Health Law Monitor

CMS Announces Cut in Physician Reimbursement Rates and Changes to Supervision Requirements for Outpatient Services

CMS issued the 2011 Medicare Physician Fee Schedule final rule, which cuts physician reimbursement by 24.9% between November 2010 and January 2011. Additionally, CMS recently released its 2011 Outpatient Prospective Payment System final rule setting forth several changes to physician supervision requirements for hospital outpatient services to take effect on January 1, 2011.

Health Care Reform Whitepaper: New IRS Mandates for Charitable Hospitals

 

    Under prior law, charitable hospitals established tax-exemption under Internal Revenue Code (“IRC”) § 501(c)(3) by providing a community benefit. Most hospitals established a community benefit by providing health care regardless of a patient’s ability to pay (including payment through Medicare or Medicaid), by providing charitable (unreimbursed) care to the community, by maintaining an emergency room, by not restricting use of its facilities to a particular group of physicians, and/or by utilizing excess funds to improve the quality of patient care, expand facilities, and advance medical education and research.

Important Changes to Medicare Secondary Payer Electronic Reporting Rules

The Centers for Medicare and Medicare Services ("CMS") announced that it is extending the date for electronic reporting under the Medicare Secondary Payer rules for all Non-Group Health Plans from April 1, 2010 to January 1, 2011.

PREPARED TO COMPLY? - HITECH ACT ENFORCEMENT SET TO BEGIN

On February 17, 2010, HHS will begin to enforce changes to the HIPAA enacted through the HITECH Act.  The new requirements imposed by the HITECH Act will have a significant impact on the privacy and security of personal health information and compliance efforts of affected healthcare Covered Entities and their Business Associates.  The HITECH Act has expanded the direct applicability of the Privacy and Security Rules to Business Associates.  Significant changes may be necessary to comply with the new requirements.  

The 'Other' Health Care Reform Moves Ahead

The federal government moves ahead with its incentive program for the adoption of electronic health records.

 

Jackson Kelly lawyer James W. Thomas recently wrote an article that explores a pair of coordinated regulations issued by the U.S. Department of Health and Human Services on Jan. 13 which will define “meaningful use” for electronic health record systems.

 

To read Thomas’ article that appeared in the Jan. 29, 2010 edition of The State Journal, click here.  

 

The State Journal is a weekly business newspaper in West Virginia.

CMS CLARIFIES SUPERVISION REQUIREMENTS FOR OUTPATIENT SERVICES

CMS recently released its 2010 Outpatient Prospective Payment System (“OPPS”) rule clarifying the requirements for supervision of certain hospital outpatient services. The rule makes clear that if direct physician supervision is required for the performance of an outpatient service, this level of supervision may not be assumed to exist in a hospital setting. Rather, a hospital must establish a plan or policy to ensure that the direct supervision required by the Centers for Medicare and Medicaid Services (“CMS”) for a particular outpatient service is available. Read More.

CMS Issues Options for Providers to Comply with EMTALA in Anticipation of H1N1

In anticipation of a possible H1N1 virus outbreak this flu season, CMS has released guidance concerning EMTALA requirements during disasters and pandemics.  CMS has outlined compliance options that are permissible under EMTALA and that grant providers with flexibility to handle extraordinary increases in emergency department visits.  The options include setting up alternative screening sites on the hospital campus, off-campus screening at hospital-controlled sites, and community screening clinics at sites not under hospital control.  To read more click here.

HHS and FTC Issue Final Breach Notification Rules

To better protect the privacy of personal health information, the Department of Health and Human Services (HHS) and the Federal Trade Commission (FTC) have published new rules implementing the HITECH breach notification requirements.  Healthcare providers and other covered entities regulated under HIPAA will be required to provide notice to individuals, HHS, and, potentially, the media when unsecured protected health information is breached.  These new rules extend the notification requirements to business associates and vendors of electronic health records, while strengthening the requirements for covered entities.  The notification requirements apply to any breach on or after September 23, 2009.  For more information about these requirements, click here.

Medicare Revs Up Secondary Payer Enforcement

 

 “Medicare Secondary Payer” is the term used when the Medicare program does not have primary payment responsibility for medical claims (that is, another entity has the responsibility for paying a medical claim before Medicare). Current law makes Medicare the secondary payer to group health plan coverage in certain situations, and the secondary payer to all forms of liability insurance (including self-insurance), no-fault insurance, and workers’ compensation.

Providing Care to Federal Employees May Mean Affirmative Action Plans and Additional Compliance Requirements.

If you provide medical services to federal government employees, you may be a government contractor without knowing it.  It is important to realize that what you don’t know can hurt you.