Hospitals Give CMS their Stark Law Wish List
Hospitals have called on the CMS to take concrete steps to revise federal anti-kickback laws and support providers’ move to value-based care, including revising what is considered a referral to giving providers protection for unintentional violations.nnAll in all, the CMS received over 300 comments after it asked providers this summer how it should amend the so-called Stark law. While the anti-kickback statute is meant to deter physicians from making excessive charges to Medicare and Medicaid by prohibiting financial relationships for referrals, it has long been criticized for thwarting alternative payment models and other care arrangements.nnPhysicians and hospitals can now be found liable even if they didn’t intend to violate the Stark law, and offenses can carry significant financial penalties.nnBut that should change, according to Barclay Berdan, CEO of the 29-hospital Texas Health Resources system, based in Arlington. He called on the CMS to revise how it punishes providers that accidentally violate Stark law due to technical errors, including lapsed agreements and missing signatures.nnInstead, the agency should determine whether Medicare, Medicaid or beneficiaries were harmed by the potential Stark law violation, he said.nn”These options would also have the effect of decreasing the administrative burden of prosecuting and reviewing self-referral disclosure protocol submissions by CMS and the Office of the Inspector General,” Berdan said in a Aug. 21 comment letter.nnOther providers asked the CMS to revisit its definition of a referral. The Stark law’s current wording has made it difficult for patients to be seen by multiple doctors within the same healthcare system, according to Tracey Stanich Witherow, director of organizational integrity and regulatory affairs at Allina Health, a 12-hospital system based in Minneapolis.nn”Care coordination requires some degree of care management, and we need the ability to work together across our organization to ensure patients get the right care at the right time,” Witherow said in a comment letter. “Some of our physicians’ efforts to do so are considered ‘referrals’ under the current Stark law, even if the referral presents no risk for increased payment to our organization.”nnThe CMS should clarify that a referral under Stark law results in an additional or increased payment from the agency to a healthcare organization, she said.nnClick here to read complete article, originally published on modernhealthcare.com.
Hard work never fades…
New login requirements for Medicare — Action RequirednnThe Centers for Medicare & Medicaid Services (CMS) will be implementing a system security change that affects the Novitasphere log in requirements for maintaining access.nnEffective September 1, 2018, registered Novitasphere users must log into 
Providers affiliated with UCHealth University of Colorado Hospital and University of Colorado School of Medicine are no longer seeing patients with UnitedHealthcare Medicare Advantage plans, a UCHealth spokesperson said.nnSpokesperson Dan Weaver said in a statement that the providers made the decision because of UnitedHealthcare’s handling of medical claims.nn“Unfortunately, United Healthcare does not follow the normal reimbursement and appeals process for Medicare Advantage claims for University of Colorado Hospital or CU Medicine,” he said.nnAbout 600 patients received letters in June informing them that they will no longer be seen by providers at University of Colorado Hospital or with the School of Medicine.nnWhile some patients received letters, it’s unclear exactly how many will ultimately be affected by the decision.nnThe providers are already out-of-network for those covered by UnitedHealthcare Medicare Advantage plans, meaning most individuals did not see providers with University of Colorado Hospital or the School of Medicine regularly.nnHowever, the providers have offered specialty services, such as cancer care, to UnitedHealthcare members when it has been requested.nnWeaver said that in some cases, UnitedHealthcare told its members that they could receive advanced care from specialists, but “then refused to pay for their care.”n
Kaiser Permanente Colorado said Monday it has notified about 2,500 patients that it will no longer serve as a Medicaid provider in some areas of the state.nnKaiser Permanente stopped providing health services as a Medicaid provider in its northern, southern and mountain service areas on June 30. It will continue providing care to Medicaid patients in the Denver-Boulder area.nnKaiser Permanente said it made the changes in Medicaid services because it is committed to seeing Medicaid and the second phase of the state’s Medicaid Accountable Care Collaborative succeed.nn“This was a difficult decision, but we feel it is the best way we can support the new program at this time,” Kaiser Permanente said in a statement. “We will closely monitor the progress of Phase 2 and re-evaluate our participation in Medicaid on an annual basis.”nnMedicaid is a government health care program for low-income adults and children.nnThe Accountable Care Collaborative is a health care program that is part of Health First Colorado, the state’s Medicaid program. The second phase of the collaborative involves initiatives, such as the state Department of Health Care Policy and Financing contracting a regional entity to coordinate physical and behavioral health for enrolled members.nn n