CMS finalizes changes to 2012 Medicare e-Prescribing penalty program

Physicians have until Nov. 1 to apply for an exemption and avoid financial penalties for failing to comply with Medicare's ePrescribing requirements. The AMA urges all physicians who have doubts about whether they met the program's requirements in the first six months of 2011 to review the allowed exemptions carefully and submit an online application for each of the exemption categories for which they qualify as soon as possible.

Under the Centers for Medicare & Medicaid Services (CMS) ePrescribing rule, physicians are required to have issued and reported at least 10 electronic scripts (e-scripts) by June 30 to avoid being penalized. The penalty reduces all their Medicare Part B claims paid under the 2012 fee schedule by 1 percent.

In November 2010 CMS made a sudden decision to require physicians to meet this criteria by June 30 in order to avoid 2012 penalties, and the AMA continually stressed that this last-minute requirement was unreasonable.

On Aug. 31, CMS released a final rule that allows qualifying physicians to avoid the 1 percent penalty by applying for one or more of six new ePrescribing penalty exemptions through a Web-based tool. (Note: If you have difficulty accessing the online application, email QualityNet, which runs the portal for CMS.)

Although the final rule does not include an additional reporting period in 2012, it does reflect several other significant improvements the AMA requested. For example, the regulation provides more flexibility under the exemption categories so that more physicians can qualify to avoid the 2012 ePrescribing penalty.

In addition, CMS extended the application deadline for one month to Nov. 1. However, physicians are encouraged to apply for an exemption as soon as possible to avoid claims reprocessing.

Physicians who found it difficult to meet the 10 e-script requirement during the first six months of this year can apply for one of the following exemption categories by Nov. 1:

• Your practice is located in a rural area without high-speed Internet access.
• Your practice is located in an area without sufficient available pharmacies for ePrescribing.
• You are registered to participate in the Medicare or Medicaid electronic health record (EHR) incentive program and you adopted certified EHR technology by Oct. 1, prior to requesting an exemption.
• You are unable to ePrescribe because of local, state or federal laws or regulations. (CMS confirmed that physicians who mainly prescribe narcotics but cannot submit these prescriptions electronically because of certain limitations can apply for this exemption category.)
• You do not prescribe on a regular basis.
• There were too few opportunities for you to report the ePrescribing measure because of limitations of the measure's denominator. For example, you do prescribe electronically but your e-scripts are not related to qualifying visits or services.

 Learn more about the steps physicians should take now to avoid the Medicare ePrescribing penalty.

Your Patients Need You to Act Now: Educate Legislators on Impact of AHCCCS Cuts

AHCCCS, our state's Medicaid program, will have deep cuts if our state legislators have their way. The Arizona House, Senate and the Governor all have differing proposals, none of which include new revenue, and all incorporate large cuts. ArMA and a coalition of health care provider groups have tried continuously since January to make it clear these cuts will not only be devastating to our medically indigent, but to the stability of the entire health-care infrastructure, and the overall economy of our state. It is clear that our legislators are going to make a potentially devastating decision to cut coverage, services, and payments to an already decimated system. It is now necessary that all physicians weigh in directly.

The Arizona Senate proposal would chop 280,000 patients from the rolls on October 1st. The projected saving for Arizona in state money only is estimated at $541 million; this does not take into account the $1 billion in federal matching funds that will be lost.

The Governor's proposal is slightly less devastating; it would reduce the AHCCCS rolls by 120,000 people, increase patient co-payments, and decrease provider re-imbursement another five percent as of July 1, 2011. This is in addition to the five percent cut scheduled for implementation on April 1, 2011.

The only proposal put forth to protect the federal matching funds was devised by the Arizona Hospital and Healthcare Association (AzHHA), the Arizona Association of Health Plans, Inc., and the Arizona Health Care Association. Realistically, at this juncture we feel this proposal will not be considered unless the Legislature and Governor's proposals all fail.

This on-going funding crisis in AHCCCS is having significant impact on many medical practices, particularly those with high AHCCCS enrollment, but the long-term impact goes far beyond AHCCCS.

It is now time for legislators to hear directly from physicians as to how these cuts will impact your practice, staffing, and ability to serve the community these legislators represent.

Points to consider making are:

1. Provide specific examples of how AHCCCS cuts could shut down programs in your community that provide health care to all patients.
2. How coverage elimination is likely to impact the health of patients with long term medical conditions.
3. How financial cutbacks of the magnitude proposed will jeopardize your practice's financial sustainability.
4. Any plans that you are prepared to implement to phase out, or stop, treating AHCCCS patients.
5. Impact on your ability to maintain current staffing levels.
6. How elimination of coverage will overwhelm our emergency facilities.
7. Specific impact on your patients' health and outcomes based on your specialty. Are there hospital programs to which you refer your patients that might be lost, i.e., NICU, burn units, trauma services, ICU services, etc?

We urge you to contact your legislators, NOW, in their offices at the Capitol. Keep the focus on patient care, as well as the direct impact on your ability to keep your doors open. Share with them what you anticipate will be the direct impact on your practice, yourself, and your employees as suggested in the points stated above.

If you are unsure of your personal legislative district, or the district(s) you primarily serve, please e-mail or call Carol Wagner at cwagner@azmedassn.org or (602) 246-8901 for assistance.

The economic impact of office-based physicians in Arizona is substantial. According to a recent study, office-based physicians support 71,653 jobs in Arizona in the state and generate $749.5 million in tax revenue. This information may prove useful when you talk with your legislators; highlights from the study are also provided in the sidebar of this communication.

Please join the campaign to help reduce the impact of cuts to the AHCCCS program. It is important to act quickly.

Arizona Medical Association



Med Marijuana - Don't Jump The Gun!

ADHS has advice on med marijuana. The link is below. It's an excellent post by Will Humble about physicians who are “jumping the gun” and attempting to issue medical marijuana certifications before the rules are finalized. 

http://directorsblog.health.azdhs.gov/?tag=medical-marijuana

President to sign Red Flags Rule change

This afternoon, the U.S. House of Representatives passed S. 3987, the Red Flag Program Clarification Act of 2010. This legislation, which passed the Senate on November 30, was originally introduced by Senators John Thune (R-SD) and Mark Begich (D-AK) to limit the type of “creditor” that must comply with the Red Flags Rule.

The Red Flags Rule requires creditors to develop identity theft prevention and detection programs, and was originally scheduled to take effect on November 1, 2008.  According to the Federal Trade Commission (FTC), physicians who do not accept payment from their patients at the time of service are creditors and so must comply with the Rule by developing and implementing written identity theft prevention and detection programs in their practices.  As a result of continued discussions with FTC’s Chairman Jon Leibowitz and an aggressive congressional advocacy campaign, AMA efforts prompted the agency to delay the November 1, 2008 compliance deadline on several occasions, up through the end of 2010.

S. 3987 defines creditors as those who regularly and in the ordinary course of business:  (1) obtain or use consumer reports, directly or indirectly, in connection with a credit transaction; (2) furnish information to certain consumer reporting agencies in connection with a credit transaction; or (3) advance funds to or on behalf of a person, based on the person's obligation to repay the funds or on repayment from specific property pledged by them or on their behalf.  The legislation explicitly excludes those who advance funds on behalf of a person for expenses incidental to a service that is provided.  Under this definition, the bill’s sponsors have stated that physicians, dentists, and other professionals would not generally meet the definition of a “creditor,” and so they are exempt them from the rule’s requirements.  However, the bill does leave open the possibility that the FTC may revisit the issue in the future through the rulemaking process.

The legislation will now be sent to the White House where President Obama is expected to sign it into law before the January 1, 2011, compliance deadline.



AHCCCS Announces Benefit Changes

In response to significant fiscal challenges facing the State and continuing growth in the Medicaid population, AHCCCS will implement several legislatively mandated changes to the adult benefit package.  Most of these changes will be effective as of October 1, 2010.  A few changes will be implemented prior to the October 1, 2010 date, in which case separate notices have been posted regarding those changes.

AHCCCS has posted detailed information regarding these benefit changes on its website that providers will need for the October 1, 2010 implementation.  The AHCCCS benefit changes website page can be found at:

http://www.azahcccs.gov/reporting/legislation/sessions/2010/BenefitChanges.aspx