2012 Pain Practice Management Conference

(click cover to view full brochure) Last Chance To:  Receive a FREE Marketing Book  (A $129.95 VALUE!) When You Register For The Conference  By November 30, 2011 Book Title: Building A Successful Pain Management Practice: The Keys To Effective Strategy Formation And Marketing  Books Will Be Provided At The Conference!       Click Here To Register Now! 21st Century Edge 2012 Pain Practice  Management  Conference Registration: Click the "Register Now" link to register or call (816) 822-8800. Register by December 19, 2011 and receive the early bird registration rate of only $650 per attendee! After December 19, 2011 the registration cost will be $750 per attendee. Approved For 12 CEU'S From The AAPC!    Conference Agenda Thursday, January 19, 2012 __________________________________________________________________ 7:00 am – 8:00 am                 Registration, Sign In, Breakfast 8:00 am – 9:00 am                 Health Care Reform Update                                                 Linda Van Horn, MBA                                                                      9:00 am – 10:00 am               2012 OIG Work Plan and Related Compliance Risks                                                 Ken Sandrock, MBA 10:00 am – 10:30 am             Refreshment Break 10:30 am – 11:30 am             2012 Pain Coding and Reimbursement Update                                                 Linda Van Horn, MBA 11:30 am – 12:30 pm             Pain Coding Exercises Using ICD-10                                                           Debbie Nelson, CPC, CPMA 12:30 pm – 1:45 pm               Lunch on Your Own 1:45 pm – 2:45 pm                 Meaningful Use of an EHR’s                                                 Linda Van Horn, MBA 2:45 pm – 3:45 pm                 Social Media                                                            Paul Stolecki, MBA 3:45 pm – 4:15 pm                 Refreshment Break 4:15 pm – 5:15 pm                 Ask the Experts         5:15 pm                                  Adjourn Friday, January 20, 2012 __________________________________________________________________ 7:00 am – 8:00 am                Registration, Sign In, Breakfast 8:00 am – 9:00 am                Health Care Trends                                                Linda Van Horn, MBA 9:00 am – 10:00 am              10 Ways to Increase Profit                                                Paul Stolecki, MBA 10:00 am – 11:00 am            How Evidence Based Medicine is Being                                                 Linda Van Horn, MBA                                                             11:00 am – 12:30 pm            Lunch on Your Own 12:30 am – 1:30 pm              Pain Coding Tales: The Good, The Bad, and the Ugly                                                Debbie Nelson, CPC, CPMA 1:30 pm – 2:30 pm                Accountable Care Organizations                                                Ken Sandrock, MBA 2:30 pm                                 Course Adjourn

FDA Posts Draft Guidelines for Continuing Education CME to be Offered to Prescribers of Long-Acting Opioids

Since May 11, 2011 the FDA has worked with developers and marketers of long-acting, extended-release opioid drugs to develop a prescriber education program assuring that the drugs will be prescribed appropriately and used safely.

The FDA cites public health estimates that more than 35 million Americans age 12 and older have reported non-medical use of opioid analgesics during 2010, up from 29 million in 20021.  In 2009, nearly 342,000 emergency department visits were associated with non medical use of opioid analgesics. In 2007, nearly 28,000 Americans died from unintended consequences of drug use, and of these, nearly 12,000 involved prescription drug pain relievers.

On November 4, 2011, the FDA posted draft guidelines for the continuing education of professionals who prescribe the drugs.  The draft provides the basic outline and central messages the FDA wants conveyed to prescribers in a 2 to 3-hour education module.  The final guidelines will be posted on the FDA web site for use by continuing education providers and staffs.

The draft guidelines cover 7 basic areas of interest to prescribers:  

• Why prescriber education is so important

• Assessing patients for treatment with long-acting opioids  

• Initiating therapy, modifying dosage, and discontinuing use  

• Therapy management  

• Counseling patients and caregivers on safe use

• General opioid drug information

• Product-specific drug information

 The FDA intends prescriber training to be conducted by accredited, independent continuing education providers.  The instruction will be free to prescribers.  Costs will be covered by unrestricted grants to accredited continuing education providers funded by the sponsors.

CMS Delegates Adopt a Policy to Block ICD-10 AMA Says Conversion from ICD-9 Poses Too Many Costs

CMS requires healthcare providers to start using ICD-10 by October 2013, but American Medical Association (AMA) delegates have embraced a resolution to block it.

Delegates to the AMA’s 65th House of Delegates Interim Meeting voted to work toward stopping implementation of diagnosis coding set ICD-10, which is scheduled to replace the current ICD-9 standard for billing medical services.  AMA leaders expressed concern over the administrative time and costs associated with the conversion. 

"The implementation of ICD-10 will create significant burdens on the practice of medicine with no direct benefit to individual patients' care," said AMA President Peter W. Carmel, MD. "At a time when we are working to get the best value possible for our health care dollar, this massive and expensive undertaking will add administrative expense and create unnecessary workflow disruptions. The timing could not be worse, as many physicians are working to implement electronic health records into their practices.”

The ICD-10 coding system provides much greater detail for describing illnesses and medical conditions, but is much more complex than ICD-9.  ICD-10 would impose 69,000 new codes on healthcare providers and coders.  In contrast, the current ICD-9 system has only 14,000 codes.

Supreme Court Agrees to Review the Affordable Care Act To Decide If Individual Insurance Mandate is Constitutional

U.S. Supreme Court justices agreed to review the constitutionality of the administration’s federal healthcare law, known as the Affordable Care Act.  The justices plan to hear arguments in the case in March.

The central question is whether Congressional lawmakers exceeded their authority to regulate interstate commerce.  Opponents of the law, including 26 states led by Florida, argue that they exceeded that authority by requiring people to buy health insurance even if they don’t want it or else pay a penalty.

“The act is without precedent both in its coercive impositions on the states and in its effort to force individuals to engage in commerce so that the federal government may regulate them,” the 26 states argued in a brief filed by former U.S. Solicitor General Paul Clement.

The question divided the federal appeals courts.  Two upheld the law, a third declared it unconstitutional, and a fourth stated that a definitive ruling would be premature. The case is certain to influence the 2012 presidential campaign. 

Given its importance, the Supreme Court justices have scheduled 5 1/2 hours of argument to the case instead of the Court’s usual one-hour argument sessions.

CMS Final Physician Rule Calls for 27.4% Pay Cut Budget Impasse Could Block a Legislative Fix This Year

On October 21, 2011, Health and Human Services Secretary Kathleen Sebelius approved the Final Rule setting the SGR-based Medicare Part B Physician Fee Schedule for 2012. 

Barring Congressional intervention, the Final Rule will cut physician reimbursement and other Medicare Part B payments based on the physician fee schedule by 27.4% effective January 1, 2012. 

The cut results from a scheduled reduction in the conversion factor, from its current level of $33.9764 in 2011 to $24.6712, on January 1.

In recent years, Congress intervened legislatively to stop SGR cuts.  This time may be different.  With lawmakers at an impasse over balancing the budget, it is questionable whether Congress can reach an agreement over any payment fix.  In that case, a substantial reduction in physician reimbursement will occur.

2012 Pain Practice Management Conference

It's Official! 

The 2012 Pain Practice Management Conference will be held January 19th & 20th, 2012 at the Sheraton Suite Hotel on the Country Club Plaza in Kansas City, MO. 

21st Century Edge is excited to host this conference that will feature lectures on 

Coding, Social Media, Health Care Reform and More! 

Federal Deficit Cutting Committee Now Goes to Work Physicians Fear Sebelius’ Health Care Budget Knife

Federal Deficit Cutting Committee Now Goes to Work

Physicians Fear Sebelius’ Health Care Budget Knife

 

The Congressional deficit reduction Super Committee charged with determining where to cut $1.3 trillion from the federal deficit over the next 10 years has begun a series of public hearings to determine how and where to trim.

 

The Committee has until November 23 to come up with answers.  It has stated that all sectors of health care are candidates for significant cuts.

 

If the Super Committee fails to win Congressional approval or if President Obama vetoes its proposed reductions, overall federal spending would be cut automatically, divided between defense spending and non-defense discretionary spending.  The cut would include 2% across the board affecting all Medicare providers.

 

Cuts to the Medicare program would be capped at 2% of total Medicare spending over the 10-year period,approximately $100 to $120 billion. 

 

Certain entitlements would be exempt from the cuts, including Social Security, veterans' benefits, civilian and military retirement funding and programs for low-income Americans, such as Medicaid and food stamps.

 

Because beneficiaries would be exempt from cuts, all savings must come from Medicare providers. Health and Human Services Secretary Kathleen Sebelius would be tasked with identifying and implementing the reductions.

 

Health care groups have started lobbying the Super Committee with appeals to protect their share of federal health care program dollars. 

 

Physicians, seeking a replacement for the Sustainable Growth Rate (SGR) formula determining physician payments under Medicare, argue that annual temporary pay “freezes” and token increases only mask and intensify a growing imbalance between SGR-determined physician reimbursement and actual costs.  A focus on frugality in government, they fear, will make that imbalance worse.

Proposed Rule Applies to Labs under CLIA Regulation Patients Would Get Direct Access to Lab Test Results

Proposed Rule Applies to Labs under CLIA Regulation

 

Patients Would Get Direct Access to Lab Test Results

 

CMS this month proposed a rule change to give patients of labs operating under CLIA regulations (as well as their authorized patient representatives) direct access to their test result reports.

 

At the present time, laboratory test patients in many states do not have direct access to their results because of a CLIA rule permitting direct release of test results only if (1) the ordering provider expressly authorizes the laboratory to do so at the time the test is ordered, or (2) state law expressly allows for it. 

 

Even though the HIPPA Privacy Rule generally permits direct release of health information to a patient or authorized representative, it defers to the CLIA regulation limitations.  There are 26 states without laws authorizing direct disclosure of test results to patients and 13 states that expressly prohibit it. Patients of CLIA regulated labs in these states cannot obtain their lab results directly.

 

The proposed rule would amend CLIA regulations to allow labs to give patients their test result reports on request.  

 

The proposed rule would eliminate the Privacy Rule exception for an individual’s access to laboratory test result reports.   The amended Privacy Rule would preempt contrary state laws governing a patient’s direct access to lab result reports.

 

CMS reimburses laboratory service providers under Medicare and other federal healthcare programs, CDC is responsible for lab regulation under the Clinical Laboratory Improvement Amendments of 1988 (CLIA), and OCR is responsible for administering the Privacy Rule that under the Health Insurance Portability and Accountability Act of 1986 (HIPAA).

MGMA suggest Three Things You can do to prevent the 29.5 Physician cut!

We recently received an email from MGMA letting us know of some things that we could do to help prevent the devastating physician cute scheduled to come January 1st, 2012. Check out their tips here: Three things you can do to help avert the 29.5 percent Medicare payment cut MGMA needs your help to stop the 29.5 percent payment cut scheduled for Jan. 1. Here are three things you can do to keep the pressure on Congress to address this important issue. Take a brief survey on the impact the payment cut may have on your practice. Your response will enhance MGMA's advocacy efforts to get Congress to repeal this flawed payment system. Sign a petition and ask the physicians, patients and staff in your practice to do the same. MGMA and several physician specialties have launched a campaign,EveryPatientCounts.org, that calls on Congress to permanently fix the SGR. Tell your lawmaker. Urge the Joint Select Committee on Deficit Reduction and Congress to repeal the SGR. Through these outlets you can express your support for a permanent solution to the SGR crisis. We need a coordinated and amplified voice from MGMA members! Visit our website to learn more at mgma.com/policy.

American Academy of Pain Management Annual Clinical Meeting

On September 23^rd, 2011, our own Linda Van Horn, MBA and Debbie Nelson, CPC, CPMA presented lectures at the American Academy of Pain Management’s Annual Clinical Meeting. The meeting was held in Las Vegas, NV at the gorgeous Caesars Palace.  They presented a varied of topics to attendees including What HealthCare means to Pain Practitioners, how to incorporate Non-Physician Providers in your practice, Federal Scrutiny of Pain HEAT’s Up and How to prepare for ICD-10.  They both had a wonderful time and thank everyone who was able to attend their sessions. 

Check out our website to see where you can see us next!

Physicians/NPP’s Must be Accredited to Bill Image TC Accreditation is Mandatory On/After January 1, 2012

Physicians/NPP’s Must be Accredited to Bill Image TC

Accreditation is Mandatory On/After January 1, 2012

 

CMS reminds physicians, non-physician practitioners (NPP’s) and other Medicare Part B suppliers who bill the technical component (TC) of certain advanced diagnostic imaging procedures must be accredited beginning January 1, 2012 in order to bill Medicare for the technical component of services performed on/after that date.  It is required by the Medicare Improvements for Patients and Providers Act (MIPPA).

 

Accreditation is not necessary if the physician or NPP only performs X-ray, ultrasound or fluoroscopy, as these are not advanced diagnostic imaging procedures under the law.

 

Advanced diagnostic services include MRI, CT and nuclear medicine imaging, including positron emission tomography (PET). It is important to note that the accreditation requirement applies only to suppliers of the images themselves (TC) and not the physician’s interpretation (professional component) of the image.

 

Affected physicians, NPP’s and other suppliers should apply for accreditation now if they are not already accredited.  Visit the Advanced Diagnostic Imaging Accreditation Enrollment Procedures site at www.cms.gov/medicareprovidersupenroll at the Centers for Medicare and Medicaid Services (CMS) website and review each of the three accreditation organizations:

• American College of Radiology

• Intersocietal Accreditation Commission

• The Joint Commission

Call or email each of these three accreditation organizations to determine which one best fits your needs.  Follow all of the application requirements so that your application is not delayed.  The accreditation process may take up to 5 months.  The sooner you start, the better.

CMS releases final 2012 e-prescribing penalty exemptions

CMS releases final 2012 e-prescribing penalty exemptions
 

This afternoon (Aug. 31) the Centers for Medicare & Medicaid Services (CMS) released a final rule detailing additional exemptions from the 2012 e-prescribing penalty for providers unable to comply with the current requirements. CMS finalized all exemption categories that were included in a proposed rule released in June of this year. Eligible professionals must submit hardship exemption requests by Nov. 1.The finalized 2012 e-prescribing penalty exemption categories include:

• The practice is located in a rural area without high speed internet access.
• The practice is located in an area without sufficient available pharmacies for electronic prescribing.
• Registration to participate in the Medicare or Medicaid EHR Incentive Program and adoption of Certified EHR Technology.
• Inability to electronically prescribe due to local, State or Federal law or regulation.
• Limited prescribing activity.
• Insufficient opportunities to report the e-prescribing measure due to limitations of the measure's denominator.

CMS released the following fact sheet with links to the rule and additional information. MGMA will provide further details as they become available from CMS. View existing and future MGMA e-prescribing resources at mgma.com/e-prescribe

CMS: Most Providers Must Re-Enroll

CMS: Most Providers Must Re-Enroll

CMS has issued a reminder that all providers and suppliers enrolled with Medicare before March 25, 2011 must revalidate enrollment information, but only after receiving notification from their MAC.

Please note that this special re-enrollment is NOT required of providers or suppliers that were enrolled on or after March 25, 2011.

Because this special re-enrollment does not apply to everyone, CMS MACs are contacting affected Medicare providers and suppliers as it comes time for their re-enrollment.  Do not submit re-enrollment until you have heard from your MAC!

When you receive notification from your MAC to revalidate:

• Update your enrollment through Internet-based Provider Enrollment, Chain and Ownership System (PECOS) or complete the 855

• Sign the certification statement on the application

• If applicable, pay your fee thru pay.gov and

• Mail your supporting documents and certification statement to your MAC

Section 6401 (a) of the Affordable Care Act established a requirement for all enrolled providers and suppliers to revalidate their enrollment information under new enrollment screening criteria. This revalidation effort applies ONLY to those providers and suppliers that were enrolled prior to March 25, 2011.  Newly enrolled providers and suppliers that submitted their enrollment applications to CMS on or after March 25, 2011, are not impacted.  

For a smoother process, CMS will stagger the re-enrollments under 42 CFR 424.515(d) which provides CMS the authority to conduct these off-cycle re validations.

Between now and March 23, 2013, MACs will send out notices on a regular basis to begin the revalidation process for each provider and supplier.  Providers and suppliers must wait to submit the revalidation only after being asked by their MAC to do so. 

Healthcare Entities can Test 5010 Transaction Compliance CMS National 5010 Testing Week is THIS WEEK!

Healthcare Entities can Test 5010 Transaction Compliance CMS National 5010 Testing Week will be August 22-26, 2011 CMS conducted its first National Testing Day on June 15, 2011 allowing medical practices and other entities upgrading to Version 5010 claim transaction files to submit sample data to test their systems.  In this first such event, 349 entities submitted 974 files with no significant errors.  Of the participants surveyed afterwards, 32% felt ready to process Version 5010 transactions. CMS is following this up with an even bigger National 5010 Testing Week scheduled for August 22-26, 2011.  National 5010 Testing Week will provide entities that are working toward 5010 compatibility an opportunity to test the compliance of their systems with the support of a real-time help desk and access to Medicare Administrative Contractors (MACs) for assistance with problems. Testing is critical because version 5010 is the new version of the X12 standards for HIPAA compliant electronic transfer of health information between providers and Medicare, insurers or other health-related entities.  Full 5010 compliance is required for most entities as of January 1, 2012, the deadline when they must transfer medical information electronically. Register to participate in the National 5010 Testing Week exercise through your MAC.  To ensure that your registration is properly recorded and is not rejected, be prepared to provide the information listed below: Company name Vendor/Submitter ID PTAN NPI Type of submitter (e.g., provider, billing service, clearinghouse or vendor) Street address of submitter City/state and ZIP EDI contact person E-mail address Type of transactions you are going to test (e.g., 837I, 837P, 276/277 or 835) How will you be sending your test file (e.g., Dialup, FTP or NDM) Line of Business (e.g., J1 Part A, J1 Part B, J11 Part A, J11 Part B, J11 HHH or RRB) The Secretary of the Department of Health and Human Services (HHS) adopted version 5010 to replace the current version of the X12 standard for electronic transactions including claims (professional, institutional and dental), claims status requests and responses, payment to providers, eligibility requests and responses, referral requests and responses, enrollment and disenrollment in a health plan, Coordination of Benefits and premium payments.  There are three levels of 5010 compliance.  Level I compliance, required beginning on December 31, 2010, means "that a covered entity can demonstrably create and receive compliant transactions, resulting from the compliance of all design/build activities and internal testing."  Healthcare entities must be testing throughout calendar year 2011, and must schedule testing as early as possible, to ensure sufficient time for corrective actions and re-testing. Level II compliance will be required on December 31, 2010.  Level II means "that a covered entity has completed end-to-end testing with each of its trading partners, and is able to operate in production mode with the new versions of the standards." Level III means full compliance with Version 5010.  The compliance date for Medicare providers and other entities is January 1, 2012.  The Medicaid deadline also is January 1, 2012, except for small health plans that have until January 1, 2013 to come into compliance. The requirement to adopt transaction standards originated from the 1996 Health Insurance Portability and Accountability Act (HIPAA).  The Transactions and Code Sets final rule published on Aug. 17, 2000, adopted standards for the statutorily identified transactions, some of which were modified in a subsequent final rule published on Feb. 20, 2003. On January 16, 2009, HHS published a final rule that replaces the current Version 4010/4010A and NCPDP Version 5.1 with Version 5010 and Version D.0, respectively, and adopted NCPDP Version 3.0 as well.