Updates
Bill Correctly for Medicare Telehealth Services (2/2020)
In a recent report, the Office of Inspector General (OIG) determined that the Centers for Medicare & Medicaid Services (CMS) improperly paid practitioners for some telehealth claims associated with services that did not meet Medicare requirements. CMS released the Medicare Telehealth Services video to help you bill correctly.
Additional resources:
Source: CMS
In a recent report, the Office of Inspector General (OIG) determined that the Centers for Medicare & Medicaid Services (CMS) improperly paid practitioners for some telehealth claims associated with services that did not meet Medicare requirements. CMS released the Medicare Telehealth Services video to help you bill correctly.
Additional resources:
- Telehealth Services (PDF) Medicare Learning Network Booklet
- Medicare Claims Processing Manual, Chapter 12 (PDF), Section 190
- Medicare Telehealth Payment Eligibility Analyzer
- List of Covered Telehealth Services webpage
- CMS Paid Practitioners for Telehealth Services That Did Not Meet Medicare Requirements OIG Report
Source: CMS
Over 1,500 health care organizations hit with successful ransomware attacks since 2016, report says
HealthIT Security (2/13, HealthITSecurity) reports “more than 1,500 health care organizations have been hit with successful ransomware attacks since 2016, costing the sector over $160 million during that time, according to a recent report from Comparitech, a company that provides consumers with privacy information, tools, and comparisons.”
HealthIT Security (2/13, HealthITSecurity) reports “more than 1,500 health care organizations have been hit with successful ransomware attacks since 2016, costing the sector over $160 million during that time, according to a recent report from Comparitech, a company that provides consumers with privacy information, tools, and comparisons.”
House Ways and Means Committee releases legislation on surprise medical bills
The Hill (2/7, Sullivan) reported the House Ways and Means Committee “released their legislation to protect patients from getting massive, surprise medical bills, as congressional action on the subject intensifies.” Reps. Richard Neal and Kevin Brady, the committee’s leaders, both support the legislation, which “would protect patients from getting bills for thousands of dollars when they go to the emergency room and one of their doctors happens to be outside their insurance network.”
The Hill (2/7, Sullivan) reported the House Ways and Means Committee “released their legislation to protect patients from getting massive, surprise medical bills, as congressional action on the subject intensifies.” Reps. Richard Neal and Kevin Brady, the committee’s leaders, both support the legislation, which “would protect patients from getting bills for thousands of dollars when they go to the emergency room and one of their doctors happens to be outside their insurance network.”
Pennsylvania court ruling removes limits on liability lawsuit filings (11/2019)
A medical liability law in Pennsylvania giving patients a seven-year window to file a lawsuit has been struck down as unconstitutional.
The statute, part of Pennsylvania’s Medical Care Availability and Reduction of Error (MCARE) Act passed in 2002, permitted a patient seven years to file a lawsuit. After seven years, the statute of repose barred the patient’s action.
The Pennsylvania Supreme Court struck down the statute, by a vote of 4-3, in the case of Yanakos v. UPMC, et al.
One of the dissenting justices wrote that the decision of the majority flouted the Legislature’s policymaking authority and that “it is not this court’s role to upend duly enacted legislation simply because we might sometimes deem it imperfect or unwise.”
Without a statute of repose, medical professionals and liability insurers face potential exposure for claims long after treatment is rendered. This uncertainty leaves physicians constantly in fear of a liability lawsuit, even decades after treating a patient.
Click here to read more about the ruling and its impact on Pennsylvania physicians and patients.
Source: Protect Patients Now
A medical liability law in Pennsylvania giving patients a seven-year window to file a lawsuit has been struck down as unconstitutional.
The statute, part of Pennsylvania’s Medical Care Availability and Reduction of Error (MCARE) Act passed in 2002, permitted a patient seven years to file a lawsuit. After seven years, the statute of repose barred the patient’s action.
The Pennsylvania Supreme Court struck down the statute, by a vote of 4-3, in the case of Yanakos v. UPMC, et al.
One of the dissenting justices wrote that the decision of the majority flouted the Legislature’s policymaking authority and that “it is not this court’s role to upend duly enacted legislation simply because we might sometimes deem it imperfect or unwise.”
Without a statute of repose, medical professionals and liability insurers face potential exposure for claims long after treatment is rendered. This uncertainty leaves physicians constantly in fear of a liability lawsuit, even decades after treating a patient.
Click here to read more about the ruling and its impact on Pennsylvania physicians and patients.
Source: Protect Patients Now
310 ASCs with total joint replacements
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Source: Becker's Healthcare | Written by Laura Dyrda | April 29, 2019
Total joint replacements are moving to the outpatient setting, with more than 300 ASCs across the country including total knee and hip procedures. Here is acomplete list of those centers. To add a center to this list, contact Laura Dyrda at Becker's Healthcare |
Pennsylvania
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January 2019
Pennsylvania liability rule change could lead to increase in lawsuit abuse
A rule that helped stabilize the medical liability market in Pennsylvania faces the threat of repeal, bringing worry that medical lawsuit abuse could return.
Implemented in 2002, reforms mandated that medical liability claims could only stand trial in the county where the alleged medical error occurred to avoid “venue shopping” lawsuits to courts that had a history of favoring large verdicts and personal injury attorneys.
The Pennsylvania Supreme Court now proposes eliminating that rule, allowing victims to file lawsuits in any county where the defendant does business — even if the incident in question occurred elsewhere.
A coalition that includes the Pennsylvania Medical Society (PAMED), the Hospital and Healthsystem Association of Pennsylvania (HAP), and the Pennsylvania Coalition for Civil Justice Reform (PCCJR) cites this rule as the primary reason the system has stabilized to its current point.
“If history is any indication, this could have devastating effects on patient care,” said Danae Powers, MD, president of PAMED. “In the years before we restricted venue shopping, medical liability premiums rose so quickly that some physicians couldn’t obtain the insurance they needed to treat patients. Others chose to leave Pennsylvania or retire.”
The proposed rule is open for public comments between now and Feb. 22.
To read more about how repealing this reform could lead to increases in medical lawsuit abuse and affect patient access to care,
click here.
Source: Protect Patients Now
Pennsylvania liability rule change could lead to increase in lawsuit abuse
A rule that helped stabilize the medical liability market in Pennsylvania faces the threat of repeal, bringing worry that medical lawsuit abuse could return.
Implemented in 2002, reforms mandated that medical liability claims could only stand trial in the county where the alleged medical error occurred to avoid “venue shopping” lawsuits to courts that had a history of favoring large verdicts and personal injury attorneys.
The Pennsylvania Supreme Court now proposes eliminating that rule, allowing victims to file lawsuits in any county where the defendant does business — even if the incident in question occurred elsewhere.
A coalition that includes the Pennsylvania Medical Society (PAMED), the Hospital and Healthsystem Association of Pennsylvania (HAP), and the Pennsylvania Coalition for Civil Justice Reform (PCCJR) cites this rule as the primary reason the system has stabilized to its current point.
“If history is any indication, this could have devastating effects on patient care,” said Danae Powers, MD, president of PAMED. “In the years before we restricted venue shopping, medical liability premiums rose so quickly that some physicians couldn’t obtain the insurance they needed to treat patients. Others chose to leave Pennsylvania or retire.”
The proposed rule is open for public comments between now and Feb. 22.
To read more about how repealing this reform could lead to increases in medical lawsuit abuse and affect patient access to care,
click here.
Source: Protect Patients Now
Nov 2018
Pennsylvania E-Prescribing Bill Signed Into Law
Despite Pennsylvania’s ongoing legislative efforts to halt the opioid addiction crisis, legislators previously did not realize that controlled substance prescriptions were mandated by state law to be handwritten. The Pennsylvania Orthopaedic Society (POS) brought this statutory deficiency to the fore, and Rep. Tedd Nesbit and State Sen. Richard Alloway (R-Franklin) quickly introduced vital legislation to prevent opioid prescriptions from being lost, stolen, altered, or sold. Last month, HB 353 passed the Pennsylvania State Legislature and was recently signed into law by Governor Tom Wolf.
Orthopaedic surgeons are the fourth leading opioid prescribers in Pennsylvania. One of the best ways to ensure that prescriptions for opioids are tightly controlled is through electronic means. Opioid e-prescribing will undoubtedly reduce drug diversion due to prescriptions being lost, stolen, or sold.
POS’s short-term goal was the enactment of HB 353 and elimination of a major source of drug diversion due to written prescriptions being lost, stolen, altered, or sold. POS’s intermediate goal is for this legislation to pave the way for effective communication among all players in the health care delivery system including patients, physicians, hospitals, pharmacies, insurers, and governmental entities to continue battling the crisis. POS’s long-term goal is to demonstrate to lawmakers that the opioid addiction crisis is not a “bad doctor” issue, but a complicated crisis with many actors at fault. POS wants to show that orthopaedic surgeons are part of the solution, not the problem.
The AAOS Board of Councilor’s State Legislative and Regulatory Issues (SLRI) committee supported the effort with grants.
Read the final enacted law here.
Read the impacts of the bill here.
Source: AAOS
Pennsylvania E-Prescribing Bill Signed Into Law
Despite Pennsylvania’s ongoing legislative efforts to halt the opioid addiction crisis, legislators previously did not realize that controlled substance prescriptions were mandated by state law to be handwritten. The Pennsylvania Orthopaedic Society (POS) brought this statutory deficiency to the fore, and Rep. Tedd Nesbit and State Sen. Richard Alloway (R-Franklin) quickly introduced vital legislation to prevent opioid prescriptions from being lost, stolen, altered, or sold. Last month, HB 353 passed the Pennsylvania State Legislature and was recently signed into law by Governor Tom Wolf.
Orthopaedic surgeons are the fourth leading opioid prescribers in Pennsylvania. One of the best ways to ensure that prescriptions for opioids are tightly controlled is through electronic means. Opioid e-prescribing will undoubtedly reduce drug diversion due to prescriptions being lost, stolen, or sold.
POS’s short-term goal was the enactment of HB 353 and elimination of a major source of drug diversion due to written prescriptions being lost, stolen, altered, or sold. POS’s intermediate goal is for this legislation to pave the way for effective communication among all players in the health care delivery system including patients, physicians, hospitals, pharmacies, insurers, and governmental entities to continue battling the crisis. POS’s long-term goal is to demonstrate to lawmakers that the opioid addiction crisis is not a “bad doctor” issue, but a complicated crisis with many actors at fault. POS wants to show that orthopaedic surgeons are part of the solution, not the problem.
The AAOS Board of Councilor’s State Legislative and Regulatory Issues (SLRI) committee supported the effort with grants.
Read the final enacted law here.
Read the impacts of the bill here.
Source: AAOS
Senators Introduce Legislation To Prevent Surprise Medical Bills
The Hill (9/18, Sullivan) reports senators from both parties are “unveiling a draft measure to crack down on surprise medical bills, which they say have plagued patients with massive unexpected charges for care.” The legislation “would prevent a health care provider that is outside of a patient’s insurance network from charging additional costs for emergency services to patients beyond the amount usually allowed under their insurance plan.” In addition, insurers, not patients, “would have to pay additional charges, which are limited under the proposal.”
Source: AMA Morning Rounds
The Hill (9/18, Sullivan) reports senators from both parties are “unveiling a draft measure to crack down on surprise medical bills, which they say have plagued patients with massive unexpected charges for care.” The legislation “would prevent a health care provider that is outside of a patient’s insurance network from charging additional costs for emergency services to patients beyond the amount usually allowed under their insurance plan.” In addition, insurers, not patients, “would have to pay additional charges, which are limited under the proposal.”
Source: AMA Morning Rounds
August 8, 2018
Employers contracting directly with hospitals, providers to lower health care costs, survey indicates
CNN Money (8/7, Luhby) reports more and more “companies are contracting directly with hospitals and providers to take care of their employees, according to an annual survey released Tuesday by the National Business Group on Health.” Data show about 11 percent of companies intend to do this in 2019, compared to three percent in 2018. The article says, “Also becoming more popular are direct contracts between companies and providers to handle certain pricey conditions, such as cancer, cardiovascular disease, fertility treatments and orthopedic needs.” The survey revealed that about “18% of companies said they are negotiating these deals for 2019, up from 12% this year.”
Modern Healthcare (8/7, Livingston, Subscription Publication) reports that according to the survey, large companies and their employees will pay more for health care next year. Data indicate companies will “pay $14,800 per employee for health coverage in 2019, an increase of 5% from $14,099 this year.” Companies are expected to pay approximately 70 percent of the costs, while employees will cover the remaining 30 percent.
Employers contracting directly with hospitals, providers to lower health care costs, survey indicates
CNN Money (8/7, Luhby) reports more and more “companies are contracting directly with hospitals and providers to take care of their employees, according to an annual survey released Tuesday by the National Business Group on Health.” Data show about 11 percent of companies intend to do this in 2019, compared to three percent in 2018. The article says, “Also becoming more popular are direct contracts between companies and providers to handle certain pricey conditions, such as cancer, cardiovascular disease, fertility treatments and orthopedic needs.” The survey revealed that about “18% of companies said they are negotiating these deals for 2019, up from 12% this year.”
Modern Healthcare (8/7, Livingston, Subscription Publication) reports that according to the survey, large companies and their employees will pay more for health care next year. Data indicate companies will “pay $14,800 per employee for health coverage in 2019, an increase of 5% from $14,099 this year.” Companies are expected to pay approximately 70 percent of the costs, while employees will cover the remaining 30 percent.
QPP Group Eligibility Status Now Available
The Centers for Medicare and Medicaid Services (CMS) has announced that physician practices/groups may now log into the CMS QPP website to check their 2018 eligibility for Medicare’s Merit-based Incentive Payment System (MIPS). After groups log in, they will be able to click into a details screen to see the eligibility status of every clinician in the group ( based on their National Provider Identifier or NPI) to find out whether they need to participate during the 2018 performance year for MIPS.
Unfortunately, CMS will not be sending out letters to advise physicians of their eligibility status this year so checking on the QPP participation status look-up tool is the only way to determine or verify eligibility status. Eligibility rules in 2018 are different than in 2017 so status this year may be different than last. Also as is indicated in the look-up tool, exempt individual clinicians still will need to report if their group is eligible and chooses to report as a group.
The look-up tool can be found at https://qpp.cms.gov/participation-lookup
The Centers for Medicare and Medicaid Services (CMS) has announced that physician practices/groups may now log into the CMS QPP website to check their 2018 eligibility for Medicare’s Merit-based Incentive Payment System (MIPS). After groups log in, they will be able to click into a details screen to see the eligibility status of every clinician in the group ( based on their National Provider Identifier or NPI) to find out whether they need to participate during the 2018 performance year for MIPS.
Unfortunately, CMS will not be sending out letters to advise physicians of their eligibility status this year so checking on the QPP participation status look-up tool is the only way to determine or verify eligibility status. Eligibility rules in 2018 are different than in 2017 so status this year may be different than last. Also as is indicated in the look-up tool, exempt individual clinicians still will need to report if their group is eligible and chooses to report as a group.
The look-up tool can be found at https://qpp.cms.gov/participation-lookup
