For the 24 remaining beneficiary-months, individual providers did not have timesheets supporting daily hours of service provided to the beneficiaries. OIG has set aside these services for resolution by CMS and the State agency because the providers may have followed State agency guidance and disposed of the timesheets after 2 years. OIG estimated that the State agency may have improperly claimed $30.3 million in Federal Medicaid reimbursement.

OIG recommended that the State agency (1) refund $19.4 million to the Federal Government, (2) work with CMS to resolve the $30.3 million that we set aside, (3) improve its monitoring of providers to ensure compliance with Federal and State requirements, and (4) revise its guidance to require providers to retain timesheets for 3 years. The State agency partially concurred with OIG’s recommendations.

HHS Sec. Kathleen Sebelius said they will enable the previous “pay and chase” enforcement approach to be replaced with a “more proactive” one. The new rules, she added, will make it possible to cut off the flow of funds to “suspected criminals” before the frauds they perpetrate get off the ground.

The regulation authorizes the suspension of payments to providers and suppliers while an enforcement action or investigation is underway if there is a “credible allegation” of fraud, as referred to in the reform law (HRW 7/12/10, p. 1).

Other provisions of the new rules:

1. A rigorous screening process for providers and suppliers enrolling in Medicare, Medicaid and the Children’s Health Insurance Program (CHIP) to keep fraudulent providers out.

2. A new enrollment process for Medicaid and CHIP providers, with states having to screen providers who order and refer to Medicaid beneficiaries to determine if they have a history of defrauding government.

3. Temporarily stop enrollment of new providers and suppliers if Medicare and/or a state agency identifies a trend in a category of providers or geographic area that may indicate fraud — as long as the halt won’t impact patient access to care. The government agencies may use advanced predictive modeling software for the identification purposes.

For more information, contact ChiroCode Institute or use this link: http://www.chirocode.com/New_HHS_Fraud_Prevention_Rules

Courtesy of 7th Interactive.   For full story go to http://7thspace.com/headlines/370375/owners_of_texas_health_care_company_guilty_in_massive_fraud_scheme.html

Providers won’t have to convert all your medical records and make them available on the web by 2012. Not only is such a task technically impossible right now but the no such legal requirement exists. While many public and private organizations are working to develop and implement an electronic medical records system accessible by all who treat a particular patient, the work is far from done. Many different organizations are developing and testing various systems. Beware of grapevines – many “growers” of these vines have something to sell.

Second, without going into great detail into all of the aspects of these efforts, here is an excerpt from the December report put out through the White House describing the beginnings of the efforts directed by law:

In 2009, the HITECH Act (part of the American Recovery and Reinvestment Act, or ARRA) authorized expenditures on the order of $20 billion (with estimates in the range $9 billion to $27 billion) over five years to promote the adoption and use of [electronic health records] “EHR” technologies that would be connected through a national health information network. The legislation sets forth a plan for the “meaningful use” of health IT to improve the quality of care and enable changes in delivery systems essential to healthcare reform.

The HITECH Act attempts to create incentives for all hospitals and eligible providers, not just those associated with large systems, to adopt and use electronic information. A centerpiece of the Act is to put in place strong financial incentives for hospitals and physicians to adopt and meaningfully use electronic health records. Physicians who adopt electronic records by 2014 can qualify for Medicare bonus payments of up to $44,000. Beginning in 2016, physicians who have not adopted electronic records will be penalized in the form of reduced Medicare reimbursements. Similarly, Medicaid providers can receive up to $63,750 over the five years. These payments and penalties depend on the provider meeting the requirements for meaningful use.

The definition of meaningful use under HITECH involves both ONC and CMS, but CMS is the principal rule-making body since payment will be linked to the reporting of meaningful use measures. The statute leaves CMS broad discretion, requiring only that the definition include e-prescribing, the ability to exchange information with other healthcare providers to improve care, and the reporting of clinical quality measures to CMS. With input from several Federal advisory committees, CMS has proposed to phase in meaningful use criteria in three stages. Stage 1 criteria, to take effect in 2011, focus on electronically capturing health information in a coded format, implementing decision support, sharing information with patients, testing the ability to exchange information, and initiating the reporting of clinical quality measures to CMS. Stage 2 criteria, to take effect in 2013, would require more robust exchange of information and other high value uses of EHRs. Stage 3 criteria, to take effect in 2015, would require physicians to demonstrate the use of EHR technology in ways that improve the outcomes of care. The broad goal is to gradually acclimate providers to workflow changes and practice improvement opportunities that, ideally, will accompany the adoption of technology.

Finally, many different insurance companies are experimenting with various electronic billing and medical record systems. However, these private requirements are a far cry from universal, legally mandated, internet based patient records.

We will communicate new legal mandates to your association when and if they appear. For those who wish to access a more credible source of information on EHR activities, this link will help – White House Report

 Best regards,

John

Tel. (253) 759-7767 Fax. (253) 761-5328

Conniff Website

 Assignment. This Agreement, being intended to secure the services of Practitioner, may not be assigned, delegated, or otherwise transferred by Practitioner. For the purposes of continuity of care, Network will consider every reasonable request for an application from a practitioner who practices in the office of an existing Practitioner or has purchased the practice of an existing Practitioner. The applicant will be subject to Network’s Credentialing and Network criteria at the time of the application.  

Note that the contract does not promise to accept a practitioner who purchases a practice but rather to “consider every reasonable request.” Some contracts don’t even promise this much consideration.