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Those practices with electronic health record systems (EHR) in place appear to be very happy with the results. A survey conducted by the Medical Group Management Association found that 72% of practices with implemented EHR systems were “satisfied” with the results. Further, those practices which have optimized their EHR systems have reported an 82% level of satisfaction.

If you have any questions or concerns about the compliance or regulatory issues involved with the implementation of a EHR system, please contact an attorney at Wachler & Associates at 248-544-0888.

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Despite efforts by various groups to have the face-to-face  encounter requirement delayed for hospices and home health agencies, the requirement became effective as of April 1, 2011.  For more information regarding this issue, please see a recently authored article by Wachler & Associates attorneys Amy K. Fehn and Jennifer Colagiovanni entitled New Audit Risk for Home Health Agencies: Face to Face Certification Requirements.

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On April 7, 2011 CMS held a telephone conference for hospitals to answer questions on the recently released Accountable Care Organizations proposed rule and to provide further instruction on the submission of comments to CMS for consideration.

The CMS representatives stated that more information regarding the Centers for Medicare and Medicaid Innovation Center would also be provided soon. This statement arose in light of questions regarding possibilities for ACOs that are not quite ready for the Shared Savings Program. The representatives did reiterate that, pursuant to the statute, ACOs will not be able to participate in more than one shared savings program. The representatives further stated that the required organizational structure for ACOs wishing to participate in other programs might not necessarily be the same as for the Medicare Shared Savings Program.

CMS representatives also discussed the fact that primary care services provided by rural health clinics or federally qualified health clinics would not be considered in the patient attribution process because CMS does not collect sufficient data in claims from these organizations to determine whether the services are “primary care”.

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CMS Recently released a proposed rule which would reverse the policy of heightening restrictions on suppliers of durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS).  The proposed rule relaxes previously onerous rules regarding the prohibition of telemarketing and beneficiary solicitation which were implemented on September 27, 2010.  If you have any questions about how this proposed rule will affect your current compliance program, please contact a Wachler & Associates attorney at 248-544-0888.

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On March 31, 2011, CMS released the proposed rule implementing the Medicare Shared Savings program and establishing the requirements for Accountable Care Organizations (ACOs) that wish to participate in this program.  The following is a list of some of the highlights from this Proposed Rule.

1. The proposed rule contemplates two models: a “one-sided” model in which providers do not share risk and a “two-sided” model in which providers share in risk and realize greater return on the shared savings.

2. ACOs must commit to participate in the shared savings program for three years.  Providers who select the “one-sided” option will need to agree to share risk in their final year of participation.  If an ACO wants to terminate early, they will need to give a 60 day notice to CMS, as well as a notice to beneficiaries, and will forfeit a portion of previously earned shared savings that was withheld by CMS.

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The proposed legislation would allow Michigan healthcare providers to apologize to patients without fear that those comments will be used against them in legal proceedings.  The law will not provide total immunity to comments, but allow for greater leeway when it comes to expressing remorse for procedures that did not achieve the desired result.  

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If the rumors are true, tomorrow the Centers for Medicare and Medicaid Services, the Office of the Inspector General and the Federal Trade Commission will be releasing voluminous regulations governing the formation of Accountable Care Organizations (“ACO”) and the Medicare Shared Savings Program.  But before we receive all the minutiae of the regulations, we wanted to provide a brief overview of what is already known about ACOs.

1. The purposes of ACOs are to: (1) facilitate coordination and cooperation, (2) improve the quality of care and (3) reduce unnecessary costs.

2. ACOs were created by the Affordable Care Act, which was signed by President Obama approximately one year ago.

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Thirteen medical societies and several senior citizen advocacy groups have requested that CMS delay the enforcement of the new face-to-face encounter requirement.  These groups are seeking to delay the effective date to no sooner than July 1, 2011.  This new requirement stipulates that physicians, or a nurse practitioner working with the physician, conduct an in person consultation before the patient is covered by Medicare for certain procedures.  The requirement, which was enacted by the Affordable Care Act, was already delayed from  its original effective date of January 1, 2011, to April 1, 2011.  For a full explanation of the rule and its requirments, please see a recently authored article by Wachler & Associates attorneys Amy K. Fehn and Jennifer Colagiovanni entitled New Audit Risk for Home Health Agencies: Face to Face Certification Requirements.

Regardless of whether the new rule is delayed, having an up to date and effective compliance program will be necessary to ensure Medicare coverage of services.  To review an existing compliance program, or create a new program, contact an attorney at Wachler & Associates at 248-544-0888.

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A Republican Senator out of Iowa, Chuck Grassley, has introduced a new bill to the Senate.  This bill, which is entitled the Strengthening Program Integrity and Accountability in Health Care Act of 2011, seeks to amend the Social Security Act in a way that prevents improper billing, either through fraud or abuse, and waste in Medicare, Medicaid, and the Children’s Health Insurance Program (CHIP).  These amendments would serve to bolster and expand upon the prevention measures implemented in last year’s Patient Protection and Affordable Care Act.

This Proposed legislation, which is part of a larger trend towards eliminating fraud and abuse in the health care arean, highlights the importance of providers maintaining up to date and comprehensive compliance programs.  To discuss new and existing compliance requirements and ways to meet these requirements, please contact a Wachler & Associates attorney at 248-544-0888. 

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The Department of Health and Human Service’s Office for Civil Rights will be conducting a series of workshops to help educate and train state Attorney Generals in enforcing the Health Insurance Portability and Accountability Act of 2009 (HIPAA).  These workshops will include reviews of HIPAA and state privacy laws and the new enforcement role of the Attorney Generals as promulgated under the Health Information Technology for Economic and Clinical Health Act (HITECH).

These workshops are part of a larger plan to increase awareness about HIPAA compliance and enforcement.  Experts anticipate an increase in HIPAA related enforcement activity in the coming months.  To discuss possible improvements to your current compliance program, or to develop a new program, contact a Wachler & Associates Attorney at 248-544-0888.

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