OIG Work Plan for Fiscal Year 2011

A quick review of the Office of Inspector General's work plan indicates 2011 reviews will continue to focus on ensuring providers can justify the appropriateness of what they are doing, either from a clincial perspective or a documentation perspective.

 

Evaluation & Management (E&M) claims will be evaluated to ensure:

•  Documentation supports the level of service reported - specifically that there is not identical documenation used to record the patient encounter for each & every patient. 
• Coding patterns, by provider, accurately reflect the service provided.  Specifically, that billing for E&M services reflect the individual type, setting and complexity of services provided to each patient.    

For services performed in hospital outpatient departments or ambulatory surgical centers (ASC), the OIG will audit to determine whether physicains properly coded the place of service on claims.  To review the current list of location codes used for billing go to: https://www.cms.gov/MedHCPCSGenInfo/Downloads/Place_of_Service.pdf

 

 

 

Meaningful Use - What's Next?

The Health IT Policy Committee, a federal advisory group, has begun work on developing the meaningful use requirements for stages 2 and 3 of the federal Medicare and Medicaid healthcare IT adoption incentive program. 

Stage 1 incentives begin in January, 2011 and CMS and the Office of the National Coordinator for Health Information Technology will begin monitoring data submitted to help fomulate some aspects of the stage 2 and 3 requirements.  Currently, interoperability appears to be a big focus of the stage 2 requirements, however a meaningful use workgroup is expected to present recommendations to the HIT policy committee today (October 20th), with opportunities for additional public input beginning in November. 

If all goes well, providers and vendors should have a good idea of what will be expcted in the Stage 2 and 3 incentives by mid-year 2011. 

Collaborative efforts could speed medical advances

Is there a gap in the medical research system?  A recent segment on PBS highlights the need to change the model for connecting academic research to the pharmaceutical and biotech industry.   Their premise:  Basic scientific research may address intriguing scientific questions, but doesn’t always focus on research that might help the patient the most.  Instead, a more collaborative approach will be necessary to ensure the creation of new drugs and treatments for diseases like Multiple Sclerosis.

For more information go to:  http://www.pbs.org/newshour/video/module.html?s=news01s43bcqf7f

New pain-medication law in the state of Washington

Earlier this year, legislators in the state of Washington passed a first of a kind bill that changes the way providers can prescribe opiates to chronic pain patients.  This bill directs five boards and commissions to adopt rules concerning management of chronic, noncancer pain. Thus far, it appears the rules will govern how physicians and other prescribers maintain and update detailed screening, history and treatment plans for most pain patients.  Additionally, a prescriber whose patient reaches a certain dosage level must consult a pain specialist. 

To learn more about the law, or to receive email notifications about pain management prescribing rules, go to:  http://www.doh.wa.gov/hsqa/Professions/PainManagement/

No EMG for PAs in New Jersey

The Appellate Division of the New Jersey Supreme Court ruled in July that “physician assistants are precluded by statute from performing EMG needle tests.” This ruling was the result of a case involving a physician billing for EMG studies performed by a physician assistant. The court relied heavily on the legislative intent of the statutory language added in 2005 that limits performance of needle EMG to a “person licensed to practice medicine and surgery” in New Jersey.

As a result of this case the AANEM Board of Directors considered the organization’s policies regarding non-physician providers and voted to add specific language to the organization’s Recommended Policy for EDX Medicine and its Model Policy for EMG and NCS.

Those policies are available at http://www.aanem.org/.

AANEM files a motion to intervene in the Red Flag lawsuit

Normally, a lawsuit involves the plaintiffs (who bring the suit), and the defendants (whom the suit is brought against). A motion to intervene is used when a someone not party to a lawsuit in progress wants to become a party in that suit.


On Monday, August 16th, AANEM joined forces with 25 other medical societies to file a motion to intervene in the AMA lawsuit seeking relief from the Red Flag Rules for physicians.   Without other groups intervening in the lawsuit, there were concerns raised that any ruling would apply only to AMA members.

Once the motion is granted, all 26 medical societies will file a proposed complaint and ask the FTC to expand the current stipulation to refrain from enforcing the Red Flags Rule against physicians, including those who are not members of the AMA, and their medical practice groups. The AANEM action will ensure that any decision will apply to all AANEM members

For more information on the Red Flags Rule, visit: http://www.ftc.gov/opa/2010/05/redflags.shtm

CMS awards funding to six states & District of Columbia for EHR incentive programs

Connecticut, Delaware, Indiana, New Hampshire, Rhode Island, West Virginia, and the District of Columbia are the latest to receive federal matching funds for state planning activities necessary to implement the electronic health record incentive program established by the American Recovery and Reinvestment Act of 2009.

The recipients will use the funds for planning activities that include an analysis of health IT activities in the region.  They will gather information on issues such as existing barriers to use of EHRs, provider eligibility for EHR inventive payments and the creation of a state Medicaid health IT plan, all of which will help define the vision for long-term health IT use.

CMS has thus far allocated funding to 39 other states and Puerto Rico and the US Virgin Islands.

Regional Extension Center News

As part of the HITECH act, Regional Extension Centers were established to offer technical assistance, guidance and information to support and accelerate health care provider's efforts to become meaningful users of an Electronic Health Record. 

The federally designated Regional Extension Center for New York City (NYC REACH) will be offering an electronic medical record and practice management system developed by eClinicalWorks to its providers in the five boroughs of New York City.  NYC REACH will be using a $21.7 million grant awarded by HHS to assist providers with the purchase and implementation of an EHR. Check out their website (www.nycreach.org) for upcoming events that are designed to help providers learn more about switching from a paper based record to an electronic record.

West Virginia has also established a Regional Health Information Technology Extension Center (WVRHITEC) to help providers across the state implement electronic health records systems.  WVRHITEC will begin working with regional and community based organizations during the summer of 2010 to provide information, guidance and technical assistance to eligible participants in primary care settings.  This includes providers in rural and medically under served areas, community health centers and certain public, not for profit or critical access hospitals.

To find information about these and other State's Regional Extension Centers, click on this link:  http://healthit.hhs.gov/portal/server.pt?open=512&objID=1495&mode=2&cached=true