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A New Year, A New Congress: Will it Make a Difference Regarding Healthcare Legislation?

January 7, 2015

 

Thirteen new senators and 58 new House members were sworn in as the 114th Congress opened with its traditional pomp on Tuesday, January 6, 2014.  With Republicans winning control of the Senate in the November election, their party now has command of the House and Senate for the first time in eight years and will control the legislative branch during the final two years of President Obama’s term and the run-up to the 2016 elections.  Most Americans are likely wondering if it will make a difference.  The 6.7 million newly insured under the Affordable Care Act (ACA) might be asking, so what now?

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Sony’s Security Shockwave: Healthcare Providers Need to Finally Pay Attention to HIPAA Security

December 31, 2014

 

Last month, a previously unknown group that calls itself the Guardians of Peace (GoP) hacked Sony Pictures Entertainment (SPE). The group has since posted online financial figures and tens of thousands of emails between top Sony executives. Some of the emails deal with costs for upcoming films, casting decisions, release schedules through 2018 and corporate royalties from iTunes, Spotify and Pandora. There has been speculation that North Korea organized or paid for the Sony hack. Whether the hackers were or were not agents of the North Korean government does not change the fact that every government, corporation and organization, including healthcare information systems, has been or may be hacked by both foreign and domestic attacks.

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New Rules to Protect Against Fraud and Abuse

December 10, 2014

 

The Centers for Medicare and Medicaid Services (CMS) has announced new rules that strengthen oversight of Medicare providers and protect taxpayer dollars against abusive practices.  The rules are designed to prevent physicians and other providers with unpaid debt from re-entering Medicare, remove providers with patterns or practices of abusive billing and implement other provisions.

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Lame Duck Congress: Will They Take Action on Pending Healthcare Bills?

December 3, 2014

 

The short answer is unlikely. Based on the Congressional calendar, adjournment is set for the holidays as of December 12. The overarching priority between now and the holiday recess is a bill to keep the government running to avoid a shutdown. The appropriations committees in the House and Senate, which allocate the funding, said they would have a $1 trillion spending bill ready by next week. Other top priorities are to reauthorize funding and training of Syrian moderates to strike at ISIS militants in Iraq and Syria and continue tax breaks set to expire. For a Congress that has a bit of controversy between the White House and its members, not to mention party line politics, this is an ambitious agenda to accomplish in the span of two weeks. The unfinished business, some of it untouched for two years, needs to be completed before Congress takes off for the holiday and its new session begins in January.

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Thanksgiving: A Time to be Thankful for The American Healthcare System

November 26, 2014

 

It is easy to complain about what is wrong with Healthcare in America and what keeps healthcare executives up at night, e.g. lower reimbursement, meaningful use, overall too many changes at the same time.  On the eve of a truly great American holiday, Thanksgiving Day, it is fitting to take a look at five trends in healthcare that all Americans can appreciate.  They are:

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Hospital Outpatient Prospective Payment System (OPPS) 2015 Final Rule

November 19, 2014

 

The Centers for Medicare & Medicaid Services (CMS) issued the Calendar Year (CY) 2015 Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payment System Policy Changes and Payment Rates final rule with comment period [CMS-1613-FC] on October 31, 2014.  The final rule appeared in the November 10, 2014 Federal Register.  The provisions in the rule will generally take effect on January 1, 2015.  The public comment period will close on December 30, 2014.  The major changes included in CMS' CY 2015 Hospital OPPS Final Rule are:

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CMS Releases Final Rules on Medicare Physician Payments

November 12, 2014

 

Last Friday the Centers for Medicare & Medicaid Services (CMS) released final rules that implemented changes and updates to payments made under the Medicare Physician Fee Schedule (PFS).  Last year the Protecting Access to Medicare Act of 2014 prevented significant reductions to physician payment through the sustainable growth rate (SGR) formula, but this policy is in effect only until March 31, 2015.  The new Congress will need to address physician payment early next year to prevent the significant reductions to payments that are scheduled to start in April 2015.

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The 2015 Office of Inspector General Work Plan

November 5, 2014

 

Last Friday, the U.S. Department of Health and Human Services (HHS) Office of Inspector General (OIG) released its 2015 Work Plan which summarizes new and ongoing reviews and activities that OIG plans to pursue with respect to HHS programs and operations during the current fiscal year and beyond.

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Panic, Pandemic and Protected Health Information

October 29, 2014

 

Do you remember H1N1?  Can you recall the panic across the United States (US) when AIDS/HIV first hit the news?  Now we find our country in a panic over Ebola—a disease that has been contained to impoverished countries with little to no healthcare—until September 28th when the Centers for Disease Control and Prevention (CDC) confirmed, through laboratory tests, the first case of Ebola to be diagnosed in the US.1 There is much that we are learning daily about Ebola, how to treat it and how to protect healthcare workers against exposure.  This disease is a frightening situation to nurses, other healthcare workers and every day citizens.  We have seen cruise ships and schools impacted and many people fear that their community may be next.  Some believe it will get worse in the US before it gets better.  Others feel we have little reason to panic.

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Electronic Health Records and Meaningful Use Challenges

October 22, 2014

 

The Office of the National Coordinator for Health Information Technology (ONC) Office of the Secretary, United States Department of Health and Human Services (HHS) 2014 Report to Congress found that electronic health record (EHR) adoption among hospitals and physicians has grown substantially since the passage of the Health Information Technology for Economic and Clinical Health Act (HITECH).  In 2013, 59 percent of hospitals and 48 percent of physicians had at least a basic EHR system, respective increases of 47 percentage points and 26 percentage points since 2009, the year the HITECH Act was signed into law.  Moreover, there is widespread participation among eligible hospitals and professionals in the Centers for Medicare and Medicaid Services (CMS) EHR Incentive Programs.  As of June 2014, 75 percent (403,000+) of the nation’s eligible professionals and 92 percent (4,500+) of eligible hospitals and Critical Access Hospitals (CAHs) had received incentive payments.

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Reality TV Show: Pioneer Accountable Care Organizations

October 15, 2014

 

Fall means a new batch of reality television.  We can watch Real Housewives go bad, designers throwing tantrums while vying for a spot at Fashion Week and even everyday folks seeking Utopia.  Critics often cite the best reality shows to watch are those that combine common sense, creativity and the survival adventure.  After reviewing the Centers for Medicare & Medicaid Services (CMS) financial data released last Thursday on the trail-blazed Pioneer accountable care organizations (ACOs), it is amazing that the networks and cable executive producers missed out on this real life financial drama.  With healthcare reform a popular topic, the bumpy road the original 32 Pioneer ACOs have experienced would have served as some exciting trials and tribulations as CMS officials, hospital executives, physicians and patients tried to navigate better healthcare quality while achieving cost savings.

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ICD-10 Gearing Up Again: One Year to Go—Hopefully!

October 1, 2014

 

The healthcare industry is expecting the October 1, 2015 conversion date to stick this time.  That is, unless for the third time, there is an unexpected delay.  Most Health Information Management (HIM), certified coders and billers felt blindsided when Congress legislatively decided last March that:

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Tackling Crisis Management in an Era of Social Media: Hospitals Need to Evaluate Their Policies and Risks

September 24, 2014

 

It is a hard-hitting sport that generates lots of money and attention, both on and off the playing field.  Controversies involving football players, coaches, owners and referees have come and gone for the National Football League (NFL).  Fans have dealt with disputed championship wins as far back as 1925, teams relocating in the middle of the night, Michael Vick dog fighting and prior domestic abuse issues.  Yet Ray Rice, Adrian Peterson, Roger Goodell and all the others involved in the current NFL drama appear to be so blatantly inept at managing the growing controversy.

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The New, Latest, Final Rule for Meaningful Use

September 10, 2014

 

In the final rule on Meaningful Use (MU) released August 29, the Centers for Medicare and Medicaid Services (CMS) and the Office of the National Coordinator for Health Information Technology (ONC) finalized deadlines that could affect hospitals' and physicians' bottom line.  While some providers are breathing a sigh of relief, others are finding the changes and rules too confusing to draw any immediate conclusions.  In some cases it seems to resolve several challenges certain providers were having in receiving an Electronic Health Record (EHR) incentive in 2014.

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Phase Three of the Hospital Readmission Reduction Program Slated for October 1, 2014

September 3, 2014

 

According to a 2009 study, nearly 20 percent of Medicare beneficiaries are rehospitalized within 30 days after discharge, at an annual cost of $17 billion.1  Causes of avoidable readmissions include:

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American Hospital Association Turns up the Heat

August 27, 2014

 

The heat was turned up again last week by the American Hospital Association (AHA), the lobbying organization representing nearly 5,000 member hospitals, health systems and other healthcare organizations.  The AHA sharply criticized the audit methods used by the Office of the Inspector General (OIG) for the U.S. Department of Health and Human Services (HHS), saying in a letter that the watchdog has been “grossly” inflating Medicare overpayment estimates.

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Quality Management vs. Total Quality Excellence

August 20, 2014

 

This past week it is doubtful that any of us didn’t pause for a few minutes to reminisce about Robin Williams’ acting career.  From the voice of the genie in Disney’s Aladdin to Good Morning Vietnam, he will be remembered and missed.  For many, Robin Williams' favorite role was portraying John Keating in The Dead Poets Society.  Some readers may be scratching their heads and wondering where this article is headed but please indulge a fan.

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CMS Issues Final FY2015 Rule on Inpatient Hospital Payments

 

On August 1, 2014 the Centers for Medicare & Medicaid Services (CMS) issued a final rule that will update fiscal year (FY) 2015 Medicare payment policies and rates under the Inpatient Prospective Payment System (IPPS) and the Long-Term Care Hospital Prospective Payment System (LTCH PPS).  The final rule, which applies to approximately 3,400 acute care hospitals and approximately 435 LTCHs, will generally be effective for discharges occurring on or after October 1, 2014.  Under the final rule, the operating payment rates for inpatient stays in general acute care hospitals paid under the IPPS that successfully participate in the Hospital Inpatient Quality Reporting (IQR) Program and are meaningful electronic health record (EHR) users will be increased by 1.4 percent.  Beginning with FY 2015, those hospitals that do not successfully participate in the Hospital IQR Program and do not submit the required quality data will be subject to a one-fourth reduction of the market basket update (previously these hospitals received a two percentage point reduction).  Also, the law requires that the update for any hospital that is not a meaningful EHR user will be reduced by one-quarter of the market basket update in FY 2015, one-half of the market basket update in FY 2016, and three-fourths of the market basket update in FY 2017 and later years.  Total IPPS payments are projected to decrease by $756 million.  Medicare payments to LTCHs in FY 2015 are projected to increase by approximately 1.1 percent, or approximately $62 million.

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HIPAA Updates

August 6, 2014

 

The Office of Civil Rights (OCR) recently released two reports required by the Health Information Technology for Economic and Clinical Health (HITECH) Act:  (i) the Annual Report to Congress on Breaches of Unsecured Protected Information (Breach Report); and (ii) the Annual Report to Congress on HIPAA Privacy, Security and Breach Notification Rule Compliance (Compliance Report).  Both reports covering calendar years 2011 and 2012 reveal some interesting details about data breach activity under the Health Insurance Portability and Accountability Act of 1996 (HIPAA), as well as some helpful reminders and recommendations for covered entities and business associates.

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Medicare Billing and Payment for Telehealth Services

July 30, 2014

Generally, for Medicare payments to be made for telehealth services under the Physician Fee Schedule (PFS) several conditions must be met.  Specifically, the service must be on the Medicare list of telehealth services and meet all of the following other requirements for coverage:

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Off-Campus Provider-Based Departments May Get a New Modifier

July 23, 2014

 

The Centers for Medicare & Medicaid Services (CMS) issued the Calendar Year (CY) 2015 Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payment System Policy Changes and Payment Rates proposed rule [CMS-1613-P] on July 3, 2014.  The proposed rule would update Medicare payment policies and rates for hospital outpatient department and ASC services, and update and streamline programs that encourage high-quality care in these outpatient settings.  This proposal would continue the progress made so far in moving the OPPS from what currently resembles a hybrid of a prospective payment system and a fee schedule, to a more complete prospective payment system.

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