Payment Matters

January 14, 2011

Registration for the Medicare and Medicaid EHR Incentive Programs Opened January 3, 2011

By: James B. Wieland and *Joshua J. Freemire

Providers interested in the Electronic Health Record (EHR) Incentive Program may now take the first concrete steps necessary to enter the program. Registration for the programs opened January 3, 2011, and CMS has encouraged providers to register even if they still have not created an entry in Provider Enrollment, Chain and Ownership System (PECOS) or purchased an EHR system. Providers can access more detailed instructions, along with Registration User Guides specific to Eligible Hospitals and Eligible Physicians on the CMS EHR Incentive Program web page. For an article addressing the type of EHR providers must purchase, you can read our Client Alert on “Certified EHR Technology” here.

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Red Flag Enforcement Delay Expired January 1, 2011; No Clarification Yet From FTC

By: James B. Wieland and *Joshua J. Freemire

The last FTC action with regard to the Red Flag Rule delayed enforcement through December 31, 2010 to allow Congress time to clarify the scope of the rule. On November 30, 2010, Congress passed the “Red Flag Program Clarification Act of 2010”; (Clarification Act). That bill was signed into law on December 18, 2010. As we described here, the Clarification Act leaves some questions unanswered. In the interim, the FTC’s enforcement delay has expired, but the FTC has not yet explained its interpretation of the Clarification Act. As of the writing of this note, visitors to the FTC Red Flag website are instead greeted with a text box noting the passage of the Clarification Act, and an explanation that “The FTC is revising the materials on this site to reflect the change in the law.”

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CMS Seeks Comments on Applicability of EMTALA to Hospital Inpatients and to Hospitals with Specialized Capabilities

By: Leslie Demaree Goldsmith

CMS published an advance notice of rulemaking in the Dec. 23, 2010 Federal Register addressing the applicability of the Emergency Medical Treatment and Labor Act (EMTALA) [PDF]. Specifically, CMS is soliciting public comments by February 20, 2011 on two EMTALA issues: the applicability of EMTALA to hospital inpatients and the applicability of EMTALA to hospitals with specialized capabilities.

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OIG Reports Ambulatory Surgical Centers Incorrectly Billed for Skilled Nursing Facility Bundled Services

By: Christopher P. Dean

The Office of Inspector General (OIG) recently released an audit of ambulatory surgical center (ASC) services [PDF] provided to skilled nursing facility (SNF) residents that were billed to Medicare Part B and concluded that 100% of the services were billed, and reimbursed, incorrectly. The OIG audited 100 claims for bundled services provided by ASCs from CYs 2006 through 2008 to SNF residents during their Part A covered stays. The OIG concluded that these samples represented overpayments by Medicare Part B of $102,879 to the ASCs.

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