May 28, 2010
Congress failed to act to stop the 21.2 percent Medicare physician payment cut from taking effect on June 1. CMS will hold claims for 10 business days, with Congress expected to act on the SGR after they return from the Memorial Day Recess. Both chambers will be back in session the week of June 7. Yesterday the House leadership failed to garner enough votes to pass the scaled back tax extenders and SGR package. The House is still in session and may vote on an SGR patch today. It is unclear still whether the House will try to approve the 19 month SGR patch or a shorter term one. The Senate, however, will adjourn for the Memorial Day Recess without taking up the SGR.
In other news, the Federal Trade Commission's (FTC) "Red Flags" identity theft rules are slated to take effect on June 1. In an effort to address the growing risk of identity theft, the FTC released rules in November 2007 requiring all financial institutions and "creditors" (including health care providers) to develop and implement a written program to protect consumers by identifying potentially suspicious "red flags" that may signal identity theft. Your ACC, the American Medical Association (AMA) and other medical associations have strongly opposed the inclusion of physicians as creditors and have repeatedly been able to delay the rule's implementation date. Most recently, the AMA, the American Osteopath Association (AOA) and the Medical Society of the District of Columbia filed a lawsuit on this point. Your ACC will keep you informed regarding any late-breaking developments in this area. However, given the fast-approaching deadline, the ACC strongly recommends that practices prepare a written identity theft detection and prevention program. The AMA and MGMA have developed Red Flags Rule guidance documents and sample policies that can be modified, which can be accessed at: MGMA Red Flags Rule Resource Center and AMA Red Flags Rule Physician Resources.
Are you eligible? An interim final rule released by the Centers for Medicare and Medicaid Services (CMS) this month, revisits an issue regarding ordering and referring providers that was included in the 2010 Medicare Physician Fee Schedule. CMS last summer issued changes requiring an individual ordering or referring an imaging or laboratory service to be a physician or other health care professional able to enroll in Medicare and permitted to order or refer for the service. According to CMS, claims that did not contain the name of an enrolled ordering or referring provider would not be paid beginning in January 2010. However, based on concerns raised by the ACC and others, CMS had agreed to push the implementation date to January 2011. The new rule makes several changes to the previously announced policy, including moving the implementation date forward from January 2011 to July 6, 2010. It also requires that individuals ordering or referring patients for "specialist services" be enrolled.