Fowler White Health Care eNews

CMS Issues Final Rule for Payment Error Rate Measurement Program

On August 10, 2010, the Centers for Medicare and Medicaid Services (CMS) issued its final rule to further improve the Payment Error Rate Measurement program (PERM) for Medicaid and the Children’s Health Insurance Program (CHIP). PERM is a comprehensive and ongoing federal audit intended to measure how frequently errors occur when providers submit claims to states and when states pay those claims. The audit focuses on three distinct areas: data processing; medical necessity; and recipient eligibility.

The goal of PERM is to curb improper payments in certain governmental programs by making the process more transparent. It seeks to achieve this goal by measuring improper payments among states in Medicaid and CHIP and producing error rates for each program on the national level. These reviews are conducted to determine whether the sampled cases meet applicable Medicaid and CHIP fee-for-service, managed care, and eligibility requirements. CMS specifically chose Medicaid and CHIP because those programs were deemed as being at risk for significant erroneous payments.

PERM was initially proposed on August 27, 2004, and has subsequently been amended five times. The final rule effects PERM in the following ways: (1) changes the process for reviewing cases in which states have used simplified enrollment efforts such as self declaration for eligibility cases; (2) eliminates duplication of effort between eligibility reviews administered in the same fiscal year; (3) extends the timeframe for providers to submit documentation; and (4) provides states additional time to submit corrective action plans.

PERM is conducted in all 50 states over a three-year period, with 17 states being conducted annually. Typically, a state will participate in the program only once every three years. The State of Florida was audited in 2008 and will be audited again in 2011. For more information on this final rule or the PERM program, please contact Carlton Gammons.

Law and Order: Workplace Edition (Penalties, Liabilities and Enforcement...oh my!)

Board Certified immigration attorney, Jennifer G. Roeper, will be a panelist at the South Palm Beach County Bar Association's Labor and Employment Law Committee seminar on September 29, 2010 at the Boca Raton Marriott at Boca Center. The seminar will focus on the possible fines, penalties and other actions that can be imposed against employers by various state and federal agencies. Click here for more details.

Many States Say They Lack Authority to Implement Health Law

Faced with the need to review insurance rates and enforce a panoply of new rights granted to consumers, states are scrambling to make sure they have the necessary legal authority to carry out the responsibilities being placed on them by President Obama's health care law. Insurance commissioners in about half the states say they do not have clear authority to enforce consumer protection standards that take effect next month.
Read full story at The New York Times (free reg. req'd).

Health Law Funding Provision Could Get Modified, Repealed

Five months after the adoption of the sweeping new health-care law, momentum is building to modify and possibly repeal one of its funding sources. The sums in question are small in comparison with the total trillion-dollar tab for the health-care overhaul, but some see the move as an opening for further changes to a law Democrats had been determined to leave untouched.
Read full story at The Washington Post (free reg. req'd).

Government Lays Out Steps to Combat Rising Healthcare Fraud

Top Obama administration officials outlined new federal enforcement efforts to combat healthcare fraud, saying quickly expanding criminal enterprises are costing taxpayers billions of dollars each year. During a healthcare fraud summit in Los Angeles, Atty. Gen. Eric H. Holder Jr. and Health and Human Services Secretary Kathleen Sebelius said their agencies were jointly targeting fraud in the federal Medicare and Medicaid programs.
Read full story at Los Angeles Times (free reg. req'd).

CMS Publishes Details on Medicaid Guidelines for E-Health Records

The Centers for Medicare & Medicaid Services has published details for state Medicaid directors on what they should expect from the federal government as they administer the Medicaid portion of the electronic medical records incentive program starting in 2011. The incentive program stipulates that the federal government will pay the full cost of Medicaid bonuses to eligible physicians who adopt certified EMR technology in a way that meets the government's "meaningful use" criteria.
Read full story at American Medical News.

Government Working on New Rules to Protect Medical Privacy

The Obama administration is rewriting new rules on medical privacy after an outpouring of criticism from consumer groups and members of Congress who say the rules do not adequately protect the rights of patients. The rules specify when doctors, hospitals and insurers must tell patients about the improper use or disclosure of information in their medical records.
Read full story at The New York Times (free reg. req'd).

Trade Association Disappointed Over Generic Drug Patent Ruling

The trade association representing generic drugmakers said it was "extremely disappointed" by Senate appropriators' vote limiting their ability to receive cash settlements in patent disputes. The provision passed by a vote of 15-15.
Read full story at The Hill.

Despite Growth in E-Prescription Use, Obstacles Remain

By 2012, physicians who do not electronically prescribe medications -- instead of hand-writing them -- will be penalized financially by the federal government. While e-prescribing has grown dramatically in recent years, local doctors said there continue to be barriers to widespread acceptance of a technology that could save thousands of lives.
Read full story at Post-Tribune.

FDA to Make Changes to Improve Drug Information Fliers

The little white bag you get from the pharmacy that holds your medicine often comes with an attachment -- a flier that's supposed to give you information about your drug. It's often several pages long and filled with technical medical jargon and legal-speak, but the Food and Drug Administration is about to make some changes.
Read full story at NPR.

Income Crisis Will Continue to Cause Primary Care Doctor Shortage

Last year, the U.S. government spent over $2 trillion on health care, the most of any OECD country. Still, with all that money going out the door there is a worsening income crisis among primary-care physicians that, if unaddressed, will lead to an acute shortage of these doctors in the years ahead, when retiring baby boomers will need them most.
Read full story at Time.

Admitting Errors, Apologizing Could Prevent Malpractice Suits

When doctors make mistakes, admitting the error, saying "I'm sorry" and offering compensation may go a long way toward preventing malpractice lawsuits, new research shows.
Read full story at HealthDay.

Cash-Strapped Patients Asking Doctors for a Discount

More patients looking to save money on healthcare are asking doctors for a discount. As monthly insurance premiums, deductibles and co-payments increase, even people with insurance can have trouble paying their out-of-pocket medical expenses.
Read full story at Los Angeles Times (free reg. req'd).