Legislative News
February 2008 AOA State Government Affairs Bulletin
Medicare Conversion Factor Announced
Effective January 1, the Medicare conversion factor for physician services will be $36.0666, which includes a 1.1 percent payment update resulting from the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA), according to the 2009 Medicare Physician Fee Schedule final rule.
The AOA provided lengthy comments on the proposed rule on issues such as diagnostic imaging, incentive payment/shared savings programs, hospital acquired conditions (HAC), Physician Quality Reporting Initiative (PQRI) and the MIPPA provisions.
The Centers for Medicare and Medicaid Services (CMS) have decided not to finalize its proposal at the present time to require physicians to enroll as Independent Diagnostic Facility Centers and have reopened its comment period for the incentive payment/shared savings provision for an additional 90 days. CMS is looking to expand its Value-Based Purchasing initiatives and plans to hold a public listening session to discuss the expansion of the HAC payment provision, specifically targeting both the inpatient and hospital outpatient department (HOPD) settings of care.
For the 2009 PQRI, eligible professionals who satisfactorily report data on quality measures for covered professional services furnished between January 1, 2009 and December 31, 2009 will receive an incentive payment. The incentive payment is equal to 2.0 percent of the total estimated allowed charges submitted by no later than February 28, 2010 for all covered professional services furnished between January 1, 2009 and December 31, 2009.
In addition, CMS is establishing an Electronic Prescribing Incentive Program, as authorized under MIPPA. The new program will provide an incentive payment of 2.0 percent if the professional meets the program requirements for being a successful e-prescriber.
Between the 1.1 percent payment update and the two percent incentive payment for PQRI and the two percent incentive payment for e-prescribing, physicians may see a pay boost of 5.1 percent in 2009. For more details on the 2009 Medicare physician fee schedule, go to www.cms.hhs.gov
Carol Monaco ________________________________
FTC Postpones "Red Flag" Rule
The Federal Trade Commission (FTC) has suspended enforcement of the new "Red Flag Rules" until May 1, 2009. The rules, which require financial institutions and creditors to develop and implement written identity theft prevention programs, were supposed to go into effect Nov. 1. However, the FTC recently acknowledged that many entities were unaware of the requirements and did not know that their activities could fall under the definition of financial institution or creditor.
The identity theft prevention programs must provide for the identification, detection, and response to patterns, practices, or specific activities - known as "red flags"- that could indicate identity theft. The definition of creditor has raised several concerns for the physician community. According to the final rule, a creditor is "any person who regularly extends, renews, or continues credit; any person who regularly arranges for the extension, renewal or continuation of credit; or any assignee of an original creditor who participates in the decision to extend, renew or continue credit." Some FTC attorneys have taken the position that physicians are creditors, if they do not require full payment upfront at the time they see patients, but bill patients after the services are rendered.
The AOA, along with other physician associations, are calling on the FTC to not apply the rules to the physician community. The inclusion of physicians under the creditor definition could force practices to require payment upfront from their patients and have the patients deal with their insurance companies, disenfranchise low income patients, and put practices at risk for denying care to those with suspicious identification or who lack identification. In addition, it is the AOA's belief that physicians already are required to protect patients' medical information under the HIPAA privacy rule. The AOA is closely tracking developments and will provide updates on FTC's actions.
Carol Monaco
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Recovery Audit Contractors on Hold
The Centers for Medicare and Medicaid Services (CMS) plan to expand its Recovery Audit Contractor (RAC) program nationwide are temporarily on hold. CMS recently announced four contractors for the RACs, but the contracts are being protested by two unsuccessful bidders. Due to the protests filed, an automatic stay will stop work for all four RAC regional awards until a determination is made by the General Accountability Office (GAO). The GAO has 100 days to issue its decision, after which the program will go forward.
The agency has made several changes to the RAC to make the program less burdensome to the provider community and to assure more accuracy. For example, to minimize burden CMS is limiting the number of medical record requests and the RAC "look-back period." For accuracy, each RAC must have a physician medical director and certified coders. CMS also calls for a new issue review board (greater oversight), an independent validation contractor, and annual accuracy rates for each RAC.
CMS gave some advice on how to prepare for a RAC audit: 1) know where previous improper payments have been found (OIG, CERT, Demo RAC Reports); 2) know if you are submitting claims with improper payments; 3) get ready to respond to RAC medical record requests fully and promptly; 4) appeal when necessary; 5) keep track of overpayments and underpayments the RAC finds in claims.
Carol Monaco
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FDA Seeks Comments and Issues Rule on Reporting Adverse Events
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he FDA is seeking comments on the new web portal it is developing which would provide one place to report adverse events of regulated products. Comments are due to the agency by December 22. Complete information can be found at: http://www.access.gpo.gov/su_docs/fedreg/a081023c.html
The new system, MedWatch Plus Portal, is an improved, web based version of its current MedWatch system. This new electronic system will be for collecting, submitting, and processing adverse event reports and other safety information for all FDA-regulated products. The portal will include a data collection tool called the Rationale Questionnaire. Anyone will be able to use the questionnaire to submit adverse events, product problems, consumer complaints, and medication use error reports to the FDA.
FDA Issues Final Rule on Toll Free Number for Reporting Adverse Events The FDA issued a final rule entitled "Toll-Free Number for Reporting Adverse Events on Labeling for Human Drug Products". The Best Pharmaceuticals for Children Act (BPCA) (Public Law 107-109) directed FDA to issue a final rule requiring the labeling of medications approved under section 505 of the Federal Food, Drug and Cosmetic Act. The labeling includes a statement that has listed a toll free number maintained by the FDA for the purpose of reporting adverse drug events and advises that the number is to be used only for reporting side effects and is not intended for medical advice. The statement is as follows: Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088. This final rule also affirms the interim final rule's addition to the regulations requiring distribution of the side effects statement by pharmacies and authorized dispensers in an outpatient setting.
The final rule is effective November 28, 2008 and all affected entities are required to comply by July 1, 2009.
New Drug Safety Web Page
FDA has announced new web page on its site where patients and health care professionals can go to find a variety of information regarding prescription drugs; http://www.fda.gov/cder/drugSafety.htm
Among the items on the site:
* Drug labeling information, including patient labeling, professional labeling, and patient package inserts
* Drug-specific safety information, including safety sheets with the most recent information and related FDA press releases, fact sheets, and podcasts
* Warning Letters, Import Alerts, Recalls, and Safety Alerts
* Regulation and guidance documents
* Consumer information about safe use of medications and information on disposing of unused medicines.
Angela Jeansonne
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2008 Election Results
On Tuesday, November 4 the Honorable Barack Obama was elected the 44th President of the United States. President-Elect Obama defeated Arizona Senator John McCain in an impressive and convincing manner. President-Elect Obama received 66.9 million votes (53%) to Senator McCain's 58.3 million votes (46%). He collected 365 Electoral College. Senator Obama secured the largest popular vote margin by a Democrat since 1976.
Democrats also enjoyed broad success in races for seats in the United States Senate and House of Representatives. Democrats picked up at least 56 seats in the Senate (3 races are not final) and over 20 seats in the House of Representatives.
The following is a breakdown of the 2008 Election:
Electoral College Vote
Obama 365, McCain 173
Popular Vote
Obama 66.9 million (53%), McCain 58.3 million (46%)
United States Senate
Democrat 56, Republicans 40, Independents 2
Undecided
Minnesota and Georgia
House of Representatives
Democrats 257, Republicans 176
Undecided
4 races LA-2, LA-4, OH-15, CA-4
Leann Fox
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Recent Medicare Legislation & its Impact on e-Prescribing
We would like to make you aware of recent changes and amendments to Medicare law that promotes the use of electronic prescribing. These changes are important whether you already use e-prescribing technology or are looking for more information on getting started.
New incentives to promote use of e-prescribing
The Medicare Improvements for Patients and Providers Act of 2008 contains incentives to encourage the adoption of electronic prescribing technology by prescribers.
The Act provides positive Medicare payment incentive of up to 2% for practitioners who use e-prescribing systems in 2009 through 2013, and a reduction in payments of up to 2% for providers who do not e-prescribe by 2012.
Note – more details are to come from the Centers for Medicare and Medicaid Services on what process prescribers will engage in to receive their reimbursements.
New Rules Surrounding Computer-Generated Fax Based Prescription Transmissions to Pharmacies
Starting January 1, 2009, all computer-generated new prescriptions for Medicare Part D must comply with the NCPDP SCRIPT standard, and thus be transmitted electronically and not by computer-generated fax.
This change is particularly relevant for practices that use electronic medical record (EMR) or e-prescribing technology. Many of these systems are currently set up to transmit prescriptions only by fax. This type of transmission will no longer be allowed after January 1, for Part D prescriptions. Practices must either print the prescription and hand them to the patient or manually fax them to the pharmacy.
However some of these same systems can be enabled to exchange prescription information with pharmacies electronically. It is important for practices to know if their technologies have this ability, and to take steps to secure it.
Members are invited to find out more about securing e-prescribing connectivity by visiting a special resource site: www.GetRxConnected.com.
The site contains:
1) A special E-Prescribing Readiness Assessment that can determine if your practice EMR or prescribing technology is compatible with the NCPDP Script Standard, and thus able to send prescriptions to pharmacies electronically, not by fax.
2) A free guide and other resources detailing how to best adopt and implement electronic prescribing technology. This includes listings of state and national programs that can provide e-prescribing software at a reduced rate or for free.
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ICD-10-CM/PCS National Provider Conference Call with Q&A |
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Register Now to Participate! |
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The Centers for Medicare and Medicaid Services (CMS) will host a series of conference calls to provide an overview of ICD-10 and how it differs from ICD-9-CM. The presentations will include:
The presenters will include members of the Cooperating Parties for ICD-9-CM, a formal coalition that has been working together on ICD-10 issues. Separate conference calls have been scheduled for different provider types. The same information will be presented at each conference call. Select the appropriate link below, according to your provider type, to register for a conference call. Hospital Staff Physicians Please download this (http://www.cms.hhs.gov/ICD10) PowerPoint presentation prior to the conference call. For those who are unable to attend, a transcript will be posted on the ICD-10 Web Page at http://www.cms.hhs.gov/ICD10 shortly after the conference call. |
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DO Washington Update - September 18, 2008
TAKE ACTION
Reach out to your Member of Congress. Remember that it is just as important to communicate with a Member of Congress in appreciation for their action and not just when you want something.
National E-Prescribing Conference
The Centers for Medicare and Medicaid Services (CMS), the American Osteopathic Association, the American Osteopathic Association of Medical Informatics, and other industry partners are joining together to host the National E-prescribing Conference in Boston, MA on October 6-7.
The conference is designed to educate physicians and other stakeholders about a recently enacted federal program that provides incentive payments to encourage the adoption and use of electronic prescribing. The "Medicare Improvements for Patients and Providers Act of 2008" (MIPPA) created a five-year pilot program with incentives for those eligible professionals considered "successful electronic prescribers." To be eligible for the program, professionals must either report applicable electronic prescribing measures established under the Physician Quality Reporting Initiative (PQRI) or electronically submit prescriptions under Medicare Part D at a level to be determined by CMS.
The National E-prescribing Conference will delve into all of these details and will answer questions about privacy, security and risk management. You can register now for the conference by going to www.e-prescribeconference.com .
Brandon Fuller (bfuller@osteopathic.org )
House Committee Meeting on Medicare Payment
On Thursday, September 11 the House Ways and Means Health Subcommittee held a hearing entitled "Reforming Medicare's Physician Payment System." The panelists focused their testimony on potential solutions for replacing the current Sustainable Growth Rate (SGR) formula. Although the ideas varied greatly from one panelist to the next, the following themes emerged:
- Bundling of payments
- Payment via Medical Home model
- Capitated payments
The panelists agreed that a variety of solutions must be put in place in order to accurately pay physicians for the services they provide. It was further agreed that these solutions must be aimed at moderating costs, improving quality, and incentivizing the practice of medicine. The panelists also discussed the impending physician shortage as well as their concerns about physicians choosing to no longer participate in the Medicare program. An alternative to the current SGR must be in place prior to 2010 when 20 percent cuts are scheduled to take effect.
Members of the Ways and Means committee expressed great concern with the problem and their commitment to finding a long-term solution rather than another short-term patch.
Ray Quintero (rquintero@osteopathic.org )
Save the Date! - DO Day on Capitol Hill 2009
It may seem like only a short time has passed since DO Day on Capitol Hill 2008, but it is already time to start thinking about registering for next year. This is especially true for 2009, because the event will take place one month earlier than in previous years. The 2009 DO Day on Capitol Hill is scheduled to take place on March 5.
If you have not participated in DO Day on Capitol Hill in the past, your colleagues who have will tell you that it is an unequaled opportunity to bring your concerns, and the concerns of your patients, directly to the policy makers in Washington, DC.
Each year, hundreds of osteopathic physicians and students from across the country visit the nation's Capital to attend meetings with Members of Congress and their staff. The AOA will prepare you for your meetings so you can thoughtfully share our profession's view on a variety of policy issues to advance the legislative process.
Please set aside March 5, 2009 so you can join the osteopathic community on Capitol Hill for what promises to be another exciting event.
Brandon Fuller (bfuller@osteopathic.org )
Hill Fact: Former Governors
Nine Members of Congress once served as Governor.
- Sen. Lamar Alexander, R-TN
- Sen. Evan Bayh, D-IN
- Sen. Christopher S. Bond, R-MO
- Sen. Thomas R. Carper, D-DE
- Rep. Michael N. Castle, R-DE
- Sen. Judd Gregg, R-NH
- Sen. Ben Nelson, D-NE
- Sen. John D. Rockefeller IV, D-WV
- Sen. George V. Voinovich, R-OH
Brandon Fuller (bfuller@osteopathic.org)
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