Regulatory Update 

• Healthcare Reform
• Ambulatory Services
• Hospital Services
• Compliance Concerns

• Senate Finance Committee – America’s Healthy Future Act of 2009 – Passed by Committee October 13, 2009
• Senate HELP Committee – Affordable Health Choices Act – Passed by Committee July 15, 2009
• House Tri-Committee – America’s Affordable Health Choices Act of 2009 – Passed by Committee June 19, 2009

• Medicare Administrative Contractors (MACs) expected to increase audits of physicians
• Tips to handle increased audits
• Consults linked to confusion and documentation concerns
• E-prescribing 2010 requirements
• Advanced imaging providers 2012 accrediting requirements
• CMS to increase PQRI measures by 22 and eliminate 7 measures for 2010
• CMS approves national sleep test coverage
• Observation claims to be reviewed
• Senate Finance Committee .5% pay boost
• Clearly document E/M services
• Rogue ware threat to computers
• Revenue declined in medical practices for 2008
• HIV screening tests
• New CMS enrollment forms
• RAC’s reviewing infusion therapy
• Tips to prepare for a RAC demand level
• Higher level E/M codes utilization
• Incident-to billing reviewed by OIG
• PECOS system to enroll in Medicare
• Top challenges for physicians per MGMA
• Repeal of CMS physician payment formula blocked by the Senate

• Pulmonary and intensive cardiac rehab services provided outpatient departments
• Uninsured 20% of ER visits
• Moody’s ratings downgrades exceed upgrades for three quarters in a row
• Proposed outpatient rule increases the conversion factor by 2.1% for hospitals submitting quality data
• Proposed outpatient rule increases the conversion factor by .1% for hospitals not submitting quality data
• The 2010 outpatient outlier threshold payment increases to $2,225
• Standard & Poor’s 2008 median ratios worsened across all rating categories
• Forecasted decrease for inpatient volumes and modest increases in outpatient volumes
• The market basket rate increase for inpatient hospitals is 2.1% for 2010 for hospitals submitting quality data
• The market basket rate increase for inpatient hospitals is .1% for 2010 for hospitals not submitting quality data
• The hospital national capital rate will have a net increase of 1.4%
• Hospital ER overcrowding to increase
• Full capital IME adjustment for teaching hospitals
• Numerous MS-DRG weight changes will effect individual hospital reimbursement
• Outlier payment threshold for inpatient increased to $23,140 in 2010
• EMTALA transfer sanctions waived for various emergency situations
• Fitch maintains downgrades for not-for-profit sector for the next 12 to 24 months
• $1.2 Billion released for implementation of Electronic Health Records (EHR)
• Proposed bundled payments for outpatient dialysis services
• More hospital discharges with shorter stays
• RAC audits have started for Region A
• CMS expected to tell States that hospitals may be exempt from NDC code collection for Medicaid patients

• OIG gainsharing options for physicians
• Medicaid Integrity Contractors (MIC’s)
• OIG overpayments to physicians for place-of-service codes
• Home Health Fraud and Abuse
• CMS to stop payment on claims by nonparticipating providers
• Interventional Radiology coding errors
• Perform a RAC risk assessment
• Focus on E/M documentation
• Administration of HIPAA Security rule delegated to the Office of Civil Rights (OCR)
• Notification required to individuals for health information breaches
• Medical fraud a minimum of $60 Billion a year
• New rules protect patients genetic information – GINA 2008

EisnerAmper’s Healthcare Services Group 

• Michael McLafferty - E-mail
• Office Phone – 732-598-8858