FTC Red Flag Rules Enforcement Delayed Until June 1, 2010

The Federal Trade Commission (“FTC”) has again extended enforcement of the Red Flag Rules, now until June 1, 2010.

The latest delay comes at the request of Congress, which is considering a bill that amends the identity theft rule by eliminating entities with fewer than 20 employees from complying.  The House of Representatives passed that bill in late October 2009. The bill is now in the hands of the Senate.

The Red Flag Rules impact financial institutions and creditors subject to FTC jurisdiction. According to the Rules, created under the Fair and Accurate Credit Transactions Act, creditors of covered accounts must establish a program to detect, prevent and mitigate identity theft.

Originally, the Red Flag Rules would have taken effect on November 1, 2008, which was then extended to May 1, 2009, and then further extended to November 1, 2009.

For more information on the Red Flag Rules, visit: http://pvwlaw.wordpress.com/category/red-flag-rules/.

© 2009 Parsonage Vandenack Williams LLC

  For more information, contact info@pvwlaw.com

MGMA Releases Proposed 2010 Medicare Physician Fee Schedule Analysis –

The Centers for Medicare & Medicaid Services (“CMS”) recently released the 2010 Medicare proposed physician fee schedule along with a related press release and fact sheet. The regulation includes provisions that confirm a 21.5 percent reduction in 2010 Medicare physician payments unless Congress enacts legislation to reverse this cut.  The regulation also proposes to “remove physician-administered drugs from the definition of “physician services” for purposes of computing the physician update formula in anticipation of enactment of legislation to provide fundamental reforms to Medicare physician payments,” a move that has been advocated by the Medical Group Management Association (“MGMA”) for a long time.

MGMA analyzed the regulation’s impact on medical group practices and is making its analysis available only to members at mgma.com. The proposed fee schedule includes provisions that would affect physician practices as follows:

• Start implementation of the congressionally-mandated requirement that suppliers of advanced diagnostic imaging services become accredited
• Notably change the practice expense relative value units for many covered services
• Increase the equipment usage assumption for equipment costing greater than $1 million
• Transfer responsibility from the patient to the Medicare program for co-payments for covered outpatient mental health services
• Add a group practice reporting option to both the Physician Quality Reporting Initiative and the E-Prescribing Incentive Program

 The member-only analysis can be accessed here: http://www.mgma.com/policy/default.aspx?id=5802.

© 2009 Parsonage Vandenack Williams LLC

  For more information, contact info@pvwlaw.com

How to Select a Third-Party Billing Entity

 Selecting a third-party billing entity (“TPBE”) can be a difficult process for medical group administrators and their organizations.  A TPBE usually offers medical billing services, which may include charge-data entry, billing, electronic claims submission, payment posting and collection follow-up.

             Upon beginning a search for a TPBE, a medical group must first set its own priorities and determine the services it needs.  The following are some important things to consider regarding TPBEs:

 1.    Size. 

 Large TPBEs typically have the benefits of in-depth compliance programs, multispecialty expertise, many employees, cross-training, and the ability to offer additional services.  However, large TPBEs may also include higher TPBE overhead costs, inconvenient locations, and the potential for high employee turnover.

 Small TPBEs typically have the benefits of lower prices and less overhead, more personalized service, quicker response time, and potentially more control for the medical group.  On the other hand, they may only have limited compliance plans and limited multispecialty expertise, there may be coverage issues due to fewer employees, and they may offer fewer services.

 2.    Scope of Services.

 The medical group should decide whether it wants to pay extra for services such as record storage, computer equipment, software upgrades, ad-hoc reports, correspondence backlogs, and in-person representation for appeals with payers.

 3.  Billing.

 The group should decide how to be billed: per transaction or per claim? By a flat monthly fee or a percentage of practice revenue collected?  It is important to ask vendors for samples of management reports such as accounts receivable, charges billed, collection/revenue, denied claims, credit balance, and contractual and other write-offs.  Vendors should also be asked for a list of policies and procedures, a sample contract, and a tour of the facility.

             Finally, before entering into a contract, the medical group should refer to the Department of Health and Human Services’ Office of Inspector General’s guidelines for TPBEs (http://oig.hhs.gov/fraud/docs/complianceguidance/thirdparty.pdf) to ensure vendor compliance. 

It is a good idea for medical groups to include specific terms and agreed-upon standards in the contract for the following: (1) maximum average number of days in accounts receivable; (2) maximum number of charge lag days; (3) other benchmark numbers important to the group; and (4) consequences if the TPBE does not achieve the stipulated benchmarks.  The group will need to provide the TPBE with accurate billing and patient information so that both parties can meet the terms of the contract.  Knowledge on both sided will greatly help to build a successful long-term billing arrangement.[1]

 [1] (Billing) Help Wanted, MGMA Connexion, February 2008, pp. 27-28.

 

© 2008 Parsonage Vandenack Williams LLC

 

For more information, contact info@pvwlaw.com