SUMMARY This eAlert offers news briefs of interest to anesthesia practices on: the Republicans' latest attempt to repeal and replace the Affordable Care Act; the new Medicare ID number initiative and what practices should be doing now to prepare; a primer on additional documentation requests (ADRs) and why a timely response is essential; and c...

Last week’s e-Alert introduced our readers to the proposed regulations implementing the MACRA Quality Payment Program (Medicare Program; Merit-Based Incentive Payment System (MIPS) and Alternative Payment Model (APM) Incentive under the Physician Fee Schedule, and Criteria for Physician-Focused Payment Models).  We focused in Part I on the MIPS pathway, which consolidates Medicare’s current quality, cost and EHR reporting programs and promised an overview of the second major physician payment pathway set forth in the proposed rule, the APM Incentive program. All eligible clinicians will be participating in either the MIPS or the APM program in the near future, as the Physician Quality Reporting System (PQRS), the Value-Based Modifier (VBM) program and the EHR Incentive-Meaningful Use (MU) program phase out, by the end of 2018.  Beginning on January 1, 2019, payments will reflect participation in MIPS or APM, based on each clinician’s performance in 2017.  The APM incentives are as follows: For...

In the Winter 2016 issue of The Communique, we offered Part I of a summary of state laws (Alabama through Iowa) involving the peer review process. Here we are continuing that summary with the remaining states (Kansas through Wyoming).1     1Special thanks is given to Amy Bell for her assistance in preparing this article.

We have known since Congress passed the Medicare Access and CHIP Reauthorization Act (MACRA), just over a year ago, that big changes in the way that CMS pays physicians are coming. MACRA has already repealed the detested Sustainable Growth Rate formula. On Wednesday, April 27, CMS released the proposed regulations (Medicare Program; Merit-Based Incentive Payment System (MIPS) and Alternative Payment Model (APM) Incentive under the Physician Fee Schedule, and Criteria for Physician-Focused Payment Models) that begin to define the new unified framework called the Quality Payment Program going forward. The 962-page proposed rule is just that: proposed. CMS will be receiving public comments through June 27 and will then consider them for several months before publishing the final rule later this year. We hope that the final will be released sooner rather than later, because anesthesiologists and other physicians will need to know what they must do before January 1, 2017....

If you receive a letter by email that begins like this:     You should respond within the 14 days mentioned in the letter.  Congratulations; you are participating in Phase 2 of the HIPAA Audit Program.   With this letter, OCR is seeking just to identify contacts to create a pool of HIPAA-covered entities (CEs) and their business associates (BAs) for possible audits.  In the next step, OCR will transmit a pre-audit questionnaire to gather data about the size, type, and operations of CEs and their BAs.  These data will then be used with other information to create potential audit subject pools.  Eventually more than 200 entities will face audits in Phase 2 of the HIPAA Audit Program, which will primarily be desk audits, although some on-site audits will also be conducted.   Phase 1 of the HIPAA Audits   HIPAA established national standards for the privacy and security of protected...