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The good, the bad, and the ugly - 2011 Final Policy and Payment Changes for Medicare Print E-mail
Written by Joe L. Miller   
Thursday, 09 December 2010 15:04

The Good

Believe it or not, there are some good things, particularly for primary care physicians, coming out of the 2011 Medicare Policy and Payment changes:

  • Elimination of Deductible and Coinsurance for most preventative services
  • Addition of reimbursement for an Annual Wellness visit
  • Incentive payments - 10% paid quarterly - to primary care physicians for primary care services - applies to all physicians with a primary care designation as well as nurse practitioners, clinical nurse specialists or physician assistants (primary care services must account for at least 60% of their Part B allowable charges)
  • Incentive payments - 10% paid quarterly - to general surgeons for Major Surgical Procedures in Health Professional Shortage Areas (HPSAs)

Not So Good to Downright Bad

  • Advanced imaging services (CT and MRI) will be paid less due to an adjustment in the equipment utilization rate assumption
  • Therapy services will be reimbursed 25% less for the second and subsequent services provided in the same visit
  • Medicare claims must be submitted in twelve (12) months or less from the date of service

Just Plain Ugly

"...the rule calls for Medicare physician payments to be slashed by 23% -- 25% on Dec. 1, 2010 and 2% on Jan. 1, 2011." (from AMA)

Click here to view the CMS Fact Sheet. 

About the author - Mr. Miller is a Principal at PYA and concentrates his practice on healthcare; providing tax planning, consulting and compliance services.  In September, PYA was listed by Modern Healthcare as a top 20 consulting firm.   

For more information, please visit

Last Updated on Thursday, 23 December 2010 06:57
House passes Red Flags Program Clarification Act Print E-mail
Written by Sandra Greenblatt, Esq.   
Thursday, 09 December 2010 00:00

Is it time to celebrate the New Year?  On 12/8, the U.S. House of Representatives passed S. 3987, the "Red Flag Program Clarification Act of 2010"-legislation that limits the type of creditor that must comply with the "red flags" rule and  appears to permanently exempt physicians. Because the U.S. Senate unanimously passed the bill on Nov. 30, it is being sent to the White House where President Obama is expected to sign it into law before the Jan. 1, 2011, deadline.   Assuming the President signs the legislation, providers would still have to wait for the FTC's blessing before uncorking the bubbly.  For more information click here:  

A Red Flag Reprieve for Health Care Providers? The Door Remains Open Pending Federal Agency Action

Update 12.22.10 - The President has signed the legislation. We await the FTC's interpretation.

About the author:  Ms. Greenblatt is a Board Certified Health Law Attorney practicing in Miami.

Last Updated on Sunday, 02 January 2011 17:44
Health Law Update Print E-mail
Written by Sandra P Greenblatt, Esq,   
Thursday, 21 October 2010 14:28


My partners and I are planning to go to the concierge business plan to cope with declining reimbursements and to restore our quality of life.  We are a three doc, primary care group (all internists in Broward county).  We would like to retain several patients who have limited incomes and would not be able to pay the annual fee.  Are there Stark issues associated with accepting some patients without charging them the annual fee?

Internal Medicine Group

Fort Lauderdale


Stark Law is not your issue. There are no referrals here. The primary legal restriction on concierge practices is that you must not charge the membership fee for access or any service covered by Medicare (or private insurance). Most VIP practices thus focused the fee on preventive health care, such as a free annual physical, and amenities such as faster and longer appointments, etc.

The problem is that the new Health Care Reform laws significantly expanded Medicare coverage for preventive services and you must be aware of these changes in structuring your new program. You need a good patient contract spelling out your new relationship and its limitations.

Although it is difficult to say goodbye to old patients, also consider how the paying concierge patients will feel and react should they learn others are not paying.

Sandra P Greenblatt is a Board Certified Health Lawyer practicing in Miami, FL.

Contact Ms. Greenblat at 305.305.577.9995 or

via E mail

EHR & Meaningful Use Update Print E-mail
Written by Scott C. Quinn   
Thursday, 21 October 2010 14:24

The Office of the National Coordinator for Health Information Technology (ONC) named the Chicago-based Certification Commission for Health Information Technology (CCHIT) and The Drummond Group, Inc. of Austin, TX as the first technology review bodies authorized to test and certify EMR (electronic medical record) software and systems for compliance with the standards and certification criteria issued by the U.S. Department of Health and Human Services (HHS) earlier this year.  HHS/ONC-certified EMR software users are eligible for financial incentives and higher Medicare/Medicaid reimbursements.

The announcement means that EMR software vendors now can have their products certified as meeting the HHS' "meaningful use" criteria. HHS/ONC certified EMR software must pass 45 tests covering critical issues such as encryption, access management and reporting. For healthcare providers, using HHS/ONC certified EMR software not only helps ensure compliance, it may help boost your practice's revenues as well.

CCHIT Certification is good for two years, and several companies have had their solutions certified at one stage or another since 2006.  However, in order to qualify for "meaningful use" reimbursement, those solutions must receive 2011 CCHIT Certification or a comparable certification from the Drummond Group.  As of August 20, 2010, only 32 EMR products have achieved 2011 CCHIT Certification.

EMR software certification is part of a broad initiative undertaken by President Obama and Congress under the Health Information Technology for Economic and Clinical Health (HITECH) Act, part of the American Recovery and Reinvestment Act (ARRA) of 2009. The HITECH Act provides for upwards of $27 billion in incentives to help health care providers recoup costs of transitioning from paper-based medical records to EMRs. Individual physicians and other eligible healthcare professionals can receive up to $44,000 through Medicare and almost $64,000 through Medicaid. Hospitals can receive millions of dollars.

To qualify, healthcare providers must implement and demonstrate meaningful use of HHS/ONC-certified EMR software systems as defined by the Centers for Medicare and Medicaid Services in July.  Physicians must also accept Medicare and must have at least $24,000.00 in total Medicare allowable charges per year.

About the author: Mr. Quinn works with a variety of healthcare organizations throughout Florida and nationwide to assess their individual, financial, operational and strategic challenges and to develop tailored solutions designed to streamline administrative, billing and coding functions, free up resources to focus on core competencies and boost revenue.

Scott C. Quinn |  Iatros Healthcare Solutions

(904) 296-1160, option 1 |


Last Updated on Thursday, 28 October 2010 10:56
PPAHA Amends Stark II; effective immediately Print E-mail
Written by Sandra Greenblatt   
Monday, 05 July 2010 16:16

Sandra Greenblatt, Esq.
Board Certified Health Law Attorney

We have heard a great deal about the Patient Protection and Affordable Healthcare Act ("PPAHA") being targeted at insurers, HMOs and employer and not being effective until 2014.  However, buried in PPAHA, Section 6003, on page 1564, is an amendment to the Stark II law targeting physician practices and effective immediately (actually 1/1/2010). 

PPAHA amends the Stark II law and requires physician practices which provide MRI, CT and PET under the in-office ancillary services exception to advise their Medicare patients in writing that  such services can be obtained from someone other than the practice of the physician ordering the procedure.  PPAHA also requires the referring physician to provide the patient with a written list of alternative suppliers who furnish such services in the area in which the patient resides (at least 2, not including hospitals). 

If your medical practice provides some other Stark law designated health service (DHS), these provisions may at some  future point also apply, as the Secretary of HHS is authorized under PPAHA to add to the list of covered DHS requiring patient notification.  This law now applies to your practice if you provide MRI, CT or PET services billable to Medicare.  We recommend that you have your patients sign something to indicate that you have given them notice of their choice of suppliers and keep this in the patients' records, in the event the government ever audits.  We understand that CMS may not seek to enforce this provision immediately, but that doesn't protect you against a whistleblower who might!

Contact the author:
(305) 577-9995

Last Updated on Monday, 05 July 2010 17:12
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