Washington Watch Weekly June 8, 2012

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LEGISLATIVE NEWS-ON THE HILL

ASCRS/ASOA WEB SEMINAR SERIES ON MEDICARE INCENTIVE PROGRAMS

eRx NEWS

MEDICARE NEWS

QUALITY NEWS

UPCOMING CALLS

EYEPAC


House of Representatives Passes Legislation to Repeal Medical Device Tax

On June 7, the House passed, by a vote of 270–146, H.R. 436, the “Health Care Cost Reductions Act,” which repeals the tax on medical devices and limitations on the purchase of over-the-counter medications included in the health care reform law.  The legislation also includes provisions to allow individuals to recoup up to $500 of unused funds remaining in their flexible-spending accounts (FSAs) after the end of the plan year.  The original bill to repeal the medical device tax, sponsored by Congressman Erik Paulsen (R-MN), was combined with H.R. 5852 to repeal restrictions on using tax-preferred accounts to pay for over-the counter drugs, as well as provisions of a third bill, H.R. 1004, to improve flexible spending arrangements.

According to the Joint Committee on Taxation (JCT), repealing the medical device tax would cost $29 billion over 10 years.  The JCT also estimated that the over-the-counter restrictions would reduce federal revenue by about $4 billion and allowing payouts of remaining FSA funds would reduce revenue by $4.1 billion over the same period.  To offset the cost, the bill includes a provision that would make those with subsidized coverage from state insurance exchanges liable for any overpayments.  In a recent cost estimate by the Congressional Budget Office (CBO), the House-passed bill would decrease the deficit by $6.7 billion over 10 years.

The bill faces opposition from the Senate leadership and received a veto threat from the President.  Discussions have begun regarding possible paths to enactment in the Senate, such as adding it onto larger tax reform measures that may be addressed at the end of the year.  Congressman Paulsen indicated that the medical device tax’s link to the health care bill and those who supported health care reform could be the biggest challenge, and the offset included in the House-passed bill will not be popular in the Senate.

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Senate Finance Committee to Hold Second Roundtable on “Medicare Physician Payment Policy:  Lessons from the Private Sector.”

On Thursday, June 14, the Senate Finance Committee will hold its second roundtable focusing on Medicare physician payment policy and lessons learned from the private sector.  The participants include representatives from Blue Cross Blue Shield of Massachusetts, Humana, Aetna, CareFirst BlueCross BlueShield, and Hill Physicians Medical Group.  A third roundtable will be held at the end of the month and will include representatives from the physician community. 

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ASCRS/ASOA to Hold EMR/Meaningful Use Web Seminar on Wednesday, June 13 - Register Today!

ASCRS/ASOA will hold the second session in a three-part series of web seminars on Medicare Incentive Programs on Wednesday, June 13 from 2:00 – 3:00 PM.  You will receive an overview of the changes and updates to the 2012 Medicare EMR/Meaningful Use Incentive Payment Program and tips on how to prepare for selecting/implementing an EMR system.

EMR/Meaningful Use Incentive Program
Wednesday, June 13, 2012
2:00-3:00 p.m. EDT
Registration

ASOA and ASCRS Members: Free Registration with Promo Code: z21a3
Nonmembers: $199.00

Learning Objectives:

  • How to Become a Meaningful User
  • The Registration Process
  • Details on Certification
  • Demonstrating Meaningful Use: Stage 1 Requirements for Eligible Providers Using Certified EMR Technology. This will be a review of the criteria you must meet to prove that you are using EMR in ways that qualify for the incentive payment.

Speakers: Speakers: Travis Broome, CMS, Tina Pinke, COT, COE   

Credits: Earn 1.00 COE credits by attending this seminar. 

Registration
All attendees must register at least 24 hours in advance of each web seminar.
Enter Promo Code: z21a3 at the end of the credit card registration process to receive this web seminar for free.
 
Questions: asoa@asoa.org

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ASCRS and ASOA Web Seminar Series on Medicare Incentive Programs: eRx, EMR, PQRS

The three-part series on Medicare Incentive Programs presents an overview of the CMS EMR Meaningful Use Incentive, e-Prescribing, and PQRS programs, including details on how eligible professionals (EPs) can maximize bonus payments and avoid penalties now and in the future.

EMR Incentive Program
Wednesday, June 13
2:00-3:00 p.m. EDT
Registration
Promo Code: z21a3

PQRS 
Wednesday, June 20

2:00-3:00 p.m. EDT
Registration
Promo Code: j1255
Registration:  All attendees must register at least 24 hours in advance of the web seminar.

Nonmembers–$199.00
ASOA and ASCRS Members–Complimentary Registration
with Seminar Promo Code.
Enter Promo Codes at the end of the credit card registration process to receive the web seminar(s) for free.
Questions: asoa@asoa.org

eRx Incentive Program 
The archived recording of the June 6 web seminar will be available to ASOA and ASCRS members.
More details will be released in next week’s Washington Watch.

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Warning: 3 Weeks Remain to Avoid 2013 eRx Payment Reduction

Unless you have successfully e-prescribed or qualify for an exemption by June 30, 2012, you will be hit with a -1.5% payment reduction on your total estimated Medicare Part B allowed charges in 2013.

Successful E-Prescribing

You submitted 10 or more eRx codes (G8553) on your Medicare Part B claim forms, for any Medicare Part B physician fee schedule service provided between January 1, 2012 to June 30, 2012, using a qualifying eRx system or certified electronic health record (EHR), and the claims were received and processed by CMS by no later than July 31, 2012.

If you submit 25 eRx claims (must be denominator eligible) between July 1 and December 31, 2012, you are eligible for the 1% incentive, and would also avoid an e-prescribing penalty in 2014.

Qualifying for an Exemption

If you meet the following criteria, you are not subject to the payment reduction and no further action is needed:

  • You are a successful electronic prescriber (see above).
  • Anyone who qualified for the 2011 incentive (payable in the fall of 2012) by reporting the ERx measure 25 times for denominator-eligible events is automatically excluded from the ERx payment adjustment for 2013.
  • You are not a physician, nurse practitioner, or physician assistant as of June 30, 2012.
  • Less than 10% of your Medicare Part B allowed charges for the reporting period (January 1, 2012, through June 30, 2012) are composed of office visits and other services listed in the CMS e-prescribing measure specifications.
  • You do not have at least 100 cases (100 claims for patient services) containing an encounter code that falls within the denominator of the e-Rx measure for dates of services during the six-month 2013 payment adjustment period (January 1, 2012–June 30, 2012).
  • You do not have prescribing privileges and you reported the G-code, G8644, at least one time on a Medicare Part B claim prior to June 30, 2012.

If you meet any of the following hardship exemptions, you must file for an exemption that applies to your particular hardship situation no later than June 30, 2012, by using CMS’ on-line Web-based tool.

  • You prescribe fewer than 100 prescriptions during a 6-month payment adjustment reporting period.
  • You practice in a rural area with limited high-speed internet access (report G-code G8642).
  • You practice in an area with limited available pharmacies for e-Rx (report G-code G8643).
  • You do not have the ability to electronically prescribe due to local, state, or federal law or regulation.

If you are not sure whether you successfully participated in the eRx program or if you are subject to penalties, apply on-line for an exemption that pertains to your particular hardship anyway.

Submitting an Exemption Request

Go to the Quality Reporting Communication Support Page to request a significant hardship exemption for the 2013 electronic prescribing (eRx) payment adjustment.

Important Things to Remember

  • Practice office staff can request a hardship exemption on behalf of the eligible professional.
  • Physician Assistants (PA)—subject to payment adjustment
  • Nurse Practitioners* (NP)—subject to payment adjustment
  • Refills are not eligible.
  • OTCs are eligible.
  • “Unique” in this context means encounters, not patients or prescriptions. So you could file an ERX code for the same patient for two separate denominator-eligible visits, but not for two prescriptions issued during the same denominator-eligible visit.
  • Claims filed for events that are not denominator-eligible do not count for the incentive, only for the penalty.
  • Review your remittance advice: It must have the N365 code, your indication that the G8553 code passed into the Medicare National Claims History (NCH) database.
  • Exemption applications cannot be submitted via mail, e-mail, or fax. 
  • You are still eligible to receive the eRx Incentive Bonus of 1% if you submit 25 unique, denominator eligible, events by December 21, 2012.

Resources

Quality Support Page User Manual 

ASCRS/ASOA eRx Webpage

CMS eRx Home Page

Questions can be directed to Jenny Liljeberg, associate director of regulatory affairs, at jliljeberg@ascrs.org.

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Were You Sent a Request to Revalidate Your Medicare Enrollment?

At this time, the quickest way to find out whether a revalidation letter was mailed to you is to check the downloads on the Revalidation page on the cms.gov website. You can now view

  • Medicare Part A/B Revalidation Letters Mailed February – March 2012
  • Medicare Part A/B Revalidation Letters Mailed January 2012
  • Medicare Part A/B Revalidation Letters Mailed November – December 2011
  • Medicare Part A/B Revalidation Letters Mailed September – October 2011

Also, CMS now allows an Authorized Official (AO) or Delegated Official (DO) of an organization to e-sign their application within an authenticated Internet-based PECOS session. The AO or DO of an organization that is listed in the Individual Control section of an enrollment will be permitted to e-sign the applicable certification and/or authorization statements and CMS 588  (Electronic Funds Transfer) within Internet-based PECOS instead of being directed to a separate PECOS E-signature Application. However, if the AO or DO is not the individual completing the application or if they do not currently have access to PECOS, they will continue to receive an email directing them to the separate PECOS E-signature Application.

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Patient-Centered Outcomes Research Institute (PCORI) Issues Draft Methodology for Patient-Centered Outcomes Research

On June 5, PCORI released its preliminary draft methodology report, “Our Questions, Our Decisions: Standards for Patient-centered Outcomes Research”, which is intended to set the groundwork for the standards and types of research methods that can be used to develop comparative effectiveness research (CER). The report includes 60 standards for research that address four broad categories of activities:

•    What should we study?

•    What study designs should we use?

•    How do we carry out and govern the study?

•    How do we enable people to apply the study results?

The Patient Protection and Affordable Care Act (ACA) authorized PCORI, as a nonprofit corporation, to assist patients, clinicians, purchasers, and policymakers in making informed health decisions by providing quality-relevant evidence on how best to prevent, diagnose, treat, and monitor diseases and other health conditions.

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National Provider Call: Physician Quality Reporting System & Electronic Prescribing (eRx) Incentive Program – Tuesday, June 19; 1:30–3:00 PM EDT

On Tuesday, June 19, CMS subject matter experts will provide an overview of “The 2010 Physician Quality Reporting System and eRx Incentive Program Reporting Experience Including Trends (2007-2011)”. In February, CMS released the report detailing the 2010 participation rates and incentives paid to physicians for PQRS and eRx, and ophthalmology continued to improve their rates of participation and success compared with the 2009 rate.  In the eRx program, ophthalmology had the second highest rate of participation at 33.8%;  63% of those who participated qualified for the 2% incentive payment.  Ophthalmology is also one of the highest performing specialties for PQRS reporting. In 2010, 39.9% of ophthalmologists participated via claims-based reporting and nearly 60% of those who participated qualified for the incentive payment. 

Agenda:

  • Opening remarks
  • Program announcements
  • Overview of “The 2010 Physician Quality Reporting System and eRx Incentive Program Reporting Experience Including Trends (2007-2011)”
  • Question & Answer Session

REGISTER NOW

Presentation will be available on the FFS National Provider Calls web page. In addition, a link to the slide presentation will be emailed to all registrants on the day of the call.

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Make Your 2012 eyePAC Contribution Today

On May 22, all ASCRS members who have not contributed to eyePAC in 2012 were asked to make their annual contribution. You can make your contribution online at the ASCRS web site by going to Government Relations and clicking on eyePAC in the drop-down box or clicking here to download a contribution form to fax back. Thank you in advance for making a contribution. If you have questions, please contact ASCRS PAC/Grassroots Specialist Gerrie Gray-Benedi at 703-591-2220 or by email at gbenedi@ascrs.org.

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To find out more about the articles in this communication or to read more about legislative and regulatory issues that affect you and your practice, visit the ASCRS and ASOA websites. You can also visit http://www.specialtydocs.org/, the web site of the Alliance of Specialty Medicine.

© 2012 ASCRS/ASOA

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