scoanet

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.
Read more...

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.
Read more...

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.

Read More...

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.
Read more...

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.
Read More...

Medicaid Announces Service Reductions Due to Budget Cuts

Earlier this month, the Department of Health and Human Services distributed a memo to Medicaid participating physicians in South Carolina concerning a number of reductions in Medicaid benefits due to cuts in the State Budget.  The memo that was distributed has been added to the SCOA Blog.  You may want to review the list of cuts so you are aware of any coverage issues that may impact your patients who are on Medicaid.

Download Medcaid Changes Bulletin

Diagnostic imaging on the rise; insurers respond with tighter scrutiny.

Diagnostic imaging has been called the biggest driver of increasing healthcare costs. A study published in the November/December 2008 issue of the journal Health Affairs reviews data covering about 5 million radiology tests among 377,000 patients enrolled in the Group Health Cooperative in the state of Washington between 1997 and 2006. The authors found that the average total imaging cost per patient/year doubled during the study period, from $229 to $443. Study results showed the per-patient number of computed tomography (CT) scans doubled over the 10 years, and the number of magnetic resonance imaging (MRI) scans tripled across the board, with no single patient group or disease group dominating. According to the researchers, newer tests are being conducted in addition to, rather than instead of, older tests, leading to an increase in costs.
Read More...

FTC delays enforcement of part of the Red Flag Rule for six months.

The Federal Trade Commission (FTC) announced this week that it will "suspend enforcement" until May 1, 2009, of a portion of the Red Flag Rule that affects healthcare providers. The rule states that creditors and financial institutions must develop and implement a written Identity Theft Prevention Program by Nov. 1, 2008. The FTC determined that some entities generally not subject to FTC rules, such as healthcare providers, would need additional time to develop and implement a written program. Numerous healthcare associations have complained to the FTC that physicians are not "creditors," but the FTC is unlikely to exclude healthcare providers from the definition of creditors. Orthopaedic practices may wish to use the extra time to develop and implement a comprehensive Identity Theft Prevention Program.
Read More...

Read AAOS info on Red Flag Regulations...