EHR Incentive Program Blog Series Part IV: Penalties

Medicare eligible professionals who do not meet the requirements for meaningful use by 2015 and in each subsequent year will be subject to payment adjustments to their Medicare reimbursements that start at 1% per year, up to a maximum 5%.

For the Medicaid EHR Incentive Program, there are no penalties. Medicaid eligible professionals who are not eligible to participate in the Medicare and the Medicaid EHR Incentive Program will not be subject to payment adjustments. However, Medicaid eligible professionals who also treat Medicare patients will have a payment adjustment to Medicare reimbursements starting in 2015 if they do not successfully demonstrate meaningful use.


Tiptastic Tuesday: This Year’s Top 6 Food Trends

Healthy foods are always a good idea-trendy or not. Here are this year’s top food trends.

  1. Clean eating: Clean eating is the new buzzword for healthy. It means eating more vegetables, less meat, less sodium, watching your alcohol intake, limiting processed foods and choosing whole grains.
  2. Trash fish: This is the fish that is caught up in the fisherman’s nets but aren’t the popular fish, like halibut or salmon. This year, these underappreciated species, such as sea robin and wolf eel, will become more available. The aim is to get Americans to eat a wider range of seafood and to protect the balance of fish populations in our oceans.
  3. Cauliflower is the new ‘it’ vegetable: Kale is still in, but so is nutrient-rich cauliflower. It can often be substituted for starchier, higher-calorie potatoes in dishes and used in soups to make them creamy and rich (without any cream!)
  4. Introducing quinoa’s little cousin, kaniwa: Kaniwa is similar to quinoa, but slightly smaller. It cooks quickly and is high in protein.
  5. Fermented foods and drinks: Fermentation transforms flavors and textures of foods; milk is turned into creamy yogurt, cabbage into sauerkraut, and tea into kombucha. It’s a delicious addition to any healthy diet.

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Hospital Observation Stays Dramatically Increased

According to a new AARP report, observations stays increased by more than 100% and long stays became more common between 2001 and 2009.  During the same time, observation stays that lasted longer than 48 hours also increased significantly; observation stays lasting more than two days that didn’t end with inpatient admission increased almost 250%.

Researchers cite a number of factors including increased payer and regulator scrutiny of short inpatient stays and changes in reimbursement.  It was also noted that a potential driver of observation stays, hospital readmission penalties, started last year.  Long-term care providers and other senior advocates are not in favor of the rise in observation stays since it can keep patients from qualifying for Medicare coverage in LTC facilities.

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Breaking News: Americans Can Keep Insurance!

President Obama announced today that Americans will not be losing their existing health plans under the ACA for another year.  Insurance companies that have been sending out cancellation notices will need to reinstate policies.  Americans will also be able to keep plans that don’t meet all the requirements of the new law such as prescription drug coverage. Obama admitted that the rollout was not as expected but that come January, more than 500,000 Americans will have health insurance, some for the first time ever.

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Potential Cure for MRSA!

You’ve most likely heard about methicillin-resistant staphylococcus aureus or MRSA, a deadly bacteria that has long troubled healthcare facilities like nursing homes. Researchers have now found a way of eradicating the antibiotic-resistant bacteria. According to the new research, MRSA contains persister cells which survive even in the presence of antibiotics.  The drug ADEP combined with antibiotics has been found to kill these persister cells and wipe out MRSA in laboratory tests.  Scientists hope that this approach can also be used to fight other infections in humans.

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What’s Next for the Federal Exchange?

HHS announced that less than 27,000 Americans signed up for insurance coverage in the first five weeks of its rollout.  To be clear, 26,794 people signed up for private plans through the federal exchange while nationally, a total of more than 106,000 Americans signed up for coverage through exchanges, including state-run exchanges.  Although there are still issues with, officials say it is improving daily and that enrollment figures are expected to increase.  Some Republicans lawmakers argue that the enrollment figures have been inflated and that the website was never designed to handle much traffic.

Government officials are scrounging for ways to make the rollout more successful.  So far, three policy changes have been proposed including delaying the individual mandate and its associated tax penalty for failing to buy coverage, extending the open enrollment period to buy coverage, and allowing individuals with plans that have been canceled to keep their plans through 2014.  So far, no decisions have been made.

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What’s Behind Exorbitant Healthcare Costs?

According to a new study published in the Journal of the American Medical Association, the reason behind high healthcare costs is price increases, not a larger senior population. More recently, it has been theorized that a much larger aging population and their demand for services due to chronic conditions was the culprit behind these costs.  But, researchers who examined publicly available data determined that healthcare costs “exceed any other industry as a share of gross domestic product.”  91% of cost increases can be attributed solely to price increases since hospital charges, professional services, drugs, devices, and administrative costs are much higher than they ever were.

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Bundled Payments for Dummies: Model 4

As we wrap up our bundled payment series (see here for an archive of our series), we’d like to introduce you to the fourth and last model:

Acute Care Hospital Stay Only: In this model, CMS would make a single, bundled payment to the hospital that would cover all costs for any services provided.  Physicians and other practitioners will be able to submit “no-pay” claims to Medicare and be paid by the hospital out of the bundled payment.  Any related readmissions for 30 days after discharge will also be included in this bundled payment.  Participants in this model will be able to choose from 48 different clinical condition bundles.

We hope our series has given you a better understanding of bundled payments.  And, as always, the experts at HMS are here to answer any questions and/or concerns you may have about the new model.  If you would like to contact us, please call  (203) 294-6659.

Tiptastic Tuesday: Creating an Effective Privacy Compliance Program for Physician Practices

Although it seems hard to believe, we’re nearing the new year.  This means it’s time for your practice to have an up-to-date, effective compliance program.  If you want to prevent your practice from scrutiny from auditors and hefty fines, look no further. Here are some quick tips on creating and maintaining an effective privacy compliance program:

  • Your compliance program should address specific areas including: lack of appropriate safeguards for patients’ protected health information (PHI), impermissible use of patients’ PHI, difficulty with patient access to PHI and inappropriate disclosure of PHI
  • It’s extremely important for practices to perform regular self-audits to ensure privacy policies are being followed. Begin this process by reviewing procedures you already have in place to make sure they’re compliant with recent updates.
  • Your policy should address PHI stored on all electronic devices and should note the employees who have access to it.
  • Check with your business associates to make sure their policies regarding PHI are in compliance.  Also, make sure your HIPAA policy is up to date- this applies to business associates, too (see here for more information about business associates and HIPAA).
  • Make sure all usernames and passwords are secure.  Longer passwords with different characters are the most secure.  Never use personal information in a password.  We recommend you change passwords every 90 days (see here for more information about securing safe passwords).
  • Have a policy centered around employee training with a detailed record of how often staff is updated about any relevant changes
  • Evaluate any potential risks with a written assessment

Stay tuned to our blog for more compliance tips!

Reminder: Dec. 1st Deadline for OPR Claim Edits for Home Health and Hospice Providers

The Affordable Care Act requires all ordering, prescribing and referring  (OPR) providers who render services to HUSKY clients (Medicaid) be enrolled in the Connecticut Medical Assistance Program (CMAP).  As mandated by the Department of Social Services (DSS), all OPR providers should be enrolled in CMAP in order to avoid any claim denials.  If you bill Medicaid for any services, this mandate will impact you and your ability to get paid by Medicaid as of December 1, 2013.

Click here to read more from DSS