Health Care Reform

Uploaded by ECImedTV on Oct 25, 2010
Hello, I am Dr. Robert Williams, Chairman of ECI
2010 has been an historic and tumultuous year for American healthcare. On March 23, 2010, after a prolonged and highly partisan process, President Obama signed the Patient Protection and Affordable Care Act, known simply as ACA.
Although the ACA will not be fully implemented for several years, this law will have a profound effect on our healthcare system, including emergency medicine and hospitalist services.
So, what are the implications of healthcare reform? (slide?)
• significant insurance reform,
• expanded coverage to more than 30 million people,
• a huge expansion of Medicaid, which is a joint federal/state program,
• an individual mandate -- meaning that everyone must have health insurance or pay penalties,
• higher taxes on the wealthy,
• plus, over 2700 pages of details, yet to be determined.
There are a several important details not addressed by this legislation. These include: (slide?)
• universal coverage --23 million people remain uninsured. Most of these people are undocumented immigrants.
• also, meaningful cost control,
• tort reform, and
• a clear understanding of the long-term effects of the legislation, or
• a permanent fix to the physician compensation formula.
The ACA was not a quick fix, and paying for health care reform remains a daunting task. Under the new law, financing will come primarily from:
• a 500 billion dollar cut in the growth of Medicare spending,
• tax increases on the wealthy, and
• substantial new taxes on drug companies and medical equipment suppliers.
These resources will support Medicaid funding on a national level, but many states will struggle to pay their portion of this program expansion. State funding issues are especially relevant to emergency medicine. Recent articles in the Journal of the American Medical Association and from the CDC report huge increases in ED volumes, which reached as high as 124 million in 2008. Most of this growth is attributed to more visits from Medicaid patients.
These types of challenges leave us with no permanent resolution to the physician compensation formula, known as the SRG. In 1998, all physicians were scheduled to receive a 21% cut in Medicare reimbursement effective January 1st of this year. Fortunately, as they have for the past few years, the cuts have been put on hold. The pending cuts represent an estimated $370 billion in costs that were not included in the $1 trillion cost estimates for healthcare reform. This will continue to compound if the physician compensation issue is not resolved and will reach an estimated $500 billion by 2015.
There is a lot we do not know and understand about the future implications of this new law, but there are things we know that will affect all of us at ECI and HCI.
In coming years, there will be an increased focus in several important areas: (slide?)
• higher quality
• improved efficiency
• increased accountability and verification, and
• better risk management.
Since 1972, our organization has remained committed to achieving all of these ideals. As a result, we have created a wealth of highly innovative programs that continue to benefit practitioners across the country.
This organization has the skills, expertise, and commitment required to meet the many new challenges of health care reform.
As a new day dawns in American healthcare, all of us at ECI and HCI are awake, energized, and ready to go!
Thank you.

Dallas L Alford IV, CPA is a licensed Certified Public Accountant in the state of North Carolina and owner of Atlantic Financial Consulting, a consulting firm that provides comprehensive medical billing services, practice management consulting, coding audits, Medicare compliance, Medicare RAC support and other general medical practice consulting services.
To learn more about Atlantic Financial Consulting you may visit their website at
http://atlanticfinancial.us/ or contact Dallas L Alford IV, CPA directly at 1 888-428-2555, Ext. 200.

ICD-10 Implementation Strategies for Physicians National Provider Call

Join Us:

Wednesday, August 3, 2011 from 1-3 pm ET



Is your office preparing for a smooth transition to ICD-10 on October 1,
2013? The Centers for Medicare & Medicaid Services (CMS) will host a
National Provider Call on "ICD-10 Implementation Strategies for Physicians."
CMS subject matter experts will discuss ways that physician offices can
prepare for the change to ICD-10 for medical diagnosis and inpatient
procedure coding. A question and answer session will follow the
presentations.



Agenda:

· ICD-10 requirements and resources overview

· Implementation strategies for physician offices

· Update on coverage conversion activities

· National ICD-10 implementation issues

· Update on bill processing, including claims that span the
implementation date

· Update on Home Health Agency Home Health Resource Grouper



Target Audience:

Physicians, physician office staff, provider billing staff, medical coders,
health records staff, vendors, educators, system maintainers, laboratories,
and all Medicare fee-for-service (FFS) providers.



Registration:

To register for this informative session, please go to
http://www.cms.gov/ICD10/Tel10/itemdetail.asp?itemID=CMS1249632 on the CMS
website. Registration will close on Tue Aug 2 at 1pm ET or when available
space has been filled. No exceptions will be made. Please register early.

Dallas L Alford IV, CPA is a licensed Certified Public Accountant in the state of North Carolina and owner of Atlantic Financial Consulting, a consulting firm that provides comprehensive medical billing services, practice management consulting, coding audits, Medicare compliance, Medicare RAC support and other general medical practice consulting services.
To learn more about Atlantic Financial Consulting you may visit their website at
http://atlanticfinancial.us  or contact Dallas L Alford IV, CPA directly at 1 888-428-2555, Ext. 200.

Six Month Check-in: Act Now for the Version 5010 Transition

The Version 5010 transition is less than six months away for all HIPAA covered entities. This means that to submit transactions electronically, all covered entities must upgrade from Version 4010/4010A to Version 5010. Version 5010, unlike Version 4010, accommodates the new ICD-10 code sets, and is a required preliminary step for the use of the new ICD-10 medical code sets.

Before the compliance deadline of January 1, 2012, you should conduct internal and external transactions within your organizations and with your billing partners – including payers, vendors, clearinghouses and providers. External testing should take place now in order to make sure that you are able to send and receive compliant transactions effectively. Testing now will help identify any potential issues that may arise, and allow the necessary time to address them.

The CMS ICD-10 website has resources to support providers, payers and vendors as they make the transition to Version 5010 and ICD-10.
Keep Up to Date on Version 5010 and ICD-10.
Please visit www.cms.gov/ICD10 for the latest news and resources to help you prepare.

Dallas L Alford IV, CPA is a licensed Certified Public Accountant in the state of North Carolina and owner of Atlantic Financial Consulting, a consulting firm that provides comprehensive medical billing services, practice management consulting, coding audits, Medicare compliance, Medicare RAC support and other general medical practice consulting services.

To learn more about Atlantic Financial Consulting you may visit their website at

http://atlanticfinancial.us  or contact Dallas L Alford IV, CPA directly at 1 888-428-2555, Ext. 200.

CMS Coverage Email Updates

Shown below are the details for the item you selected from the list.

Date	07/21/2011
Subject	CMS Updates to Coverage Pages
Content	Posted final decision memo for Prothrombin Time (PT) (Addition of two ICD-9-CM diagnosis codes)

Coding Analysis for Labs Prothrombin Time (PT) (Addition of two ICD-9-CM diagnosis codes)      Posted final decision memo https://www.cms.gov/medicare-coverage-database/details/cal-decision-memo.aspx?CALId=254cal-tracking-sheet.aspx?CALId=254

Dallas L Alford IV, CPA is a licensed Certified Public Accountant in the state of North Carolina and owner of Atlantic Financial Consulting, a consulting firm that provides comprehensive medical billing services, practice management consulting, coding audits, Medicare compliance, Medicare RAC support and other general medical practice consulting services.

To learn more about Atlantic Financial Consulting you may visit their website at

http://atlanticfinancial.us  or contact Dallas L Alford IV, CPA directly at 1 888-428-2555, Ext. 200.

Updated CMS Quarterly Provider Update (QPU)

This page lists the What's New downloads for the Centers for Medicare & Medicaid Services (CMS) Quarterly Provider Update (QPU).  These downloads are designed to keep you informed of all updates made to the QPU within a particular quarter.

If you do not want to check this page daily, but would like to be informed as soon as updates are made to the QPU, you may join the CMS QPU mailing list (see the link in the "Related Links Inside CMS" section below).  An e-mail message will be sent periodically throughout the quarter as regulations and program instructions are added to the QPU.

http://www.cms.gov/QuarterlyProviderUpdates/02_Spotlight.asp

Dallas L Alford IV, CPA is a licensed Certified Public Accountant in the state of North Carolina and owner of Atlantic Financial Consulting, a consulting firm that provides comprehensive medical billing services, practice management consulting, coding audits, Medicare compliance, Medicare RAC support and other general medical practice consulting services.

To learn more about Atlantic Financial Consulting you may visit their website at

http://atlanticfinancial.us  or contact Dallas L Alford IV, CPA directly at 1 888-428-2555, Ext. 200.

Advisory Opinion 11-09 (PDF)

http://oig.hhs.gov/fraud/docs/advisoryopinions/2011/AdvOpn11-09.pdf

Dallas L Alford IV, CPA is a licensed Certified Public Accountant in the state of North Carolina and owner of Atlantic Financial Consulting, a consulting firm that provides comprehensive medical billing services, practice management consulting, coding audits, Medicare compliance, Medicare RAC support and other general medical practice consulting services.

To learn more about Atlantic Financial Consulting you may visit their website at

http://atlanticfinancial.us  or contact Dallas L Alford IV, CPA directly at 1 888-428-2555, Ext. 200.

Law Judge Upholds HHS OIG's Exclusion of Owner of Orlando, Florida, Diagnostic Imaging Services Company

Washington, DC - The Office of Inspector General (OIG) of the Department of Health & Human Services (HHS) announced today that Administrative Law Judge (ALJ) Steven T. Kessel upheld OIG's exclusion of Michael D. Dinkel from participation in all Federal health care programs under section 1128(b)(7) of the Social Security Act for a period of 8 years.

"I'm the owner of Drew Medical. The buck stops with me," Dinkel acknowledged in his testimony at the hearing.

ALJ Kessel agreed, holding that Dinkel was personally responsible for ensuring that Drew Medical claimed reimbursement appropriately and that his failure to do so "constituted reckless indifference to the propriety of the claims he caused to be presented." He emphasized that point finding Dinkel had a duty "to understand Medicare and Medicaid billing requirements and to apply them scrupulously to the claims that he caused to be presented."

"The decision reached in this case reinforces OIG's use of its administrative authorities, such as exclusion, to hold accountable individuals who engage in Medicare and Medicaid fraud," said HHS Inspector General Daniel R. Levinson.

The United States Department of Justice previously entered into a civil False Claims Act settlement with Dinkel, Drew Medical, and Central Florida Radiology, Inc., for $1,147,564. Prior to the civil settlement, OIG notified Dinkel that OIG intended to exclude him.

"In cases such as these, payment of civil damages is important but not always sufficient. OIG excluded Mr. Dinkel based on the magnitude of the false claims and our assessment that he is untrustworthy and should not be allowed to participate in Federal health care programs," Inspector General Levinson said.

Dinkel is the owner and President of Drew Medical, Inc., a diagnostic imaging services provider located in Orlando, Florida, which provides outpatient radiology services. Based upon evidence presented at an administrative hearing, ALJ Kessel found that Dinkel and Drew Medical submitted false claims to the Medicare and Medicaid programs for services relating to a radiological procedure known as venography. In fact, Drew Medical had not performed any such services. Specifically, Dinkel and Drew Medical presented claims to Medicare and Medicaid for a procedural code that corresponds to injection for extremity venography, whenever MRI and CT procedures with contrast were performed.

ALJ Kessel found that over a more than 2-year period, Dinkel caused the submission of nearly 9,500 false claims seeking more than $1.6 million in reimbursement.

Under section 1128(b)(7) of the Social Security Act, OIG may exclude individuals and entities from Federal health care programs for presenting or causing to be presented claims for items or services that the individual or entity knows or should know were not provided as claimed, or are otherwise false or fraudulent. OIG's exclusion authority is designed to protect the integrity of the Federal health care programs from individuals or entities who present a risk to those programs.

OIG Assistant Special Agent in Charge Kelly A. McCoy investigated the case. Senior Counsel Christina K. McGarvey, David M. Blank, and Robert M. Penezic and Associate Counsel Lauren E. Marziani represented the Inspector General in the litigation of this matter.

Dallas L Alford IV, CPA is a licensed Certified Public Accountant in the state of North Carolina and owner of Atlantic Financial Consulting, a consulting firm that provides comprehensive medical billing services, practice management consulting, coding audits, Medicare compliance, Medicare RAC support and other general medical practice consulting services.

To learn more about Atlantic Financial Consulting you may visit their website at

http://atlanticfinancial.us  or contact Dallas L Alford IV, CPA directly at 1 888-428-2555, Ext. 200.