Note: ABC encourages all anesthesiology groups to participate in ASA’s 13th survey of commercial payment rates, launched on June 9th. The results will be published in the ASA Newsletter later this year and obviously they will be more meaningful if there are many responses. For further information go to http://www.asahq.org/advocacy/fda-and-washington-alerts/washington-alerts/2015/06/please-participate-in-2015-survey-of-commercial-payment-rates.
Many anesthesiologists serve as the paid medical director of their operating room suite or ambulatory surgical center (ASC). Many others would like to receive compensation for medical director services. The Health and Human Services Office of the Inspector General (OIG) has just issued a Fraud Alert entitled Physician Compensation Arrangements May Result in Significant Liability, of which they should all be aware.
The Anti-Kickback Statute
As the OIG has stated in numerous Advisory Opinions,
The anti-kickback statute makes it a criminal offense knowingly and willfully to offer, pay, solicit, or receive any remuneration to induce or reward referrals of items or...
Cyber attacks on health databases are occurring so frequently that they are only newsworthy when they affect millions of records, as happened with the recently-reported massive Anthem (about 80 million individuals) and Premera Blue Cross (more than 11 million) data breaches. Last year, in fact, was characterized as the “year of the data breach” by some, according to Becker’s Hospital Review, which reports that: “Across industries, the healthcare sector experienced the highest percentage of breaches in 2014, according to Identity Theft Resource. Of the 761 data breaches reported last year, 322 of them came from the healthcare industry.”
These attacks are the source of personal data not just from patients’ insurance records. They are also perpetrated on physicians’ personal and financial information, which is then used to commit tax identity fraud. Physicians are an attractive target for tax fraud because their income levels and potential tax refunds are higher than average. ...
Health policy dominated the news media last week, with the Supreme Court hearing oral arguments in King v. Burwell, the case with the potential to eviscerate Obamacare, on Wednesday March 4. Demonstrators crowded the steps in front of the Court during the hearing; most urged that the Affordable Care Act (ACA) be left intact.
The interest in King v. Burwell is not surprising. If the Court decides in favor of the plaintiffs, between 7.5 and 8.2 million persons in 34 states that have not created their own health insurance exchanges stand to lose the coverage that they have been able to obtain because of the ACA subsidies. Eighty-seven percent of individuals who have signed up in the 34 states are eligible for subsidies, which average about $268 per month. Premiums are expected to increase by about 35-57 percent for those who remain in the federally run exchanges if and when many of... 
On January 29, CMS stated that it plans to shorten the EHR reporting period from the full year 2015 to 90 days. This will be accomplished through a formal rule-making process in which CMS will attempt to reduce program complexity and the reporting burden on providers including physicians.
Before addressing the requirements for earning MU incentive payments going forward, we would remind anesthesiologists that they benefit from an automatic exemption, based on their Provider, Enrollment, Chain and Ownership System (PECOS) specialty designation. This exemption is particularly important now, since eligible professionals (EPs) who are not exempt—including physicians who have enrolled in PECOS using one of the pain medicine codes rather than the anesthesiology code as their primary specialty designation—will face a one percent (-1%) penalty in 2015 if they have not attested to 2014 MU by February 28, 2015. The penalties will increase to two percent (-2%) in 2016 and three percent... 
The Physician Quality Reporting System (PQRS) was one of the hottest topics on attendees’ minds at the January 23-25, 2015 ASA Practice Management Conference in Atlanta. There is still a great deal of confusion regarding how anesthesiologists and pain physicians can satisfy the reporting requirements and avoid the penalties. In addition to explanations given at the Conference, the following recent publications clarify those requirements:
CMS 2015 PQRS Implementation Guide; 2015 PQRS Measure-Applicability Validation (MAV) Process for Claims-Based Reporting of Individual Measures
ASA 2015 PQRS FAQS, and
MGMA PQRS/Value-Modifier Survival Guide
As most readers know, eligible professionals (EPs) who do not satisfactorily report PQRS measures in 2015 will see a negative two percent (-2%) payment adjustment—government-speak for “penalty”—on all of their Medicare remittances in 2017. The questions most frequently asked are: what quality measures can anesthesiologists, nurse anesthetists, anesthesiologist assistants and pain physicians report? And how many do they have to report? ...