Medicare SGR Physician 21.5% Cut Will Happen March 1, 2010

The Senate failed to act on The House bill to postpone the Sustainable Growth Rate (SGR) Medicare Physician Fee Schedule cut. Therefore the mandatory 21.5% Medcare cut will happen on March1. Legislators have promised renewed efforts but there is no immediate relief in sight.

However, CMS is suggesting anpther 10 day hold to provide time to resolve this.

 

The Centers for Medicare & Medicaid Services (CMS) is working with Congress, health care providers, and the beneficiary community to avoid disruption in the delivery of health care services and payment of claims for physicians, non-physician practitioners, and other providers of services paid under the Medicare physician fee schedule. As you are aware, the Department of Defense Appropriations Act of 2010 provided a zero percent (0%) update to the 2010 MPFS effective for dates of service January 1, 2010, through February 28, 2010.

CMS believes Congress is working to avoid the negative update that will take effect March 1. Consequently, CMS has instructed its contactors to hold claims containing services paid under the MPFS for the first 10 business days of March. The holding of MPFS claims will only affect claims with dates of service March 1, 2010, and forward. This hold should have a minimum impact on provider cash flow because, under current law, clean electronic claims are not paid any sooner than 14 calendar days (29 for paper claims) after the date of receipt. Be on the alert for more information about the 2010 Medicare Physician Fee Schedule Update.

Advisory FY 2011 H-1B Quota Opens April 1, 2010

 Contributed by Piyush Seth

412.594.5640, pseth@tuckerlaw.com

The filing period for new H-1B petitions for Fiscal Year 2011 (FY 2011) begins on April 1, 2010.  The annual quota limit for cap subject H-1B petitions remains at 65,000 for standard cases and 20,000 for those with U.S. Masters degree or higher.  There is a 6,800 H-1B's set aside for citizens/nationals of Chile or Singapore.  It is recommended that employers begin to identify their current and future employees who will require an H-1B status to remain in the United States and be legally employed.  This may include those who are currently employed as F-1 students or J-1 trainees that are eligible and will need appropriate status to continue working.  Additionally, if there are workers that are currently overseas with qualifications your company requires, we would need to begin the preparation of those cases as soon as possible.  March 31st is the initial mailing date for completed petitions seeking H-1B status with an effective start date of October 1, 2010. 

In Fiscal Years 2008 and 2009 the H-1B Quota was filled within the first week.  There is no way for us to predict how long the H-1B Quota will remain open and therefore we recommend that you anticipate your need now.  Additionally, due to changes in the Labor Condition Application system (iCERT), you will need to anticipate a minimum of two weeks for case preparation due to governmental processing delays.  New H-1B filers may require more time for registration. 
 
Also, please note that certain employers are exempt from the H-1B Quota.  This includes those that are filing extensions, transfers or amendments as well as institutions of higher education, nonprofit entities, nonprofit research organizations, or governmental organizations.
 
Additionally, if there are any questions and you wish to review any recent developments in the law or media regarding the filing of H-1B, I will be happy to review it with you.  As always, if you have a legitimate need for an employee and run a legitimate company then you will have a case that we can present.  The recent employee employer memo provides a strong basis to demonstrate employment relationships and I would be happy to discuss with you your company processes and ways to maintain compliance with the laws. 
 
If there are any questions, please do not hesitate to contact me.

21.2 Percent Cut To Take Effect March 1

Courtesy of the MGMA

Barring last-minute action by Congress, the 21.2 percent cut to Medicare physician payments will take effect next Monday, March 1. Despite previous indications that the Senate was considering an amendment to an anticipated job-creation bill to avert the cut, no clear legislative pathway for relief has yet been defined.  Medical Group Management Association (MGMA) has reiterated to the Senate leadership the importance of permanently repealing the sustainable growth rate (SGR) formula at this time. All MGMA members and their practices' staff are urged to join physician organizations in repeatedly expressing the importance of addressing this issue to their senators. You can contact your senators via the MGMA Advocacy Center or by calling the American Medical Association Grassroots Hotline, 800.833.6354.
 
On Thursday morning, the president will convene a bipartisan summit with congressional leadership to discuss efforts to achieve consensus on broad healthcare reform legislation. The White House has released proposed legislation in anticipation of this meeting. These discussions will be streamed online

CMS Mandates Advanced Imaging Accreditation by January 2012

 

Section 135(a) of the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA) amended section 1834(e) of the Social Security Act and required the Secretary to designate organizations to accredit suppliers, including but not limited to physicians, non-physician practitioners and Independent Diagnostic Testing Facilities, that furnish the technical component (TC) of advanced diagnostic imaging services.

MIPPA specifically defines advanced diagnostic imaging procedures as including diagnostic magnetic resonance imaging (MRI), computed tomography (CT), and nuclear medicine imaging such as positron emission tomography (PET). The law also authorizes the Secretary to specify other diagnostic imaging services in consultation with physician specialty organizations and other stakeholders.

MIPPA expressly excludes from the accreditation requirement x-ray, ultrasound, and fluoroscopy procedures. The law also excludes from the CMS accreditation requirement diagnostic and screening mammography which are subject to quality oversight by the Food and Drug Administration under the Mammography Quality Standards Act.

In order to furnish the TC of advanced diagnostic imaging services for Medicare beneficiaries, suppliers must be accredited by January 1, 2012.

The Centers for Medicare & Medicaid Services (CMS) approved three national accreditation organizations – the American College of Radiology, the Intersocietal Accreditation Commission, and The Joint Commission - to provide accreditation services for suppliers of the TC of advanced diagnostic imaging procedures. The accreditation will apply only to the suppliers of the images themselves, and not to the physician's interpretation of the image. All accreditation organizations have quality standards that address the safety of the equipment as well as the safety of the patients and staff. To obtain additional information about the accreditation process, please contact the accreditation organizations shown below.

American College of Radiology (ACR)
505 9th St. N.W.
Suite 910
Washington, DC 20004
202-223-1670

Intersocietal Accreditation Commission (IAC)
6021 University Boulevard, Suite 500
Ellicott City, MD 21043
800-838-2110

The Joint Commission (TJC)
601 13th Street, NW
Suite 1150 N
Washington, DC 20005
202-783-6655
 

Key HITECH Act Compliance Date of February 17, 2010 Quickly Approaching

 

The Health Information Technology for Economic and Clinical Health Act ("HITECH") provisions of the American Recovery & Reinvestment Act of 2009 ("ARRA") contain a number of changes affecting the compliance obligations of covered entities and business associates under HIPAA. Many of the key provisions of HITECH are effective as of February 17, 2010 and it is important to take appropriate steps to address these new compliance requirements. Some of these changes relate to: 

  • how a business associate must comply with HIPAA;
  • the HIPAA Privacy Regulations;
  • the HIPAA Security Regulations;
  • a new requirement that covered entities provide notification to individuals in the event their health information is breached;
  • strengthened rights for individuals to restrict disclosures of protected health information;
  • guidance on the minimum necessary standard and limited data sets;
  • the requirements for accounting of disclosures;
  • the marketing rules under HIPAA; and
  • increased obligations for the Secretary to periodically perform audits to insure compliance with HIPAA.

The attorneys at Tucker Arensberg have developed a HITECH Act Compliance Package to assist health care providers in complying with certain requirements of the HITECH Act relative to HIPAA. The HITECH Act Compliance Package includes the following:

  • an Addendum to current HIPAA Policy and Procedure Manuals which addresses the additional obligations placed upon covered entities under HITECH;
  • a Breach Notification Policy addressing the breach notification obligations provided for under Section 13402 of HITECH and the regulations published thereunder;
  • a HIPAA Business Associate Agreement Addendum (for use with current Business Associates);
  • a HIPAA Business Associate Agreement (for use with new Business Associates on a going forward basis); and
  • a form corporate consent document to be executed and maintained in the records of the practice following adoption of the Addendum.

The cost for the HITECH Act Compliance Package is $450. If you would like to purchase a HITECH Act Compliance Package, please contact Paul Welk via email at pwelk@tuckerlaw.com or by phone at 412-594-5536.

 

Hospital Uses After-Acquired Evidence to Support Summary Suspension of Physician

Dr. Gary Ritten was a medical staff member at Lapeer Regional Medical Center in Indiana. He was summarily suspended in September 2005, allegedly in retaliation for refusing to transfer a patient who had not been stabilized as required by EMTALA. The suspension was initially rescinded by the Medical Executive Committee, although it was reinstated by the hospital’s board of trustees. In July 2006, a peer review committee voted to continue the suspension after an extensive investigation of Dr. Ritten’s practices led its members to the conclusion that Dr. Ritten should no longer practice at the hospital.

One of the issues in the case was the applicability of HCQIA immunity and whether the action taken could be said to be “in the reasonable belief that the action was in furtherance of health care quality,” when in fact the initial suspension was allegedly retaliatory and not justifiable. In Ritten v. Lapeer Regional Medical Center, the United States District Court for the Eastern District of Michigan concluded that immunity was available because the ultimate decision was based upon legitimate health care quality concerns identified during the investigation, regardless of whether the initial suspension satisfied those standards.

Furthermore, the Court concluded that it could not issue equitable relief ordering reinstatement after considering evidence that it had been uncovered during the hearing process which supported the continued suspension.

Pittsburgh Included In CMS DMEPOS Round One Competitive Bidding Program

http://www.cms.hhs.gov/MLNMattersArticles/downloads/SE1007.pdf

CMS APPROVES THREE NATIONAL ORGANIZATIONS TO ACCREDIT SUPPLIERS OF ADVANCED IMAGING SERVICES

 

CMS APPROVES THREE NATIONAL ORGANIZATIONS TO

ACCREDIT SUPPLIERS OF ADVANCED IMAGING SERVICES

 

MRI, CT AND PET SCANS AMONG SERVICES TO BE AFFECTED

The Centers for Medicare & Medicaid Services (CMS) is designating three national accreditation organizations – the American College of Radiology (ACR), the Intersocietal Accreditation Commission (IAC), and The Joint Commission (TJC) - to accredit suppliers furnishing the technical component (TC) of advanced diagnostic imaging procedures.  The accreditation requirement will apply only to the suppliers furnishing the imaging services, and not to the physician’s interpretation of the images.

As required by the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA), all suppliers of the TC of advanced imaging will have to become accredited by an accreditation organization designated by the Secretary of Health and Human Services by Jan. 1, 2012.  The accreditation requirement applies to physicians, non-physician practitioners, and physician and non-physician organizations that are paid for providing the technical component of advanced imaging services under the Medicare Physician Fee Schedule.

MIPPA specifically defines advanced diagnostic imaging procedures as including diagnostic magnetic resonance imaging (MRI), computed tomography (CT), and nuclear medicine imaging such as positron emission tomography (PET).  The details of the accreditation organization selection process went through notice and comment rulemaking in the calendar year 2010 Physician Fee Schedule rule.

“While advanced diagnostic imaging procedures can be useful in identifying health problems that might otherwise require surgery, the rapid growth in their use raises important questions of quality and safety,” said Barry Straube, M.D., CMS chief medical officer and director of the CMS Office of Standards and Quality.  “The three organizations that will be accrediting suppliers have the expertise and authority to set a standard of excellence industry-wide.”

To be designated, the accrediting organizations had to demonstrate that they were experienced in the advanced diagnostic imaging area, and that their accreditation requirements met or exceeded the standards set out in MIPPA, including requirements for:

·         Qualifications of non-physician personnel performing the imaging;

·         Qualifications and responsibilities or medical directors and supervising physicians;

·         Procedures to ensure the safety of the individuals furnishing the imaging procedure and of the persons to whom the services are furnished;

·         Procedures to ensure the reliability, clarity, and accuracy of the technical quality of the diagnostic images produced by the supplier;

·         Procedures to assist the beneficiary in obtaining his/her imaging records on request; and

·         Procedures to notify CMS of any changes to the imaging modalities subsequent to the accrediting organization’s decision.

In addition, the accrediting organizations were required to develop a plan for reducing the burden and cost of accreditation to small and rural suppliers.  The accrediting organizations are also required to provide CMS with detailed information about their survey processes.

MIPPA specifically excluded from the accreditation requirement certain imaging services such as x-rays, ultrasound, and fluoroscopy procedures.  The law also excludes from the CMS accreditation requirement diagnostic and screening mammography, which are subject to quality oversight by the Food and Drug Administration under the Mammography Quality Standards Act.

CMS will issue further guidance to suppliers about meeting the accreditation requirements.  CMS plans to undertake a provider education outreach program to ensure that all affected suppliers understand the requirements and are able to comply with them prior to the Jan. 1, 2012, accreditation deadline.

For more information, please see the CMS Web site at: www.cms.hhs.gov/medicareprovidersupenroll .

Congress/Senate Progress on Medicare SGR Reduction

On January 28, the Senate approved legislation that will increase the federal debt limit to $1.9 trillion. Included in this legislation was a provision to reinstate "pay-go" rules mandating that Congress must offset any future increased spending with corresponding spending reductions or revenue increases.  This bill also provides Congress a 5 year exemption from these pay-go rules to address the Medicare physician payment cut. However, this provision does not provide any funding. The current freeze on the 2009 Medicare conversion factor is scheduled to expire on Feb. 28. Any solution still requires House and Presidential approval.
 

Health Care Associations Seek Relief From FTC Under Red Flags Rule

Contributed by Paul J. Welk, Esq.

412.594.5536, pwelk@tuckerlaw.com

In a letter dated January 27, 2010, the American Medical Association, American Veterinary Medical Association, American Osteopathic Association and American Dental Association wrote to the Federal Trade Commission ("FTC") asking that the FTC make it clear that in light of a recent court decision, the Red Flags Rule will not be applied to such professionals. The letter also briefly summarizes why the above referenced associations are making this request.

New Data Bank Regulations Implement Social Security Act §1921 - MMPPA §5(h)

 

New Data Bank Regulations Implement

Social Security Act §1921 - MMPPA §5(h)

The Medicare and Medicaid Program Protection Act (MMPPA) added Soc. Sec. §1921. This law expanded state licensure reporting obligations to match those already in place for the Healthcare Integrity and Protection Data Bank (HIPDB), which became active in 1999. These regulations will make reporting of adverse actions by state licensure and certification authorities nearly identical for NPDB and HIPDB, but does not change current NPDB reporting obligations for hospitals, healthcare entities, medical practice payers or other reporting entities.

One critical issue was the definition of what must be reported, and providing sufficient protection to physicians in order  to guard against reports by entities that provided no due process protections. Although HRSA and HHS rejected the proposal of emulating the immunity due process requirements of HCQIA, the definition of "formal proceeding" was revised to state as follows:

"Formal proceeding means a proceeding held before a state licensing or certification authority, peer review organization, or private accreditation entity that maintains defined rules, policies or procedures for such a proceeding."