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Insurer overhead a large percentage of medical costs.

An article published in the Philadelphia Inquirer examines the administrative burden placed on physician practices in dealing with multiple insurance companies. A spokesperson at Cardiology Consultants of Philadelphia—one of the region's largest specialty physician groups—estimates that 45 of the organization’s 350 non-physician employees do nothing but make sure payment is received for 230,000 patient visits a year. According to information from the international Organization for Economic Cooperation and Development, payments for health administration in the United States, at 7 percent of overall spending, are double the average of the 30 member countries that share economic data. A recent study by the Medical Group Management Association found that "interaction" with insurers, other than for Medicare, costs medical practices in the United States $21 billion to $31 billion each year.
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CMS Delays PECOS Compliance Date

Responding to concerns expressed by the physician community, the Centers for Medicare & Medicaid Services (CMS) has announced a delay in the implementation of PECOS Compliance.  The full announcement can be viewed by clicking on the link below. 

CMS is phasing in an effort to make sure all Medicare Enrolled physicians have been included in the PECOS system.  Physicians started to receive warnings from Medicare in October of 2009 if they were not entered in the PECOS system.  The original compliance date of January 4, 2010 has been pushed back to April 5, 2010.  Medicare is going to publish a list of all of the physicians that are currently in the PECOS system.  Physicians will want to make sure if their name does not appear on this list that they revalidate their information with their State Medicare Fiscal Intermediary so their information is included in the PECOS system.  After April 5th physicians risk their Medicare claims being denied if they are not in the PECOS system. 

To read more on PECOS, please click on the link below:

Download CMS Delays PECOS Compliance - blog posting

FTC Extends Enforcement Deadline for Identity Theft Red Flags Rule

The Federal Trade Commission (FTC) is delaying enforcement of the “Red Flags” Rule until June 1, 2010.  As part of the Federal Trade Commission's (FTC's) implementation of the Fair and Accurate Credit Transactions (FACT) Act of 2003, most medical providers would have needed to comply with the "Red Flags" rule November 1, 2009. The rule requires "creditors" – which the FTC defines to include most health care providers – to establish a program to prevent identity theft in their practices.

New online tool helps medical practices meet FTC identity theft prevention program requirements.

The U.S. Federal Trade Commission (FTC) has designed an online program to help medical practices and other businesses comply with its Red Flags Rule. The "Do-It-Yourself Program for Businesses at Low Risk for Identity Theft" contains two parts: Part A consists of a series of questions to help you determine if your practice is at low risk for identity theft, and Part B guides you through the four steps required to comply with the requirement of a written identity theft prevention program. FTC has delayed the enforcement date of the Red Flags Rule to Aug. 1, 2009.
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Drugstore clinics look to expand scope of practice.

According to the Chicago Tribune, several large pharmacy companies plan to increase the range of specialized services found in their outpatient clinics to include care for "sprains and strains" and injections for chronic conditions such as osteoporosis. The retail clinic model has been supported by health insurers, employers, and consumer groups as one way to address rising numbers of the uninsured. However, some critics argue that patients with certain conditions would be better served by physicians—especially if the physician has a history with the patient. Retail clinics must operate under physician supervision but are often staffed by nurse practitioners.
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SC Department of Health and Human Services Distributes Reminder to Physicians Concerning Provider Eligibility

The South Carolina Department of Health and Human Services has distributed a reminder to Medicaid providers concerning their obligations to check eligibility of your physicians, employees and contractors who may be receiving Medicaid, SCHIP, and Medicare reimbursement.  Physicians and practices do need to pay attention to your obligations for verifying eligibility for participating in any of these government programs.

The Centers for Medicare and Medicaid Services (CMS), in a State Medicaid Directors Letter dated January 16, 2009 (SMDL #09-001), informed States of their obligation to direct providers to screen their own employees and contractors for excluded persons. Under federal law, health care programs such as Medicaid, the State Children’s Health Insurance Program (SCHIP) and Medicare cannot pay for services or items furnished, ordered, or prescribed by an excluded health care provider. The South Carolina Department of Health and Human Services (SCDHHS) has several processes in place to ensure that it identifies excluded providers and also denies their payment.

The bulletin from Medicaid has been added to the SCOA Blog in its entirety, http://blog.scoanet.org/.  The bulletin will help clarify the SCDHHS process and provide guidance to Medicaid providers regarding their own compliance with exclusion rules.

The HHS-OIG maintains the LEIE (List of Excluded Individuals and Entities), a database accessible to the general public that provides information about parties excluded from Medicare, Medicaid, and all other Federal health care programs. The LEIE website is located at http://www.oig.hhs.gov/fraud/exclusion.asp and is available in two formats. The on-line search engine identifies currently excluded individuals or entities. When a match is identified, it is possible for the searcher to verify the accuracy of the match by entering the Social Security Number (SSN) or Employer Identification Number (EIN). The downloadable version of the database may be compared against an existing database maintained by the provider; however, the downloadable version does not contain SSNs or EINs.

The SCDHHS website can be located at www.scdhhs.gov, and the link to the list of excluded South Carolina providers is under the “Provider” box that appears on the home page. The SCDHHS list includes only South Carolina Medicaid providers (or those with a South Carolina connection) and does include an NPI for any provider that has one.

 Download Provider Exclusion Bulletin Final

New AMA resource a one-stop shop for ePrescribing information

An online learning center launched this week by the AMA can help physicians and practice managers make informed decisions about electronic prescribing, also known as ePrescribing. With vast educational content and interactive tools, this convenient resource allows users to assess ePrescribing technology at their own pace in an impartial environment.

Aspects of the learning center include complete and unbiased coverage of ePrescribing system vendor pricing and features, calculators to estimate potential time savings and determine Medicare ePrescribing incentive payments, the latest information on federal and state programs offering ePrescribing incentives, and readiness and planning tools to help physicians map out an implementation plan.

“The AMA’s new ePrescribing learning center takes the guesswork out of the decision-making process by giving physicians all the tools they need to decide what system is best for their practice,” AMA Board Chair Joseph M. Heyman, MD, said.

Visit www.ama-assn.org/go/eprescribing to access the learning center.

Practice Management Center

American Medical Association
www.ama-assn.org/go/pmc

Stimulus packages targets $19 billion for EHRs.

Although the federal government plans to use $19 billion of the economic stimulus package to facilitate increased adoption of electronic health records (EHRs), some obstacles remain. The Los Angeles Times reports one 10-physician practice that adopted EHRs 3½ years ago has been able to eliminate tens of thousands of manila files and reduce its record-keeping staff from seven to three. The office also eliminated 2½ positions in its billing department because clerks no longer have to review handwritten notes. However, the upfront costs of implementing EHRs can be high—as much as $30,000 per physician, and interoperability across competing records systems remains low. The U.S. Department of Health and Human Services has been tasked with developing a set of standards for EHRs by the end of 2009. Watch for an in-depth article on EHRs in the April issue of AAOS Now.

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Hospitals seek to employ more physicians as smaller practices disappear.

A commentary published in Physicians News Digest states that current long-term trends favor continued growth of hospital-owned physician practices and changing compensation models. Instead of large salaries and bonuses that were not supported (and in some cases could not be supported) by productivity, compensation is refocusing on strategy and productivity. The author states that factors driving the new model from the physicians’ side include stagnation of reimbursement, a reduction in ancillary revenue, rising practice expenses, and a greater need for scale.
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An article in the Nov. 2008 issue of AAOS Now examined the issue of changing practice patterns in orthopaedic surgery.
Read "Is the private practice orthopaedist disappearing?"…

Protect your Medicare provider enrollment data by enrolling/updating information online.

The U.S. Centers for Medicare & Medicaid Services (CMS) has set up an Internet-based system, designed to make it easier for physicians and nonphysician providers enrolled in Medicare to protect their enrollment records. The Provider Enrollment, Chair and Ownership System (PECOS), will help providers reduce the risk of having their personal and financial identification numbers (e.g., birth date, Social Security Number, Tax ID Numbers) being stolen and used to commit fraud. PECOS is currently available in more than 30 states and will be expanded to all states by the end of January.
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