PROCTORSHIPS AND THE 30 DAY REPORTING REQUIREMENT
BY DAVID F. DURSO, Esq.
Recently, the United States District Court for the Eastern District of Texas issued a decision regarding a hospital’s obligation to report a restriction of a physician’s privileges to the National Practitioner Data Bank (“NPDB”). Health care entities are required to report “a professional review action that adversely affects the clinical privileges of a physician for a period of longer than 30 days” to the NPDB.
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QPP Reporting for Performance Year 2017 – An Introduction
Wednesday, January 17, 2018 | 12:00 PM – 12:30 PM EST Register here
The Merit-based Incentive Payment System (MIPS) allows clinicians to choose and report on measures/activities from three performance categories: Improvement Activities, Quality, and Advancing Care Information. This webinar will provide attendees with information on the QPP.gov reporting website and how to report collected data for the 2017 Performance Year.
Reporting Quality Data
Tuesday, January 30, 2018 | 12:00 PM – 12:30 PM EST Register here
The Merit-based Incentive Payment System (MIPS) allows clinicians to choose and report on measures/activities from three performance categories: Improvement Activities, Quality, and Advancing Care Information. This webinar will provide attendees with information on the QPP.gov reporting website and how to report collected data for the Quality performance category.
Please Urge Governor Cuomo
to Veto Disastrous Liability
Expansion Bill and Work for Comprehensive Reform. Physicians are strongly urged to continue to contact Governor Cuomo to request that he veto legislation (S.6800/A.8516) that would significantly expand the time to bring a medical malpractice lawsuit, in circumstances based upon an "alleged negligent failure to diagnose a malignant tumor or cancer". If signed into law, it would likely prompt a double digit increase in physician and hospital malpractice premiums. You can send a letter here and call 518-474-8390.
While many physicians have made these contacts, we need an overwhelming demonstration from physicians regarding how this bill will harm access to care in their communities if this bill is not paired with needed tort reforms to bring down the exorbitant costs of medical liability insurance in New York.
Physicians have been active in warning the public about the patient care access problems this bill will exacerbate if it is signed into law.
PHYSICIANS HEALTH AND WELLNESS EXPO
Saturday, November 18, 2017 12:00- 4:00 PM
To Be Held at the Historic Smithtown Brush Barn
CME CREDITS FOR THIS EVENT
ADDITIONAL INFORMATION AND SCHEDULE HERE
MSSNY Official: MAT Effective, But Underutilized Treatment for Opioid Use Disorder
On page 16 of the Fall 2017 issue of Behavioral Health News (10/26), Dr. Frank Dowling, a clinical associate professor of psychiatry at SUNY-Stony Brook and the Secretary of the Medical Society of the State of New York, writes that medication-assisted treatment (MAT) is an effective, but underutilized treatment for opioid use disorder. Dowling says that “there is a shortage of access to MAT,” and that many patients and clinicians remain opposed to MAT, because of “well intended but misguided perceptions” that “are often reinforced by drug treatment program staff and by peers in 12-step programs.”
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MIPS Participation Status Letter
CMS is reviewing claims and letting practices know which clinicians need to take part in the Merit-based Incentive Payment System https://qpp.cms.gov/learn/qpp (MIPS), an important part of the new Quality Payment Program (QPP). In late April through May, you will get a letter from your Medicare Administrative Contractor https://www.cms.gov/Medicare/Medicare-Contracting/Medicare-Administrative-Contractors/MedicareAdministrativeContractors.html that processes Medicare Part B claims, providing the participation status of each MIPS clinician associated with your Taxpayer Identification Number (TIN).
Clinicians should participate in MIPS in the 2017 transition year if they:
* Bill more than $30,000 in Medicare Part B allowed charges a year and
* Provide care for more than 100 Part B-enrolled Medicare beneficiaries a year
QPP intends to shift reimbursement from the volume of services provided toward a payment system that rewards clinicians for their overall work in delivering the best care for patients. It replaces the Sustainable Growth Rate formula and streamlines the "Legacy Programs" - Physician Quality Reporting System, the Value-based Payment Modifier, and the Medicare Electronic Health Records Incentive Program. During this first year of the program, CMS is committed to working with you to streamline the process as much as possible. Our goal is to further reduce burdensome requirements so that you can deliver the best possible care to patients. Learn more about the Quality Payment Program https://qpp.cms.gov/
Percentage Arrangements With Billing Companies
By Ellen F. Kessler
The New York State Medicaid Fraud Control Unit (“MFCU”) has recently embarked on a campaign to recover thousands of dollars of Medicaid payments plus interest from various health care providers who pay billing companies a percentage of collections for their billing services.
MFCU has been sending letters to Medicaid providers in New York State demanding the return of payments where Medicaid discovered that the providers used billing companies who were paid on a “percentage of collections” basis. This demand by Medicaid is not based on a claim of overpayment or improper billing methodology by the provider. Rather, Medicaid relies on an arcane provision found in the Medicaid rules1 which states that:
“A provider of medical care services or supplies may employ a business agent, such as a billing service or an accounting firm. Such agent may prepare and send bills and receive MA payments in the name of the provider only if the compensation paid to the agent is:
1. Reasonably related to the cost of the services;
2. Unrelated, directly or indirectly to the dollar amounts billed and collected; and
3. Not dependent on actual collection of payments.”
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2017 Medicare Electronic Health Record (EHR) Incentive Program Payment Adjustment Fact Sheet for Eligible Professionals
Overview of the Program
As part of the American Recovery and Reinvestment Act of 2009 (ARRA), Congress established payment adjustments under Medicare for eligible professionals that are not meaningful users of Certified Electronic Health Record (EHR) Technology. Eligible professional (EP) that do not successfully demonstrate meaningful use for an EHR reporting period associated with a payment adjustment year will receive reduced Medicare payments for that year. The Medicare payment adjustments began on January 1, 2015 for EP and sunset in 2018 per the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA).
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