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.

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



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

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 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

WHEN: Compliance deadline is July 6, 2010. Physicians are very concerned that if the referring/ordering physician listed on their claim was not enrolled in PECOS by this date that the physician or provider who accepted the referral could see their claims rejected. Due to significant AMA advocacy, Centers for Medicare and Medicaid Services (CMS) announced on June 30th, that claims that list the name and NPI of a referring / ordering physician who is not yet enrolled in PECOS will NOT see their claims reject beginning on this date. CMS will provide more information about when they will begin rejecting claims in the near future. We continue to urge them not to reject any for at least 6 more months. For more information we recommend physicians review the CMS June 30th press release found at:

http://www.cms.gov/apps/media/press/release.asp?Counter=3774&intNumPerPage=10&checkDate=&checkKey=&srchType=1&numDays=3500&srchOpt=0&srchData=&keywordType=All&chkNewsType=1%2C+2%2C+3%2C+4%2C+5&intPage=&showAll=&pYear=&year=&desc=&cboOrder=date.

WHO: Physicians or health care providers who refer or order the following services for Medicare patients to other physicians or health care providers:

1) Durable medical equipment, prosthetics, and supplies (DMEPOS);

2) Home health;

3) Specialist services (not yet defined by CMS);

4) Laboratory; or

5) Imaging services.

INCLUDES: Any physician/provider including those who do not traditionally bill Medicare (i.e., dentists, pediatricians, and physicians employed by VA/DOD/Public Health Service) Updated June 30, 2010.

EXCLUDES: Physicians who have opted-out of Medicare. Physicians are encouraged to call their Medicare contractor to determine whether the contractor has them officially listed as opted out.

WHY: Prior to the passage of the new health system reform law, CMS announced that all physicians / providers who order and refer services to other health care providers must be enrolled by January 3, 2011. CMS originally was going to require these same physicians / providers to be enrolled by the end of 2009, however, the AMA was successful in securing an extra year to become enrolled. But, the new law required physicians who order and refer DMEPOS and home health to be enrolled by July 2010. The law does permit CMS to allow physicians who order/refer other Part B services to be enrolled later but CMS decided instead to require them all to be enrolled in PECOS by July 6. Due to the significant number of problems physicians have had with enrollment over the past few years and the lack of appropriate contractor resources to handle the volume of enrollment applications, the AMA voiced its serious objections to CMS concerning the impact this could have on claims processing and the time needed for al referring / ordering physicians to become enrolled.

The AMA recommends physicians check with their Medicare contractors, medical societies and the AMA on any future information associated with this policy since CMS expects to publish a final rule with more details in July.

WHERE TO GO FOR MORE INFORMATION:

AMA website: www.ama-assn.org/go/regrelief (select Medicare enrollment)

Medicare contractor phone numbers:

www.cms.gov/MedicareProviderSupEnroll/downloads/contact_list.pdf

CMS Medicare enrollment website:

www.cms.gov/MedicareProviderSupEnroll/

The AMA checked again today with senior officials at the Centers for Medicare and Medicaid Services, and physician claims submitted for services provided in June are, in fact, being processed under the reduced payment rate on a rolling, first in/ first out basis.  In other words, claims submitted earliest are now being paid at the reduced rate, while newer claims will continue to be held for a ten-day period until the President is able to sign legislation into law. 

We still anticipate that whatever legislation is passed will apply retroactively to all services provided since June 1, and that claims that have already been processed will be adjusted automatically without physicians having to resubmit them.

We expect Congress to resolve the issue before the end of the week, and will keep you updated on new developments.

The choice between not getting paid from Medicare at all or getting paid 79% of current rates places physicians between a rock and a hard place with no good options.  If Congress fails to act before Friday, then carriers will start processing June claims at the reduced rates and, whenever Congress does act, these claims will need to be reprocessed and retroactively adjusted.  To avoid the hassle of reprocessing, practices that can afford it may wish to hold claims themselves until after the issue is resolved.

There is only one truly good option and that is for Congress to repeal the formula that produces these cuts.  To contact your Senators and urge them to act quickly, call (800) 833-6354.



The House easily passed, 245-171, the so-called “doc fix” on May 28, but the Senate failed to act before the Memorial Day recess. The cuts were scheduled to go into effect on Tuesday, but the agency that oversees Medicare has asked its contractors to postpone claims processing for 10 days to give lawmakers time to retroactively freeze the rate cut.

The House passed a 19-month fix that would give physicians a 2.2 percent pay bump for the remainder of the year and an extra 1 percent bump next year. In 2012, physicians would face a 33 percent rate cut if Congress doesn’t act again.

This is the fourth time this year that lawmakers have had to act to prevent the scheduled cuts, and physician groups have been clamoring for a permanent fix to Medicare’s Sustainable Growth Rate (SGR) formula. But even the House’s 19-month fix, which is unpaid for through higher taxes or spending cuts, faces a difficult time in the Senate due to the ballooning budget deficit.

In a report aired April 27 of this year, CBS reporter Armen Keteyian talked with John Juntunen of Digital Copier Security, a firm which has developed software designed to scrub data from copier hard drives, about the security risk and his ongoing frustration with manufacturers to alert consumers to the dangers. 

Also during the report, Juntunen and CBS News purchased four used copiers from a New Jersey warehouse and using data recovery software available for free on the internet managed to recover thousands of documents from the machines.

But, what was most troubling was what was discovered on machine number four which was formerly used by Affinity Health Plan of NY. There they found hundreds upon hundreds of pages if individual medical records, including everything from drug prescriptions to blood test results to cancer diagnosis.

In the end, if you plan to decommission a copier manufactured in 2002 or later don’t let it leave your office until you are certain you’ve wiped clean the internal hard drive. You may also want to consider thinking twice about using outside coping firms unless you get their assurance the copied information is deleted.