Singularity Health Law Blog

PPACA : 60-DAY TICKER REFUNDING MEDICARE OVERPAYMENTS.

 During the course of a compliance audit a Medicare overpayment issue arises when the auditor determines that the documentation for certain CPT codes is inadequate to justify  billing for the same. What to do and when to do it?  There is of course an obligation to return funds that constitute an overpayment by the government.  The Patient Protection and Accountable Care Act (“PPACA”) Section 6402(D)(2) provides that the money must be returned within 60 days after the date on which the report was identified; or the date any corresponding cost report is due. Failure of comply with the time frame under the PPACA can of course lead to False Claims Act liability.

"SNOW" BACHMANN AND THE SEVEN FOOT DOCTORS.

It was to say the least startling to watch the Utube video of Rep. Michele Bachmann holding forth in another otherworldly tirade against “Obamacare” in Webster City, Iowa. It was even more scary to see the audience sitting their calmly, politely and acceptingly as if “chewing the cud” while her fantasies poured fourth.  This is no joke. She told her audience that a seven foot plus doctor told her that he waited on the phone for 2 hours and 15 minutes with the IRS awaiting for approvals of care for “a little lady in my office,” while patients stacked up in his waiting room.

 

A COMPREHENSIVE REPUBLICAN HEALTH CARE PLAN

 To those who are struggling to understand what any of the Republican candidates embrace as to principles of health care reform other than the mantra of repeal of Obamacare: here is a Republican Plan that merits consideration.

MEDICARE SHARED SAVINGS PROGRAM: TWO ACO TRACKS

The final Accountable Care Organization (“ACO”) rules to be published next months continue to provide two alternative ACO “tracks” for participation, but have made one of the options more user friendly.  The Medicare Shared Savings Program (“MSSP”) is a new conceptual provision of the Obama Administration’s Accountable Care Act (“ACA”) that permits physicians and hospitals who are serving Medicare patients on a fee for service basis to band together to achieve greater efficiency and accountability through the opportunity to benefit from any cost savings to the program.

To qualify for the MSSP program ACOs must agree to take at least 5000 patients for a period of three years.  They must also select one of two tracks for providing care. The first track originally provided for a sharing of savings only for the first two years with a risk sharing for losses in the third year. The purpose of this track was to provide a level of protection for fledgling ACOs to get acclimated to the program before going at risk.  The final rules extend this option for all there years of the initial contract.

The second track if for those ACOs who already have experience with clinically integrated systems who are “spade ready” and prepared to undertake both benefits and risk for the entire program.  Second track participants have the opportunity to share in a greater amount of the savings (60%) than track one ACOs (50%).  The amounts of the savings bonuses to be paid are to some extent performance driven by 4 categories of quality measurements that the ACOs must report to the government.

For a comparison of the draft rule and final rule see below.

http://www.cms.gov/aco/downloads/Appendix-ACO-Table.pdf

 

WASHINGTON MEDICAID ER ACCESS BANS CHALLENGED.

It looks a little messy at the moment in the State of Washington where the state legislature directed a ban on Medicaid patients using emergency rooms for non-emergent care, which is off course an expensive delivery site.  Like the austerity protests in Greece, the Washington Chapter of the American College of Emergency Physicians has mounted the battlements and filed suit to interdict the legislative decree. See Washington Chapter of the American College of Emergency Physicians v. Washington Health Care Authority, Wash. Super. Ct.,No. 11-2-0219, filed 9/3011.

 

CALIFORNIA STREAMING: TELEHEALTH ADVANCEMENT ACT

The often contentious California legislature passed the Telehealth Advancement Act of 2011 without opposition achieving broad advances in the expansion of medical services in rural areas of the state. It expands the Telehealth Development Act of 1996 to all licensed health care providers and proscribes insurance plan requirements for an in person relationship to obtain consent. Consent can be verbal and must be recorded. Failure to obtain consent is deemed "unprofessional conduct."

 

The new Act provides for advancing hospital credential approval of distant consultants and specifies that insurance companies may not place limits on settings where telehealth services may be provided. The Act does state that it is not to be used to mandate telehealth service in settings that insurance companies deem inappropriate.

 

The Legislature in enacting the law sought to dispel any doubt about the future of telemedicine in California.

 

It is the intent of the Legislature to recognize the practice of telehealth as a legitimate means by which an individual may receive health care services from a health care provider without in-person contact with the healthcare provider. 

 

TOP HEALTHCARE SYSTEMS

With the continuing devolution of U.S. health care into at least a three tiered class structure, we are left with a number of questions as to why the U.S. with all of its wealth and power is so far down the list of top health care systems.  It may perhaps be related to the growing transformation of the U.S. into “bananarepublichood,” where the growing gross disparity in income here leads to lack of access to care by large segments of the the population which adversely effects our overall averages in quality markers such as life expectancy and infant mortality.  When you have a combination of the best and the worst features of a health care system your average necessarily drops precipitously.

 

HEALTH MANDATE, RON PAUL AND THE COLLAPSE OF COMMUNITY VALUES.

The Republican Candidate’s debate last week with all of the emphasis on who is and will be the darling of the Tea Party graphically underscored the American value creep of the past four decades away from what used to be community responsibility. Rep. Paul, a physician, continues to rail against the “individual mandate” in the Health Reform legislation enacted by Congress and signed by Mr. Obama in 2009.  He views it as a slap in the face of individual rights, because it curtails personal freedom by removing the personal freedom to choose to remain uninsured, whatever the consequences.  Moderator, Wolf Blitzer, posed the question to him that if a healthy 30 year old chose not to obtain insurance but was suddenly confronted with an unexpected need for medical assistance, should be be denied treatment?  

 

OBAMA BLUE BUTTON INITIATIVE PUSHES PHR DOWNLOAD PROGRAMS

 Recognizing the critical health care need for accurate historic  patient health records, the Obama administration has developed what it calls a “Blue Button” download initiative at the Department of Veteran Affairs, CMS and HHS. These are all programs that permit patients to go on-line and download their own medical records that they can share with their providers, caregivers and trusted others.  Some of these programs are now operational.  In the lead is the VA ( www.myhealth.va.gov ) where approximately 60,000 veterans have already accessed their records.  Medicare recipients can also access their records now at www.mymedicare.gov . Only about 5,600 have done so. There are about 47 million medicare recipients and 1 million veterans.

FOURTH CIRCUIT FINDS OBAMA CARE TO “TAXING" TO DECIDE.

A panel of the 4th Circuit Court of appeals has weighed in on the issue of the constitutionality of the Patient Protection and Accountable Care Act (the “Act”) colloquially known as Obamacare in the case of Liberty University et al. v. Geithner et al., 10-2347.  The panel ordered the dismissal of the complaint seeking to render the Act unconstitutional under the Anti-Injunction Act (“AIA”) of the Tax Code. Justice Davis in giving the majority opinion found that the AIA stripped the federal courts of jurisdiction to render pre-enforcement decisions regarding the constitutionality of the Act. Interestingly, both the government and the plaintiffs were in agreement that the AIA did not apply.