Important Events & Dates in Healthcare in 2014 Important Events & Dates in Healthcare in 2014

By Mary Pat Whaley, FACMPE, CPC

2014 is the last year that Medicare Eligible Providers (EPs) can begin participation and earn an incentive.

In 2014, all providers -- regardless of where they are (which stage) with Meaningful Use -- are required to demonstrate Meaningful Use for a 3-month reporting period - allowing time to upgrade to 2014 certified EHR technology.

Also in 2014, all participants, regardless of the stage of Meaningful Use they are in, must have an electronic patient portal.

DATE: NEW for 2014MEANINGFUL USE FOR ALL

The Centers for Medicare and Medicaid Services (CMS) now allows "the status of three or more chronic or inactive conditions" to qualify as an extendedHistory of Present Illness (HPI.)

What does this mean? Physicians that care for patients with chronic illness can now be reimbursed for a justifiable higher level of office visit using the 1995 documentation guidelines. Physicians have two options: status of at least three chronic or inactive conditions OR document at least four elements of the HPI.

DATE: NEW for 2014EVALUATION/MANAGEMENT UPDATE

Although HIPAA Omnibus Rules were in effect late in 2013, many practices have not caught up. Don’t forget to:

• Give new patients the new NPP.• Post the new NPP in your reception area.• Have vendors that “create, receive, maintain or transmit PHI” sign a new BAA (it protects the practice!)• Be ready to provide patients with their medical records electronically.• Update your policies to reflect the new law and train all

staff to understand the requirements of HIPAA!

DATE: NEW for 2014CHANGES TO HIPAA

In 2014, all payers are required to provide Electronic Remittance Advice (ERA) and Electronic Funds Transfer (EFT.) If a payer sends paper Remittance Advice or paper payments, call them and tell them they are required to send everything electronically.

DATE: NEW for 2014EFT & ERA COMPLIANCE

Important dates for Health Insurance Exchange (HIX) are as follows:

• March 31, 2014: Open enrollment for 2014 ends

• November 15, 2014: Proposed date for 2015 open enrollment to start

• January 15, 2015: Proposed date for 2015 open enrollment to end

DATE: NEW for 2014EXCHANGE ENROLLMENT

CMS will apply a value-based payment modifier (VBPM) to physician payment in all groups of 10 or more eligible professionals (EPs) starting in 2016. The VBPM program aligns with the Physician Quality Reporting System and includes a payment adjustment based on PQRS reporting. The scoring methodology for the VBP modifier will assess quality of care furnished compared to cost during the performance period (CY 2014) to calculate an adjustment to payments under the physician fee schedule during the payment adjustment period (CY 2016).

CMS will assess the size of the group of physicians based on a query of PECOS within 10 days of the close of the QRS self-nomination/registration process during the relevant performance year. For groups with 10 or more eligible providers, PQRS registration ends September 30, 2014).

DATE: NEW IN 2014VALUE-BASED MODIFIERS

CMS extends the sunset date on the Stark exception to December 31, 2021. The decision will allow hospitals to continue to finance EHR implementations for referring physician practices without breaking anti-kickback laws.

DATE: Extended Into 2014EHR SUBSIDIES

The Physician Quality Reporting System (PQRS) data collection period begins for 2014 PQRS in January.

Physicians must begin PQRS reporting to avoid the -2.0% penalty in 2016 to their Medicare reimbursements.

DATE: January 2014PQRS

Physicians, non-physician practitioners, physician groups, and non-physician practitioner groups that are enrolling as a Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) supplier via the CMS-855S application must pay the required application fee. The fee for January 1, 2014, through December 31, 2014 is $542.00.

DATE: January 1, 2014DMEPOS FEE

Relative Value Units (RVUs) are multiplied by a conversion factor to get a reimbursement amount. For 2014 Medicare’s conversion factor is $35.8228.

RVU changes can have a big impact on your practice. States RVU Guru Frank Cohen, “For 2014, CPT code 37227 (cardiology) had the largest overall loss in non-facility RVUs; from 470.33 in 2013 to 420.53 for 2014. The biggest gain (with % change) for total RVUs was 43220 (GI), going from 3.80 to 28.49 total RVUs, an increase of 650%.” To do your own impact analysis (free), visit www.frankcohen.com.

DATE: January 1, 2014CHANGES IN RVUs

Claims submitted that identify an ordering/referring provider of items or services who is not enrolled in Medicare will be denied. This includes Part B providers and suppliers of Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS.)

DATE: January 6, 2014CMS CLAIM DENIALS

If you are an Eligible Provider participating in the Medicare EHR Incentive Program, you have until February 28, 2014, to attest to demonstrating meaningful use of the data collected during the reporting period for the 2013 calendar year. You must attest by 11:59 p.m. Eastern Standard Time on February 28 to demonstrate meaningful use. If you are participating in the Medicaid EHR Incentive Program, refer to your state’s deadlines for attestation.

You must attest to demonstrating meaningful use every year to receive an incentive and avoid a payment adjustment. Need MU help? Contact David Zetter at www.zetter.com, our MU Guru!

DATE: February 28, 2014MU ATTESTATION FOR 2013

CMS will conduct national ICD-10 testing for current direct submitters (providers and clearinghouses) from March 3 through 7, 2014. This will give trading partners access to the Medicare Administrative Contractor's (MACs) and Common Electronic Data Interchange (CEDI) for testing with real-time help desk support. The event will be conducted virtually and registration is required.

DATE: March 3 -7, 2014ICD-10 TESTING

The three-month SGR "patch” expires. It is hoped that lawmakers will repeal the SGR permanently and replace it with an improved Medicare physician payment system.

DATE: March 31, 2014END of SGR “PATCH”

March 31st is the last day of reporting in the first year of the Physician Payments Sunshine Act. By this time, pharmaceutical manufacturers and group purchasers will report to the Centers for Medicare and Medicaid Services information on payments and other "transfers of value" made to doctors. The information on the first year is to be published in September 2014.

DATE: March 31, 2014SUNSHINE ACT REPORTING

Start using Version 02/12 1500 Health Insurance Claim Form (1500 Claim Form) that will accommodate reporting needs for ICD-10.

The new form addresses two priorities that were included in the revisions to the 1500 Claim Form. The first was the addition of an indicator in Item Number 21 to identify the version of the diagnosis code set being report, i.e., ICD-9 or ICD-10. The second priority was to expand the number of diagnosis codes that can be reported in Item Number 21, which was increased from 4 to 12.

DATE: April 1, 2014NEW 1500 CLAIM FORM

ICD-10 is one of two things that is keeping practice managers up at night. Practices should be already starting to train, although most billing/EMR systems will not be ready to handle ICD-10 until late spring or early summer. (By the way, the other thing is money.)

Shameless self-promotion: we help practices with ICD-10 training and that money thing.

DATE: October 1, 2014ICD-10 IN EFFECT

For Eligible Professionals (EPs) in first year of participation, any 90-day period can be used, but attestation must be concluded before October 1 to avoid the penalty in 2015.

DATE: October 1, 2014PQRS

October 3rd is the last day for Eligible Professionals (EPs) to begin their 90-day reporting period for stage 1 of Medicare's Meaningful Use program. Providers that fail to do so will face a 1% cut in Medicare reimbursement starting in 2015.

DATE: October 3, 2014START MU REPORTING

NEXT STEPS

For a downloadable schedule of all the dates in this program, click on the download link below to go to the Manage My Practice site.

DOWNLOAD

We’re here to help solo and small practices survive 2014. Call us at (919) 370-0504 or email us at marypat@managemypractice.com

We’re here to help solo and small practices survive 2014. Call us at (919) 370-0504 or email us at marypat@managemypractice.com