Medicare Fee Cut Averted Through 2013; Sequester Cut Delayed for Two Months On January 1st Congress passed the American Taxpayer Relief Act and successfully averted the average 26.5% cut in the Medicare physician fee schedule The act dodges the scheduled fee cut due to the sustainable growth rate (SGR), but does not repeal the flawed formula. The 2% sequestration cuts to Medicare payments have also been delayed, but for only two months. MSNJ and our members actively lobbied our congressional delegation to stop the Medicare fee cut, repeal the SGR and replace it with new payment models that will be sustainable. This action stops the fee cut and allows a year for the repeal and replacement of the SGR. While we are thankful that Congress prevented the drastic cut in fees, MSNJ still believes that a permanent fix to the SGR is necessary and overdue. See Senator Menendez’s response to MSNJ’s request that the SGR be repealed. We will continue our efforts to repeal the SGR.
This $25 billion band-aid was offset by assorted provisions. Thankfully, as advocated by MSNJ and the AMA, the increase in Medicaid payments to primary care providers and funds for preventive services remain untouched. Unfortunately, the offsets will have a negative impact on payments for advanced imaging services and will extend the statute of limitations on recoupment to 5 years. In addition, the act takes back unobligated funds for health insurance co-ops as a cost savings. Existing obligations will be honored.
For details on Medicare and other health provisions contained in the American Taxpayer Relief Act, visit the AMA’s website.
2013 Medicare Fee Schedule- Billing Update & Participation Deadline Extension
Many members have questions about billing Medicare, now that the cut has been averted. Although the fee cut has been prevented, it is an average, not applicable to each CPT code and there may be other changes affecting the 2013 Medicare fee schedule, besides the SGR. While the SGR cut has been delayed until after December 31, 2013, Relative Value Unit (RVU) changes will be different from last year, thus changing the 2013 fee schedule for certain CPT codes–either up or down.
We have asked for implementation information from Novitas (New Jersey’s Medicare Contractor). So far, there is no official Novitas position, but CMS published notice indicating that it is updating the 2013 Medicare Physician Fee Schedule. CMS also noted that the Medicare contractors may hold claims until January 15, 2013, while they test and implement the fee schedule. This falls within the prompt pay timeframe.
CMS will give Novitas until January 23, 2013 to post the updated fee schedule on its website. As of today, the Medicare fee schedule posted on the Novitas website still reflects the scheduled fee cut. In the meantime, we recommend that members hold claims until Novitas posts the corrected 2013 fee schedule. If a practice uses the wrong fee schedule and bills Medicare less than the new fee schedule amount, Medicare will pay the lesser of the two fees and will not reconsider the claim. CMS has also extended the deadline for changing participation status to February 15, 2013. We will notify members, once additional information is received from Novitas.
First HIPAA Breach Settlement Involving Fewer than 500 Patients Announced
The U.S. Department of Health and Human Services (HHS) recently announced a resolution agreement in which the Hospice of North Idaho (HONI) agreed to pay $50,000 for potential HIPAA violations involving less than 500 patients. This is the first settlement involving a breach of protected health information (PHI) of fewer than 500 patients. HONI also agreed to a corrective action plan (CAP) that requires HONI to notify HHS of any violation of HONI’s privacy and security policies within 30 days of the breach for two years after the date of the resolution agreement. As part of the CAP, HONI must include a description of the events leading up to the breach, a copy of the policy violated, and a description of the corrective actions taken.
The investigation was prompted by HONI’s submission of a breach report to HHS, a requirement under the HITECH Act. A HONI laptop containing electronic PHI was stolen, putting the privacy of 441 patients at risk. After investigation, HHS found that HONI did not perform necessary risk analysis and failed to establish adequate policies and procedures regarding the security of laptops and other mobile devices containing PHI. These inadequacies were in direct violation of the HIPAA Security Rule.
In its article, New Year, Same Old Health Data Breaches, FierceHealthIT noted that security risks continue to be a problem for the healthcare industry and listed several recent cases of PHI security breaches. HHS recognized that physician education is essential to reduce the frequency of such breaches. In response, HHS developed an educational initiative, Mobile Devices: Know the RISKS. Take the STEPS. PROTECT and SECURE Health Information, to assist physicians with HIPAA compliance when using laptops, smart phones, and tablets. Members are encouraged to review the HHS materials and to take the appropriate steps to protect electronic PHI contained in laptops or other mobile devices.
MSNJ Member in the News: “New Brunswick & Lumberton Physicians Share Health IT Story in the Nation’s Capital”
Now that Drs. Frank Sonnenberg, Robert Wood Johnson Medical Group, and Kennedy Ganti, Virtua Lumberton Family Physicians, have successfully implemented their electronic health record (EHR) systems, they are ready to share with the rest of our nation’s healthcare community how this technology has improved patient care. Dr. Sonnenberg (New Brunswick, NJ) and Dr. Ganti (Lumberton, NJ) are two of 82 healthcare providers from across the country whose progress in health IT will be recognized by the White House and Health and Human Services (HHS) at two events in Washington, D.C. on June 18-19, 2012.
NJ Health IT Coordinator, Colleen Woods, acknowledges, “Dr. Ganti and Dr. Sonnenberg are two of our great Health IT leaders in New Jersey. They are remarkable physicians who saw the benefit of EHR’s early on, and seized the opportunity to improve their patients’ care. They are an inspiration to all of us working in healthcare.”
The New Jersey Health Information Technology Extension Center’s (NJ-HITEC) Executive Director, Bill O’Byrne adds, “NJ-HITEC is very proud of the hard work and excellent example that Drs. Sonnenberg and Ganti have set in the community of doctors. They have earned this distinction and we celebrate in their achievements that advance the timely delivery of high quality medical care to the people of this State. It should also be noted that these two fine doctors are also representatives of the thousands of doctors that are NJ-HITEC members that have also committed to improving the delivery of healthcare to their patients through the use of health information technology.”
The HHS Office of the National Coordinator for Health IT (ONC) is hosting a Health IT Vanguard Conference in which a variety of health care professionals will share lessons learned in adopting and implementing electronic health records. As designated MUVers, Dr. Sonnenberg, Dr. Ganti, and others of the Meaningful Use Vanguard (MUVers) will discuss solutions for a variety of health IT barriers, including privacy and security and the challenges of building systems that can “talk to each other.” Some will discuss ways of leveraging health IT to promote better health in communities. MUVers throughout the country have been recognized for their leadership in local efforts that will eventually move the nation toward an electronically enabled healthcare system.
Dr. Sonnenberg explains, “One of the biggest challenges we face in the implementation of healthcare information technology is the disconnect from providers who are using a different types of EHR technology. Even if two physicians are using the same technology, there can still be difficulties in sharing information. We need to discuss and adopt a universal interchange.”
Dr. Ganti adds, “Meaningful Use is the single most important initiative since President Lyndon B. Johnson’s Great Society programs in the 1960’s. The ability to view and harness the vast amounts of health information through EHR technology assists doctors in providing true comprehensive care. Moreover, my patients leave with their personal healthcare summary so they can review what was discussed during their visit. This is so important because in the 10 to 15 minutes that a patient spends with a doctor, so much information is reviewed. The patient healthcare summary provides the status of an individual’s health, past and current medication lists as well as referral information to further engage a person in his/her healthcare management.
At the White House Health IT Town Hall on June 19, senior White House and HHS officials will discuss progress and barriers to a national Health IT system with MUVers in attendance. In addition to discussing the Meaningful Use of EHRs, providers will share their insight on the important role that Health IT programs, such as the Regional Extension Centers (RECs), have played in helping them implement EHR technology. Over 132,000 primary care providers, almost half in the country, are partnering with RECs to overcome the significant barriers that primary care and rural providers face in EHR adoption.
O’Byrne states, “We are the Garden State’s sole Regional Extension Center working with providers to assist them in achieving Meaningful Use. With a membership close to 6,000, we have assisted over 835 providers successfully achieve Meaningful Use. These providers have received over $15 million federal incentives. We are committed to a health IT and assisting our members improve healthcare in New Jersey through EHR technology.”
NJ-HITEC is the primary care provider’s trusted advisor in the timely delivery of high quality healthcare through the selection, implementation, and achievement of Meaningful Use of an accredited Electronic Healthcare Record (EHR) system. NJ-HITEC is the federally designated Regional Extension Center (REC) for New Jersey established by the New Jersey Institute of Technology (NJIT) and funded through the Office of the National Coordinator (ONC), U.S. Department of Health and Human Services. To learn more about NJ-HITEC or to become a member, visit us at http://www.njhitec.org or call (973) 642-4055.
NJ-HITEC Media Contact: Denise Anderson, firstname.lastname@example.org, 732-618-3867.