On October 22, 2009, the Equal Employment Opportunity Commission (”EEOC”) announced a revision of “EEO is the Law,” the notice that employers covered by federal anti-discrimination laws must post in the workplace. The revised version reflects current federal employment discrimination law, incuding information about the Genetic Information Nondiscrimination Act of 2008, which became effective November 21, 2009. The revised poster also includes updates from the Department of Labor.
Employers may either download and print the revised supplement from the EEOC website and post that document alongside the EEOC’s 2002 edition of “EEO is the Law,” download and post the November 2009 update from the EEOC website, or order copies of the new posters, which are available in English, Spanish, Chinese, and Arabic.
A recently released IRS private letter ruling denied tax exemption for a health information data exchange. A group of insurers and large employers formed an organization designed to aggregate and share health care data with the goal of improving healthcare quality and efficiency. The organization planned to gather, manage and process data on providers and the providers’ performance as to quality benchmarks, but did not require that this information be shared with the public. The IRS found that the organization’s benefits flowed primarily to its members and not to the general public. Further, the organization’s activities were similar to a “commercial business” in providing health care data analysis and distribution only to the organization’s members. It appears that the major flaw in the organization’s proposed operations was distribution of the data it gathered and analyzed was limited to its members, which were both employers and health plans. The organization functioned primarily to benefit its members and not the general public, and therefore, the organization was both operating for a non-exempt purpose and conferring a substantial private benefit on its members.
The Act, titled the Medicare Physician Payment Reform Act of 2009 (H.R. 3961), passed the House of Representatives by a vote of 243-183. The Act will repeal the 21.2% cut in Medicare reimbursement for physician services in 2010. The Act will also create a new sustainable growth rate formula. The Act, available here, still faces a vote in the Senate.
The ARRA provides for the development of National Broadband Plan, part of which involves enhancing the US broadband infrastructure to advance health care delivery. The FCC is gathering information in anticipation of creating the health care elements of the broadband plan, including how to best benefit rural health care initiatives. The deadline is December 4th. Download NBP Public Notice #17 and weigh in to provide real world guidance to the FCC.
CMS announced today that the Department of Health and Human Services (HHS) will employ new standards in calculating improper Medicare payment rates for 2009. The tougher standards are intended to facilitate CMS’s ability to target improper payments. The new standards are part of the Obama Administration’s goal of reducing waste, fraud, and abuse in Medicare. HHS Secretary Kathleen Sebelius explained that “[t]hrough a more stringent review of Medicare claims, we have been able to establish a more complete accounting of errors, enabling CMS to take more actionable steps to further reduce the error rate and identify abusive or potentially fraudulent actions before they become problems.”
CMS’s full press release may be found here.
The Center for Medicare and Medicaid Services (“CMS”) recently published its 2010 Outpatient Prospective Payment System Final Rule (“Final Rule”). As part of its Final Rule, CMS changed and clarified the direct supervision requirements for hospital outpatient therapeutic services and procedures. The result of these changes is a relaxation of the direct supervision requirements for outpatient therapeutic services and procedures and added flexibility. Nevertheless, the Final Rule still presents challenges for hospitals in meeting the supervision standard. Read more…
Beginning January 1, 2010, Medicare will no longer accept consultation codes. Citing years of billing confusion related to the billing of consultation codes, CMS will require providers to bill all evaluation and management (E/M) services using the appropriate inpatient or outpatient visit codes. The change is expected to be budget neutral because the money spent on consults will be used to increase payment for new and established E/M services. However, many specialists who heavily bill consults will likely see a decrease in E/M reimbursement in 2010.
Additional information pertaining to the Final 2010 Medicare Physician Fee Schedule (MPFS) can be accessed here.
Scroll down to page 1171—Table 49—to view how all the 2010 MPFS changes will affect reimbursement by specialty.
Senate Assembly Bill 207 would require a health care facility or health care provider that itemizes a charge for use of the facility to notify a patient that it will impose the facility use charge and to provide the patient with a good faith estimate of that health care facility use charge. If the appointment for an office visit is made in person or by phone, the health care facility or health care provider must notify the patient of the charge and estimate orally at the time the appointment is made. If the appointment is not made in person or by phone, the health care facility or health care provider must notify the patient of the charge and estimate either orally or in writing as soon as the appointment is confirmed by the provider or facility. Any appointment reminder sent to the patient must contain information about any facility use charge and a good faith estimate of the charge. The health care facility or health care provider must also, on any bill imposing the charge, identify the facility use charge as a “facility fee.”
The Assembly Committee on Public Health will hold a hearing to discuss the bill on Tuesday, December 1. Text of the proposed bill can be accessed here.
If you just don’t get Stark, you’re not alone. Recognizing that even a simple question like “Who must sign an agreement?” continues to defy a simple answer, CMS has issued a clarification to its Phase III “stand in the shoes” doctrine that it is only necessary for a single authorized representative of a physician organization to sign an agreement; it is not necessary for all physicians who stand in the shoes of that physician organization to also sign the agreement. This regulatory change formalizes guidance issued by CMS in a January 2008 FAQ. While the result may seem obvious, the fact that CMS thought it necessary to issue formal regulatory guidance demonstrates how Stark continues to fall short of its goal as a “bright-line” statute.
This clarification, set forth in the CY 2010 Medicare Physician Fee Schedule Final Rule, was accompanied by a CMS solicitation for public comment on another area of continuing confusion involving its recent change to the definition of an “entity” under Stark. As of October 1, 2009, the term “entity” includes not only the entity billing for designated health services but also the person or entity that “performs” the DHS. While not proposing any clarification at this time, CMS has solicited comments on how it might craft future guidance, such as by tying the concept of “performing services” to factors such as the presence of a space or equipment lease, the use of supplies, management or billing services, and whether accompanying non-physician services are separately billable. While it remains to be seen what CMS actually does with the comments it receives, one thing seems certain: the adoption of a multi-variable calculus such as that mentioned by CMS would make “bright-line” comprehension that much more elusive.
