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The document below is the lastest Medicare Learning Network "Medicare Quarterly Provider Compliance Newsletter" published January 2012. The goal of CMS publishing these newsletters is to provide you with the findings identified by Medicare Administrative Contractors (MACs), Recovery Audit Contractors (RACs), Program Safeguard Contractors, Zone Program Integrity Contractors (ZPICs), the Office of the Inspector General and others.This publication is chock full of Recovery Audit findings.
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A powerful toolkit is available on the AAPC website. It is packed with the references you need for a medical practice Compliance Plan in 2012. It contains a complete Coding and Billing Compliance Plan, 2012 ICD-9 and 2012 HCPCS II Updates, and over 70 customizable forms. We have the link below for your convenience:
AAPC Physician Services - http://www.aapcps.com/services/compliance-toolkit.aspx
Author: AAPC Physician Services and Jean Acevedo of Acevedo Consulting Incorporated
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This is the latest from OIG's award-winning Health Care Fraud Prevention and Enforcement Action Team (HEAT) Provider Compliance Training initiative. These 11 free videos and audio podcasts (averaging about four minutes each) cover major health care fraud and abuse laws, the basics of health care compliance programs, and what to do when a compliance issue arises.
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2012 Medicare Physician Payment Rates, Jan. 6, 2012: The payroll tax extension legislation that was passed by Congress and signed by the President on Dec. 23, 2011 (Public Law 112-078) delayed the 27.4% Medicare pay cut due to the SGR formula for two months. The Centers for Medicare & Medicaid Services (CMS) has confirmed to the AMA, however, that all of the other changes that were included in the Medicare physician payment final rule for 2012 will still take effect. Physicians should not expect that payment rates will remain unchanged.
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ePrescribing: The Medicare program continues to have an incentive program for eligible professionals who adopt an electronic prescribing system. Read more about this at www.cms.gov/ERXincentive/
PQRI: Being paid - at least partially - based on performance measures will almost certainly be part of health care reform from both a private payer and government perspective. For now, physicians and other providers continue to be able to reap an incentive payment from Medicare for successfully reporting under the Physician Quality Reporting Initiative. Read more about this at www.cms.gov/pqrs
HIPAA: After 7 years, there have been changes to the HIPAA regulations. Your policies and procedures as well as business associate agreements should have been updated since the publication in 2009 of the HIPAA Breach Notification rule. Read more about this at:
www.hhs.gov/ocr/privacy/hipaa/administrative/breachnotificationrule/index.html
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OIG: The OIG now has videos and podcasts about the False Claims Act on its website. This is the third of 11 HEAT Provider Compliance Training video and audio presentations and also updates enforcement actions.
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Medicare News: This PDF file contains the final 2012 Medicare Physician Fee Schedule rule. This 1235 page document goes over the Medicare payment policy changes for 2012; among other topics, this includes information on PQRS, ePrescribing, the EHR incentive payment, and the new value payment modifier. Additionally, you’ll find the description of the MPPR (multiple procedure payment reduction) policy for imaging studies that will now apply to the professional component as well as the technical component, charts showing the impact of the 2012 policies by specialty as well as for certain procedures.
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