- RESOURCES & EDUCATION
- PRACTICE MANAGEMENT
Supreme Court Upholds Healthcare Law
On June 28, by a 5-4 vote, Supreme Court justices ruled to uphold the Patient Protection and Affordable Care Act (PPACA), including the individual mandate, which requires citizens to buy health insurance by 2014 or else pay a penalty. The mandate was ruled to be constitutional under the taxing power of the government. The court found problems with the law's expansion of Medicaid, but said the expansion could proceed as long as the federal government does not threaten to withhold states' entire Medicaid allotment if they don't take part in the law's extension.Click here to view a copy of the decision.
Chief Justice John Roberts sided with the four more liberal members of the court, while Justices Scalia, Thomas, Alito and Kennedy dissented.
ASCRS, in conjunction with the Alliance of Specialty Medicine, released a statement regarding the decision. Additional information will be included in Washington Watch Weekly.
On June 26, the Senate passed a compromise FDA reauthorization user fee bill. The bill will now be sent to the President for his signature. As we previously reported, the House passed the compromise legislation by a voice vote last week. The legislation reauthorizes FDA user fees that fund the approval process for prescription drugs and medical devices, as well as creating new user fees for generic drugs and generic biological medicines. It also includes many reforms to the approval process, which have been advocated by ASCRS and the medical community.
On Tuesday, June 25, Senator Rand Paul, an ophthalmologist, introduced the Access to Physicians in Medicare Act, which repeals the SGR and replaces it with a formula that is similar to the one used to calculate cost of living increases for Social Security benefits with a cap set at 3 percent. The SGR “fix” is paid for by repealing the health care reform law’s Medicaid expansion and state-based insurance exchanges. In addition, any savings greater than the cost of the SGR fix would be put towards reducing the federal deficit. Specifically, the legislation does the following:
2013 eRx Payment Reduction Exemption Request Deadline Extended to July 2, 11:59 PM EST
Due to scheduled web maintenance, EPs will be unable to access the Communication Support Page to submit requests for significant hardship exemptions to the 2013 Electronic Prescribing (eRx) Incentive Program payment adjustment beginning at 8:00 PM EST on Friday, June 29, 2012 until 11:59 PM EST on June 30, 2012.
Because this maintenance directly impacts the June 30, 2012 deadline, CMS is extending the submission date for hardship exemptions until 11:59 PM EST on July 2, 2012.
Unless you have successfully e-prescribed or qualify for and submit an exemption, you will be hit with a -1.5% payment reduction on your total estimated Medicare Part B allowed charges in 2013.
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:
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 July 2 at 11:50 PM EST, by using CMS’ on-line Web-based tool.
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
On June 28, ASCRS, in conjunction with the American College of Surgeons (ACS) and several other medical societies, submitted a letter to Congress urging them to create a small practice exception from the Medicare EHR incentive program penalty, stressing that physicians in small practices face unique challenges in implementing EHR, namely very limited financial, time, and staff resources to devote to the overall process. The letter also asks Congress to re-evaluate Stage 2 meaningful use criteria, focusing on some of the overly ambitious objectives and measures that must be met by eligible professionals (EPs) to ensure receipt of the financial incentives, and to consider introducing legislation to create an exception for those EPs who are either currently eligible or will be eligible for Social Security and retirement benefits by 2014.
Earlier this week, ASCRS, jointly with OOSS, submitted comments to CMS on the ASC Quality Reporting (QR) Program, to which all Medicare ASCs will be required to report data starting October 1, 2012, or be subject to penalties. Recommendations included in the letter are that CMS permit ASCs until April 15 of the affected payment year to submit a payment decisions reconsideration request, as opposed to March 17, as it currently stands. Also, ASCRS and OOSS expressed support for CMS’ decision to designate as compliant with the Safe Surgery Checklist measure a facility that has used such a checklist at any point during 2012.
Most importantly, regarding the Prophylactic IV Antibiotic Timing Measure (ASC-5), CMS should adopt a “no volume” or “not applicable” exemption for facilities that certify that they never administer prophylactic IV antibiotics. ASCRS worked in conjunction with OOSS and AAO in developing options that the ophthalmic ASC community believes would resolve this problem.
ASCRS will continue to work with CMS as implementation of the new ASC quality reporting program continues.
On October 20, 2011, CMS issued a final rule under the Affordable Care Act to establish the Medicare Shared Savings Program (Shared Savings Program), along with a notice for the Advance Payment Model that will provide additional support to physician-led and rural Accountable Care Organizations (ACOs) participating in the Shared Savings Program. On Monday, July 16, 2012, CMS is hosting a National Provider Call, where subject matter experts will provide an overview and updates to the Shared Savings Program application and Advance Payment Model application processes for the January 1, 2013, Shared Savings Program start date. A question and answer session will follow the presentations.
The Shared Savings Program Application and the Advance Payment Model web pages have important information, dates, and materials on the application process. Call participants are encouraged to review the applications and materials prior to the call.
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 email@example.com.
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