December 2010

Breaking News for Physicians and Physician Practices

Posted December 3, 2010

Congress Passes Bill to Postpone Physician Pay Cut

 

A 23 percent cut in Medicare payments to physicians scheduled to take effect December 1 has been postponed for one month. The U.S. House of Representatives agreed without objection November 29 to an amended bill the Senate unanimously passed November 18. President Obama signed the bill on November 30. The Physician Payment and Therapy Relief Act of 2010 (HR 5712) as amended by Senate Amendment (SA) 4711 extends the 2.2 percent physician payment update that expired November 30 through December 31.

 

The bill also applies a 20 percent reduction, rather than a 25 percent reduction, in the discount for certain multiple therapy services furnished on or after January 1, 2011; and exempts reduced expenditures attributable to the multiple procedure payment reduction from budget-neutrality requirements.

 

Physicians now face a 25 percent cut in Medicare payments beginning January 1, 2011.

 

According to a U.S. Senate Committee on Finance press release, Senate Finance Committee Chair Max Baucus (D-Mont.) and Ranking Member Charles Grassley (R-Iowa) intend to "pursue a year-long fix to the formula that could be enacted before the month-long patch expires."

 

10% Raise for Primary Care

 

Physicians who continue providing primary care services to Medicare patients stand to get a 10 percent pay raise under the health reform act.

 

Increasing medical costs and decreasing Medicare reimbursement rates have put a lot of physician practices in a financial bind. To stay afloat, many physicians have made the difficult decision to stop accepting Medicare patients. The Patient Protection and Affordable Care Act of 2010 (commonly referred to as the Affordable Care Act) includes a provision to turn this trend around by offering incentive payments to physicians and non-physician practitioners (NPPs) who continue to provide primary care services to Medicare patients.

 

Under the Primary Care Incentive Payment Program (PCIP), eligible primary care practitioners (PCPs) stand to earn incentive payments for primary care services furnished to Medicare patients on or after January 1, 2011 through December 31, 2015.

 

Quarterly incentive payments to participating PCPs are equal to 10 percent of the amount paid under Medicare Part B for primary care services furnished to Medicare patients.

 

Defining Primary Care Practitioners

 

The Affordable Care Act defines a PCP as:

• A physician who has a primary specialty designation of family medicine, internal medicine, geriatric medicine, or pediatric medicine; or
• A nurse practitioner (NP), clinical nurse specialist (CNS), or physician assistant (PA) for whom primary care services accounted for at least 60 percent of the allowed charges under the Medicare Physician Fee Schedule (MPFS) for the practitioner in a prior period as determined appropriate by Health and Human Services (HHS)—the federal agency that governs Medicare.

 

The PCIP is open to all PCPs who submit claims under their own National Provider Identifier (NPI), which is how they will be identified for incentive payments, and who meet or exceed the required 60 percent threshold of allowed charges for primary care services to Medicare patients. For 2011 payments, Medicare claims data from two years prior will be considered to establish the required threshold. A provision to accommodate newly enrolled Medicare providers will be released in 2011.

 

Services furnished incident-to physicians' services do not qualify for incentive payments.

 

Defining Primary Care Services

 

The Affordable Care Act defines primary care services as those services identified by the following CPT® codes:

 

• 99201 – 99215 for new and established patient office or other outpatient evaluation and management (E/M) visits;
• 99304 – 99340 for initial, subsequent, discharge, and other nursing facility E/M services; new and established patient domiciliary, rest home (e.g., boarding home), or custodial care E/M services; and domiciliary, rest home (e.g., assisted living facility), or home care plan oversight services; and
• 99341 – 99350 for new and established patient home E/M visits.

 

New Rules Slash Improper Pay

 

The Medicare fee-for-service (FFS) error rate dropped from 12.4 percent in 2009 to 10.5 percent, or $34.3 billion, in estimated improper claims payments for 2010, according to the Centers for Medicare & Medicaid Services (CMS). The federal agency credits the implementation of more stringent review criteria for measuring claims.

 

CMS says primary causes of errors in the Medicare FFS program for 2010 are insufficient documentation and medically unnecessary services. CMS contributes the declining error rates to stricter adherence to the documentation requirements outlined in Medicare regulation, statute, and policy, rather than allowing for clinical review judgment based on billing history and other available information.

 

The error rate for Medicare Advantage also declined and a new component measure was developed and reported for the Part D program.

 

CMS plans to report a composite error estimate for Part D beginning in 2011.

 

The 'Physician Payment and Therapy Relief Act of 2010' extends 2.2 percent MPFS update

 

On Tuesday, November 30, 2010, President Obama signed into law, "The Physician Payment and Therapy Relief Act of 2010." This law extends through Friday, December 31, 2010, the 2.2 percent update to the Medicare physician fee schedule (MPFS) that has been in effect for MPFS claims with dates of service of Tuesday, June 1, 2010, through Tuesday, November 30, 2010. Payments for 2010 services under the MPFS will continue without delay.

 

Please watch your listservs and your contractor's website for more information, should Congressional action prevent the 2011 negative update from going into effect on Saturday, January 1, 2011.

 

If you have specific questions related to this bill, please contact your LBA professional directly at 904.396.4015.

 

 

---

 

August 2010

LBA Certified Public Accountants Accepted to the
National CPA Health Care Advisors Association (HCAA)

Posted Aug. 13, 2010

LBA Certified Public Accountants, PA, is proud to announce that is has been accepted as the exclusive Jacksonville member of the National CPA Health Care Advisors Association (HCAA), a nationwide association of CPA firms that provide specialized accounting, tax and consulting services to health care practitioners. To be awarded membership in HCAA, firms must demonstrate proficiency in key aspects of health care consulting.

 

"Running a successful health care practice has become more complicated," noted Jim White, LBA's Partner in Charge of the firm’s healthcare niche. "It’s crucial that health care practitioners have an advisor who understands their unique issues and can use this insight to assist them in improving their operations and profitability. Like our firm, other HCAA members know the health care industry, and belonging to HCAA enables us to pool our knowledge and resources so that we can provide the best services and solutions for our clients."
Through HCAA, members gain access to networking and educational resources that assist them in staying on the forefront of the health care industry.

 

---

March 2010

House of Representatives passes landmark health reform legislation

Posted Mar. 21, 2010

Late on March 21, the House of Representatives passed two pieces of legislation that, together, would reform the U.S. health system and impact most employers, virtually all taxpayers, and all segments of the health care industry. First, the House by a vote of 219-212 approved H.R. 3590, the Patient Protection and Affordable Care Act as passed the Senate in December of 2008. Thus, this bill was cleared for signature by the President which subsequently occurred on March 23. Second, the House by a vote of 220 to 211 approved the “Health Care and Education Reconciliation Act of 2010,” i.e., the “Amendment in the Nature of a Substitute to H.R. 4872, as amended.” The Amendment in the Nature of a Substitute amended the health reform bill that the Senate passed in December to make it more palatable to House members. Assuming this second, “follow-on” bill passes the Senate (only a simple majority is needed under the reconciliation rules), it too will be cleared for the President’s signature, thus completing a massive overhaul of the U.S. health care system.

Click here to download this important LBA Alert to learn more.

---

October 2009

Proposed 21.2% Reduction for the Physician Fee Schedule is Frozen

Posted Oct. 31, 2009

The 2010 Federal Register that announced the Physician Fee Schedule (released on 10/31/09) included a comment period through 11/25/09. Legislation was passed to the Senate to halt the reduction after the House approved the postponement as well. The reduction is currently frozen until 2/28/2010.

2010 Annual Participation Enrollment Program Extension

Because of the delay in the 2010 fee schedule, Medicare (CMS) has extended the 2010 annual participation enrollment program end date. The enrollment period now runs from November 13, 2009- January 31, 2010. Medicare contractors will accept and process any participation elections or withdrawals made during the extended enrollment period that are post marked on or before January 31, 2010.

Click here to download this important LBA Alert to learn more.

---

 

April 2009

Red Flag Rules Compliance Deadline is May 1, 2009 – Are You Ready?

Posted April 27, 2009

Physicians and physician groups may be unaware that they have a looming deadline for compliance with complex new federal regulations. The Federal Trade Commission (“FTC”) and other federal agencies issued a set of rules that require “financial institutions” and “creditors” holding consumer or other “covered” accounts to develop and implement an identity theft prevention program that originally required compliance with the regulations by November 1, 2008. The FTC subsequently postponed enforcement of these rules until May 1, 2009. These rules, commonly referred to as the Red Flag Rules (the “Rules”), affect individual physicians, physician groups, hospitals and other healthcare organizations that qualify as “creditors” based upon billing and collection practices. The Rules provide guidelines for identifying patterns, practices and specific forms of activity – in short, red flags – that indicate the possible existence of identity theft.

Click here to download this important LBA Alert to learn more.

 

---

March 2009

Medical Economics: Transparency of President’s HIT Bill

Posted March 20, 2009

Well, it is official; President Obama has signed the American Recovery and
Reimbursement Act of 2009, which includes $20 billion for Healthcare IT. What
this means for physicians is the purchase of an Electronic Medical Record (EMR)
through a conditional “IOU.”

Click here to download this important LBA Alert to learn more.

 

---

June 2008

New Faces, New Places - Healthcare Alert

Posted June 23, 2008

copy to come

 

Click here to download this Alert.

 

---

September 2007

September 2007 Healthcare Alert

Posted September 13th, 2007

This month’s Healthcare Alert includes several industry updates including those relating to Medicare payments, HIPAA, the 2007 Physician Quality Reporting Initiative, HMO Settlements and Managed Care. Click here to download the PDF.

---

July 2007

LBA Healthcare Releases Salary Survey Results

Posted July 10th, 2007

LBA Healthcare Consulting Services, LLC has conducted its fifth semi-annual Salary & Benefits Survey for administrative and clinical positions within physician practices in Northeast Florida.  This survey serves as a valuable resource to hundreds of local practices and acts as a benchmark when reviewing salaries and benefits for staff members and planning budgets for the upcoming year.

 

This year’s results reveal that 64% of respondents have a bonus program in place for their employees.  This can be accredited to the constantly changing healthcare environment and the competitive nature of physician billing and collection issues due to the many changes in insurance payments over recent months.  Physicians may have learned that providing appropriate incentives to their staff can result in more efficient billing and collection activities.

 

With health insurance costs experiencing a plateau over the last couple of years, 90% of the responding practices now offer their employees a health insurance plan, but only 46% offer a plan that covers the families of their employees.  Similarly, 64% of the respondents offer an employee dental plan, while only 39% offer a family dental plan.

 

This year’s survey saw several increases in salaries for administrative and clinical positions within Northeast Florida.  Practice Administrators experienced an average $5.61 per hour increase; Billing Supervisors, $4.44 and Registered Nurses, $2.27.  This representation could be attributed to the types of practices that responded to this year’s survey, as several respondents were highly specialized practices.

 

Participants in the survey received a copy of the results at no charge.  Additional copies may be obtained through LBA at a cost of $50.00.  To obtain a copy, please call (904) 396.4015.

---

April 2007

April 2007 Healthcare Alert

Posted April 17th, 2007

The most up to date information on N.P.I. Numbers and Medicare, as well as the details on LBA’s upcoming office move, are provided in this month’s news. Click here to download the latest Healthcare Alert.

---

March 2007

Healthcare Alert

Posted March 9th, 2007

Several deadlines are approaching, including the requirement for N.P.I. numbers.  Read the latest Healthcare Alert for details on this hot topic, as well as some recent Managed Care News. Click here to download the PDF.