RAC: CMS Approved Audit Issues Posted
To see the Recovery Audit Contractor (RAC) CMS-approved audit issues, visit Connolly Healthcare’s website. Connolly is the RAC Contractor for Region C. The CMS Approved Audit Issues are for hospital outpatient facilities and physicians.
According to the National Association of Rehab Providers and Associations (NARA), the first set of approved issues includes outpatient rehab in the mix, and the source of the issues comes straight from the finding in the RAC demonstration project in California and New York. In the demonstration project $3.2 million of claims for speech evaluation were found to be billed in error as time-based codes, rather than as service-based codes. The Speech evaluation code may only be billed as a unit of “1″. The same is also true for physical therapy evaluation and occupational therapy evaluation codes.
CCHIT to Seek EHR Vendor Input on Town Call Meeting
The Certification Commission for Health Information Technology (CCHIT®), a nonprofit organization with the public mission of accelerating the adoption of health IT, will host a Town Call tomorrow for the vendor and developer community tomorrow. Chart Links Chief Operating Officer, Jim Hammer, will participate. On the call, CCHIT will gather input on the details and timing of its planned new paths to certification of electronic health record (EHR) technologies, with the goal of supporting more rapid, widespread adoption and meaningful use under the American Recovery and Reinvestment Act of 2009 (ARRA).
“We are concerned that providers could not achieve meaningful EHR use in 2011 if they wait until Spring 2010 – the expected date of HHS final approval of requirements – to begin adopting this technology,” said Mark Leavitt, M.D., Ph.D., Commission chair. “CCHIT has analyzed the recommendations of the Federal HIT Advisory Committees and is preparing to offer new paths to certification beginning this October.”
Besides updating and enhancing its current certification program for comprehensive EHRs in Ambulatory, Inpatient, and Emergency Department settings, the Commission plans to launch a more limited, modular inspection program for EHR technology, focusing only on compliance with ARRA-required standards.
During the event, planned for September 3 at 12:00 PM Central time, concepts and some details of these two programs will be discussed. Participants will be invited to submit questions and comments online, and respond to polling regarding their interest and readiness for participation in the process.
Information about the free Town Call is available at http://www.cchit.org/about/towncalls/commission-seeks-input-2009.
More information on CCHIT and CCHIT Certified® products is available at http://cchit.org and http://ehrdecisions.com.
2009 Physical Therapist Productivity Report
Now available from the American Physical Therapy Association (APTA) for its members is the 2009 Physical Therapist Productivity Summary Report. The report provides actual data on the number of patients seen by PTs versus previous reports on productivity dealing with “expectations” of patients seen.
Therapists Now Required to Notify Individuals of Health Information Breaches
The U.S. Department of Health and Human Services (HHS) has issued a rule requiring that individuals be notified of breaches of their health information.
These “breach notification” regulations implement provisions of the Health Information Technology for Economic and Clinical Health (HITECH) Act, passed as part of the American Recovery and Reinvestment Act of 2009 (ARRA).
The regulations, developed by the HHS Office for Civil Rights (OCR), require health care providers and other HIPAA covered entities to promptly notify affected individuals of a breach, as well as the HHS Secretary and the media in cases where a breach affects more than 500 individuals. Breaches affecting fewer than 500 individuals will be reported to the HHS Secretary on an annual basis. The regulations also require business associates of covered entities to notify the covered entity of breaches at or by the business associate.
The regulations were developed after considering public comment received in response to an April 2009 request for information and after close consultation with the Federal Trade Commission (FTC), which has issued companion breach notification regulations that apply to vendors of personal health records and certain others not covered by HIPAA.
To determine when information is “unsecured” and notification is required by the HHS and FTC rules, HHS is also issuing in the same document as the regulations an update to its guidance specifying encryption and destruction as the technologies and methodologies that render protected health information unusable, unreadable, or indecipherable to unauthorized individuals. Entities subject to the HHS and FTC regulations that secure health information as specified by the guidance through encryption or destruction are relieved from having to notify in the event of a breach of such information. This guidance will be updated annually.
The HHS interim final regulations are effective 30 days after publication in the Federal Register and include a 60-day public comment period. For more information, visit the HHS Office for Civil Rights web site at http://www.hhs.gov/ocr/privacy/
No Final Definition of EHR Meaningful Use until Spring of 2010
We’ve been anxiously awaiting a final definition for “meaningful use” of electronic health records (EHR) to determine which hospitals and providers will be eligible for Medicare and Medicaid incentive payments under the American Recovery and Reinvestment Act of 2009. However, in a press conference on August 20th, Dr. David Blumenthal, the national coordinator for health information technology, predicted that the final definition will not be available until the middle or end of spring in 2010. A preliminary definition of “meaningful use” is scheduled to be issued by the end of 2009 with a 60-day comment period.
Federal Trade Commission Delays Red Flag Rules
The Federal Trade Commission (FTC) says that it will further delay enforcement of the “Red Flag” rules until November 1. The rules were to go into effect August 1.
Therapists who provide services to patients without requiring those patients to pay in full at the time of service will need to comply with Federal Trade Commission (FTC) Red Flag rules.
Red Flag rules require the development of a written Identity Theft Prevention Program. Medical identity theft refers to situations when someone uses a person’s name and other parts of their identity, such as insurance information, without the person’s knowledge or consent to obtain medical services or goods.
For more information and resources, go to APTA’s Identity Theft Web page or visit our blog post from July.
Red Flag Rule Enforced Effective August 1, 2009
Therapists who provide services to patients without requiring those patients to pay in full at the time of service will need to comply with Federal Trade Commission (FTC) “Red Flag Rules.” We blogged back in April that practices would need to comply with these rules effective May 1, 2009. It’s important to know, now, that — effective August 1, 2009 — the FTC will begin to enforce this rule.
Red Flag rules require the development of a written Identity Theft Prevention Program. Medical identity theft refers to situations when someone uses a person’s name and other parts of their identity, such as insurance information, without the person’s knowledge or consent to obtain medical services or goods.
The FTC has posted an article called “The ‘Red Flags’ Rule: What Health Care Providers Need to Know About Complying with New Requirements for Fighting Identity Theft,” by Steven Toporoff. The article covers off on
- Who Must Comply
- Spotting Red Flags
- Setting Up Your Identity Theft Prevention Program
- What’s At Stake
We suggest that a representative from your facility reads the article to come up to speed on compliance with this rule.
CCHIT Addresses EHRs for Inpatient Rehabilitation
A task force of the Certification Commission for Healthcare Information Technology (CCHIT) has issued recommendations for a new long term and post acute care electronic health records certification program.
The program would cover EHRs in skilled nursing and nursing facilities, Medicare-certified home health agencies, inpatient rehabilitation facilities and long term acute care hospitals.
Recommendations from the task force include identifying core certification criteria common to the four priority care settings, reusing or adapting existing criteria from other CCHIT programs, identifying additional criteria specific to each care setting, and developing a roadmap indicating when the criteria are expected to be implemented.
A newly appointed CCHIT work group on long term and post acute care will start developing certification criteria in mid-July. The recommendations from the task force are available at cchit.org/about/organization/commission/advisory/ltpac.
[Source: Information taken from HealthData Management, written by Joseph Goedert.]
Medicare Administrative Contractors (MAC) Fax Scam Alert
A 06/18/09 update on the Centers for Medicare and Medicaid Services (CMS) Home Health, Hospice & Durable Medical Equipment Open Door Forum website indicates that CMS has become aware of a scam. The scam entails the submission of faxes to practices from perpetrators posing as the Medicare carrier or Medicare Administrative Contractor (MAC). The fax tells physician staff to respond to a questionnaire to provide an account information update within 48 hours in order to prevent a gap in Medicare payments. The fax may have the CMS logo and/or the contractor logo to enhance the appearance of authenticity.
Medicare FFS providers, including physicians and non-physician practitioners, should be wary of this type of request. If you receive a request for information in the manner described above, please check with your contractor before submitting any information. Medicare providers should only send information to a Medicare contractor using the address found in the download section of the CMS.gov website found at http://www.cms.hhs.gov/MLNGenInfo/ or http://www.cms.hhs.gov/MedicareProviderSupEnroll .
AOTA Advocates for Medicare Home Health Flexibility Act (HR 1094)
According to the American Occupational Therapy Association (AOTA), current law limits the appropriate use of occupational therapy in the home health setting and negatively impacts outcomes for home health care recipients by barring clinically indicated and physician authorized services.
As an important step forward, newly proposed legislation would allow occupational therapists to conduct the initial assessment when there is a qualifying service on the physician order. This will allow home health agencies to more efficiently use their occupational therapists to meet patient needs.
Representatives John Lewis (D-GA) and Lincoln Diaz-Balart introduced legislation that would improve utilization of occupational therapy as a home health service under Medicare on February 13, 2009. The Medicare Home Health Flexibility Act (H.R.1094) is also actively supported by the National Association of Home Care and Hospice (NAHC), the American Speech-Language Hearing Association (ASHA) and was previously supported by the American Physical Therapy Association in the last Congress.
AOTA is working to build support for passage during the 111th Congress.
CMS Releases 14 New RAC FAQs
The Centers for Medicare and Medicaid Services (CMS) recently released fourteen new Recovery Audit Contractor (RAC) responses to frequently asked questions. Access the entire list of RAC FAQs at the CMS website.
HITECH: An Interoperetta in Three Acts
Here’s a fun video to watch for anyone who appreciates all of the acronyms around healthcare information technology these days: HITECH, An Interoperetta in Three Acts, written and performed by Ross D. Martin, MD. (Don’t miss the big ending!)
H1N1 (Swine Flu) Resource for Physical Therapists
Are you a physical therapist looking for information on the swine flu?
The American Physical Therapy Association (APTA) has launched a web page to educate PTs and PTAs on identifying swine flu symptoms.
Sebelius is Secretary of the Department of Health and Human Services
Kansas Governor Kathleen Sebelius has been approved by the Senate as secretary of the Department of Health and Human Services. In this role, Sebelius will be a major player in the implementation of the health information technology provisions of the economic stimulus law.
Red Flag Rule Becomes Effective May 1, 2009
Physical therapists and other providers who provide services to patients without requiring those patients to pay in full at the time of service will need to comply with new “Red Flag Rules” on May 1.
Red Flag rules require the development of a written Identity Theft Prevention Program. Medical identity theft refers to situations when someone uses a person’s name and other parts of their identity, such as insurance information, without the person’s knowledge or consent to obtain medical services or goods.
The Federal Trade Commission (FTC) has indicated that these rules will apply to physicians, other health care professionals, and providers.
With the May 1 deadline fast approaching, the American Medical Association has requested the FTC to suspend application of the red flag rules to physicians and other health care professionals.
Source: American Physical Therapy Association’s PT Bulletin Online, current issue.
A copy of the FTC letter on the red flag rules is available at http://www.ftc.gov/os/closings/staff/090204amaresponse.pdf
Hospital Incentives Under Economic Stimulus Package
Prepared by the Healthcare Information and Management Systems Society (HIMSS), here are some of the estimates of what could be paid in Medicare incentive payments from 2011 to 2014 for hospitals meeting the yet-to-be-determined “meaningful use” standards of electronic health records under the American Recovery and Reinvestment Act:
- 75-bed hospital, up to $3.5 million
- 250-bed hospital, up to $5.7 million
- 750-bed hospital, up to $11.2 million
Legislation Aims to Increase Access to Physical Therapist Services by Eliminating Physican Referral Requirement
Medicare beneficiaries who need physical therapist services would find it easier and more efficient to obtain treatment under legislation introduced yesterday in the US House of Representatives. The Medicare Patient Access to Physical Therapists Act (HR 1829) would allow physical therapists to evaluate and treat Medicare Part B beneficiaries who require outpatient physical therapy services, in states in which direct access is authorized, without a physician’s referral or certification of the plan of care.
“Direct access under Medicare would remove unnecessary barriers to the cost-effective rehabilitation services provided by physical therapists,” said APTA President R Scott Ward, PT, PhD. “Currently these health care consumers, which include seniors and people with disabilities, often have the greatest need for physical therapy services and experience unnecessary burdens to access these services. The referral/certification process can often cause delays that can impede a patient’s ability to achieve his or her optimal functional outcome. In light of today’s economic environment, timely access to cost-effective physical therapy services for Medicare beneficiaries is critical.”
Forty-eight states and the District of Columbia have eliminated the physician referral requirement for patients to access physical therapists for an evaluation, while 44 states and DC allow access to some form of physical therapy treatment without referral. This legislation would defer to the state law on access regarding physical therapy.
A Senate companion bill is expected to be introduced in the next several weeks.
[Source: APTA]
Blumenthal As National Coordinator for Health Information Technology
David Blumenthal, M.D. has been named by The Department of Health and Human Services as the national coordinator for health information technology, succeeding Robert Kolodner, M.D. Blumenthal currently serves as the director of the Institute for Health Policy at Massachusetts General Hospital in Boston. He is a practicing physician, a professor of medicine at Harvard Medical School, and was a health policy advisor to Barack Obama during the presidential campaign.
Move Forward Video from APTA
Watch the video published by the American Physical Therapy Association entitled “Move Forward: Physical Therapy Brings Motion To Life (APTA).”
The video supports the APTA’s new brand launch to depict the physical therapist as the provider of choice for helping patients restore motion and improve mobility in their lives.
Impact of Stimulus Bill on Physical Therapy
“We will rebuild, we will recover, and the United States of America will emerge stronger than before.” These are the words of President Obama in his speech to the U.S. Congress last night where he called for comprehensive healthcare reform this year. The President talked about the cost of healthcare on families and businesses, indicating that reform work would begin as early as next week.
What kind of impact does Obama’s recently-passed Stimulus Bill have on physical therapists? PTProductsonline.com published this article titled “Stimulus Bill Includes Many Provisions for PTs.”