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
Yesterday CMS released their CY 2019 physician fee schedule proposed rule, which includes major proposed changes to E&M coding. Below is my review of this component of their propose rule, including page references to the source in the federal register.nnWe all know E&M coding has it flaws, and 1995/1997 guidelines could not have accounted for changes in technology today, especially the EHR. Furthermore, many consider E&M guidelines as being too complex, ambiguous and incapable of meaningfully distinguishing between different code levels. For some time, physicians and other stakeholders have asked CMS to undergo extensive research to overhaul both the E&M documentation guidelines and the underlying coding structure. You would essentially blunt any potential benefit by updating one and not the other. Based on all of the feedback provided thus far, CMS begins their proposal by defining a number of trends which emerged from the feedback:nn• Substantially different recommendations came in by specialty; any changes would have both clinical and financial specialty-specific impactsn• History and exam portions of the guidelines are most significantly outdated; they should be simplified or reduced, but not eliminatedn• Medical decision making should be given more weight in determining visit level, but those specific guidelines should be updated as welln• Reduce E&M levels generally into three, such as low / medium / high, and also correlate these to timenn n
As the CMS charts a path to level pay for outpatient services, it’s also leading toward a head-to-head battle with powerful hospital lobbying groups as some providers win and lose with site-neutral payments. Check out the article, below, for more information!
Major changes are in store for the Merit-based Inventive Payment System (MIPS) in 2019, as the Trump administration pushes to reduce the record-keeping burden shouldered by clinicians. Continue reading, below, for why you should be prepared for these changes as soon as next year.nnIn a slate of proposals released late last week, the Centers for Medicare & Medicaid Services outlined 10 new quality measures it would like to add to the MIPS program, plus dozens it wants to remove. The measures on the chopping block are process-based items clinicians have identified as “low-value or low-priority,” CMS said.nnThe agency also proposed changes to the MIPS “promoting interoperability” performance category. The changes are designed to improve interoperability of electronic health record (EHR) data, give patients easier access to their own health data, and align the performance category with a similar proposal for hospitals.nnThese proposed changes to the Quality Payment Program are good news, said Gerald Maccioli, MD, MBA, FCCM, chief quality officer for Envision Healthcare.nn”As a country, we continue on a positive and productive pathway to figuring out how to use quality measures to markedly improve the health of our communities, and with the proposed changes CMS is moving in the right direction,” Maccioli said in a statement.n
The Centers for Medicare & Medicaid Services (CMS) hopes physicians would no longer have to predict how much longer a particular Medicare patient will need home care in order to have the service re-certified, according to a regulation they proposed Monday. nn”In an effort to make improvements to the health care delivery system and to reduce unnecessary burdens for physicians, CMS is proposing to eliminate the requirement that the certifying physician estimate how much longer skilled services are required when recertifying the need for continued home health care,” the agency said in a fact sheet about the proposed rule.nn”This proposal is responsive to industry concerns about regulatory burden reduction and could reduce claims denials that solely result from an estimation missing from the recertification statement. We estimate that this proposal would result in annualized cost savings to certifying physicians of $14 million beginning in [calendar year] 2019.”nnIn addition to eliminating that requirement, “we’re releasing several proposals to modernize Medicare by increasing access to remote patient monitoring,” CMS administrator Seema Verma said Monday on a phone call with reporters.nn”This will allow more patients to share real-time data [with providers]. Last year we made changes to allow physicians to bill for remote patient monitoring,” she said. “Home health agencies, however, couldn’t bill for the new code. So in today’s proposal we address that disparity.”nnCMS also is beginning to implement a new home infusion therapy benefit — using a transitional payment until the full benefit takes effect in 2021 — and proposing health and safety standards for home infusion therapy.n
Join us for an open house to gain more information about the changes that are coming to health care this summer. We will discuss the next phase of the Accountable Care Collaborative (ACC 2.0), Colorado’s innovative approach to improving the experience and outcomes of both physical and behavioral health care services for people who are part of Health First Colorado (Colorado’s Medicaid program). Learn how these changes will affect you and your patients.
On June 11, the CDC posted the 
The month-long window is the shortest turnaround from a state and doesn’t exempt the healthcare sector, effectively giving Colorado providers just half the time required by HIPAA to report. Check out the article for more information! nnColorado Gov. John Hickenlooper signed into law expansive consumer data legislation that mandates all organizations report breaches within 30 days, making it the shortest turnaround for any state.nnThere are no exemptions from the notification rule, meaning healthcare organizations must report within 30 days — half the time required by HIPAA. The legislation updates the state’s current notification language that states notification must happen without “reasonable delay.”nnIntroduced in January, the bill unanimously passed in the State House Committee. The aim is to drastically improve privacy and security for all organizations within the state.nnThe legislation overlaps with HIPAA requirements, as lawmakers added medical and health insurance identification data to the types of information covered by the law.nnAnd if there’s “a conflict between the time period for notice to individuals [under Colorado law or federal regulation or law], the law or regulation with the shortest time frame for notice to the individual controls,” the bill states.n
For the most part, providers support the Direct Provider Contracting proposal put forward by the Centers for Medicare & Medicaid Services, with some stipulations and considerable tweaking. Check out the article, below, for more information! 
nnAlthough physicians are admired for mastering medical knowledge, keeping up with the flood of medical information can lead to anxiety and self-doubt. Check out some steps to help curb clinician burnout! nn3. Measuring the clinician experiencennAddressing burnout requires collecting data on multiple measures, the report says.nn”Leaders focused on reducing burnout and improving resilience in the clinician workforce should be prepared to measure engagement with sufficient thoroughness and frequency that the data allow segmentation, benchmarking and detection of change.”nnPress Ganey has developed an eight-point assessment tool to measure clinician resilience. The first four questions gauge capacity to disengage from work:n
The Know Your Legal Rights database was launched by The Colorado Medical Society and others to help give you the knowledge about how to protect your patients from illegal practices. Keep reading, below, for more information on the Know Your Legal Rights database! nnThe Colorado Medical Society and component medical societies are pleased to launch the Know Your Legal Rights database, an online, searchable compilation of all of the Colorado laws in place to protect you and your patients from unfair, predatory and unscrupulous – not to mention illegal – practices.nnThese physician protections have been secured through more than a decade of hard-hitting advocacy by CMS and our allies in the General Assembly and the rule-setting process, but many physicians are unaware that these laws exist or how to find and use them. Now, CMS members are just a keystroke from knowing the legal tools at your disposal and how to use them effectively. It’s your instant guide to Colorado physicians’ legal rights.nnTo access the Know Your Legal Rights database, go to 
The Centers for Medicare & Medicaid Services (CMS) is targeting more than 60 million Americans with their new plan to provide rural communities quality and affordable healthcare options. nnCMS unveiled the Rural Health Strategy on Tuesday with the goal of helping millions of Americans across the United States obtain quality healthcare. “Through its implementation and our continued stakeholder engagement, this strategy will enhance the positive impacts CMS policies have on beneficiaries who live in rural areas,” said CMS Administrator, Seema Verma.nnCMS will look to raise state and local stakeholder engagement to make the agency’s policies more effective and curb the “unintended consequences of policy and program implementation” in those communities, the agency said.Through the new strategy, CMS is focused on accomplishing the five goals listed below:n
Welter Healthcare Partners is proud to announce our new partnership with HealthTeamWorks who is know for helping medical practices, physician organizations and integrated delivery networks (IDNs) improve their performance in delivering value-based services. As Welter Healthcare Partners shares a similar focus for helping improve the success of your business, we believe in the goal behind HealthTeamWorks as they are committed to improving quality measures in your team and organization.nnThe HistorynOur solutions have been developed drawing knowledge from our more than 20 years of experience working with health teams and our experienced staff with backgrounds and advanced degrees in healthcare and business.nnThe MissionnWith more than 20 years of healthcare transformation experience, our approach fosters sustainable improvement for organizations to succeed in today’s changing healthcare environment, which is becoming more regulated, expensive, and complicated to navigate. We enable our clients to achieve measurable improvements in healthcare delivery through deep client collaboration and a shared commitment to achieve improved patient care, lowered costs, workplace satisfaction, and healthier communities.nnThe VisionnThrough partnership and innovation, HealthTeamWorks is viewed as a nationally recognized leader at the forefront of healthcare transformation by providing exceptional high-quality solutions and services that are delivered by professionals who are passionate about their work and inspire our clients to transform the healthcare delivery system.nn
Join Colorado Medical Group Management Association and Professional Association of Health Care Office Management for 2018 Payer Day! Hear what’s new from our insurance carriers and have your questions answered! Get the inside track to the latest information vital to your practice including health care reform plans, claims submissions and payments. This is an excellent opportunity to connect with your peers and meet insurance representatives face to face.nn