAA privacy and security mandates? Prepare your practice and
guard against increased penalties."
Register for the Webinar.
Medicare
contractors to conduct enrollment revalidation efforts within the next 30
days
On
Friday, Aug. 21, the Centers for Medicare & Medicaid Services (CMS) instructed
Medicare contractors to conduct limited enrollment revalidation efforts
before the end of the federal fiscal year. Within the next 30 days,
Medicare contractors will contact the top 50 Medicare Part B organizational
billers in each state that do not have both an established record in the
Provider Enrollment, Chain and Ownership System (PECOS) and an Electronic
Funds Transfer Agreement (CMS-588 form). Medicare contractors will also
contact individual practitioners who constitute the top 50 billers in each
state. Medicare contractors will determine top billers by the dollar value
of claims submitted within either the previous quarter or calendar year.
These organizations and individuals will be required to complete the
appropriate Medicare provider enrollment applications (CMS-855 forms) or
use Internet-based PECOS to provide CMS with their enrollment information.
CMS implemented PECOS in
fall 2003. Organizations and individual practitioners who began furnishing
services to Medicare patients before its implementation — but have not
updated their enrollment information since that time — generally do not
have established PECOS records. Organizations and individual practitioners
who began furnishing services to Medicare patients before spring 2006 and who
have not updated their enrollment information since that time may not have
completed the CMS-588 form.
Those organizations and
individual practitioners receiving revalidation requests from their
Medicare contractors have 60 calendar days to respond to the request. If
you do not respond, CMS may revoke your Medicare provider enrollment,
preventing you from billing the Medicare program for services provided to
Medicare patients between the date of your revocation and the date of your
re-enrollment in the program. Additionally, you may be barred from billing
and re-enrolling in the Medicare program for a minimum of one year.
Also, keep in mind that if
your practice enrolled in the Medicare program between 1996 and 2003, CMS
will have on file a CMS-855B form with the name and signature of your
practice's Authorized Official. That individual must sign the new
enrollment application for your Medicare contractor to process the
application.
Individual practitioner
instructions: Change
Request 6574
Organization instructions: Change
Request 6585
For assistance with the Medicare
provider enrollment process, the American Medical Association and the
Medical Group Management Association have created The
Medicare Provider Enrollment Toolkit, available exclusively to
members.
CDC information
on the H1N1 influenza
The
Centers for Disease Control and Prevention (CDC) recently established the Novel
H1N1 Influenza: Resources for Clinicians Web page. Designed to give providers "access to the latest
guidelines and information on the evolving novel H1N1 influenza
investigation," it contains several links to guidance regarding patient
management, place of setting specific information (including 10
Actions Steps for Medical Offices and Outpatient Facilities), directions for specific patient populations
overall treatment recommendations, and patient education information.
The CDC
and Centers for Medicare & Medicaid Services have also posted frequently
asked questions regarding the H1N1, specifically on CMS' process
for issuing Emergency Medical Treatment and Labor Act (EMTALA) waivers to
hospitals that have implemented hospital disasters protocols.
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