Slight 5010-Compliance Reprieve

CMS has announced that it will NOT enforce 5010 non-compliance until March 31, 2012.  This is a slight reprieve, but all HIPAA covered entities should be actively in testing mode, and continually “working with their trading partners to become compliant with the new HIPAA standards, and to determine their readiness to accept the new standards as of January 1, 2012.”

For the full text of the CMS statement, please see: https://www.cms.gov/ICD10/Downloads/CMSStatement5010EnforcementDiscretion111711.pdf

CMS’ Revalidation Effort Delayed

Over the past few months, much has been discussed about CMS’s “revalidation” effort.  Essentially, all providers and suppliers enrolled in the Medicare program prior to March 25, 2011, will be required to submit their enrollment information so they can be revalidated under new risk screening criteria required by the Affordable Care Act (Section 6401a).  Providers/suppliers who enrolled on or after March 25, 2011, have already been subject to this screening and need not revalidate at this time.

CMS & MACs have advised providers and suppliers not to take any action intil they have received a “revlidation letter” from their MAC, for this is going to be a staged process in which all providers and suppliers would be revalidated over the course of the next two years (by March 23, 2013).  The followig link provides an example of what a validation letter would look like:  http://www.palmettogba.com/Palmetto/Providers.Nsf/files/J11_Revalidation_Letter_Web_Example.pdf/$File/J11_Revalidation_Letter_Web_Example.pdf. 

Once your office receives such a notice, please notify M.E.D.I.C., Inc. ASAP, for at that point, you have only 60 days in which to complete the revalidation process.  Providers failing to respond to such a revalidation request run the risk of being deactivated from the Medicare program.

Just this past week, however, CMS announced that it would “delay” this revalidation effort in order to streamline the process by improving the PECOS online registration system prior to revalidating all Medicare providers.  According to the Medical Society of Virginia’s website (http://www.msv.org/MainMenuCategories/MemberCenter/PressRoom/News/2011-Archives/Revalidation-effort-delayed–.aspx):

In order to comply with the program integrity screening provisions of the Affordable Care Act (ACA), the Centers for Medicare and Medicaid Services (CMS) launched an effort to revalidate the enrollment of every provider and supplier by March 23, 2013. This effort has now been pushed back to 2015. Physicians will be among the last to revalidate.
 
In addition to pushing back the revalidation efforts, CMS made improvements to the online Medicare Provider Enrollment, Chain and Ownership (PECOS) system, which include:

• E-signatures
• Electronic document upload
• Batch upload capability
• Seamless password reset
• Enhancements for authorized officials
• Reassignment reports
• New “my enrollments page” and “fast track view” screens
• Fewer duplicative document submission requirements

CMS stated that the PECOS improvements will be implemented before most physicians are asked to revalidate.

eRx Exemption Deadline Is Looming… Be Sure That You Are Not Hit With A 1% MPFS Penalty!

This past summer, I communicated with you all about the need to either start begin a consistent regimin of e-prescribing (a minimum of 25 prescriptions must have been electronically prescribed by the end of 2011), or apply for an exemption.  Initially the deadline for filing this exemption was October 1, 2011; however CMS extended it until November 1, 2011.  Just this week, CMS once again extended the deadline to November 8, 2011 — next Tuesday.  The following link is to the Medical Society of Virginia’s publication regarding this extension:  http://www.msv.org/MainMenuCategories/MemberCenter/PressRoom/News/2011-Archives/ePrescribing-deadline-extended–.aspx.   (see also, http://www.msv.org/DocumentVault/PDFs/eRx-Hardship-Exemption-PDF.aspx - this is the AMA’s information relating to the eRx exemption).

In order to qualify for the exemption, a provider must fall squarely into one of six specific categories: 

• Registered to participate in the Medicare or Medicaid electronic medical record incentive program and have adopted certified EMR technology.
• Were unable to prescribe electronically because of a local, state or federal law or regulation. (if possible, reference the actual code/statute that prohibits your e-prescriptions)
• Had limited prescribing activity.
• Had insufficient opportunities to report e-prescribing for eligible patient visits.
• Practiced in a rural area without sufficient high-speed Internet access.
• Practiced in an area without a sufficient number of pharmacies that accept electronic prescriptions.

Once you have determined that you do in fact qualify under one of these aforelisted categories, then you must submit a specific form, which is located at https://www.qualitynet.org/portal/server.pt/community/communications_support_system/234.    Click “Communication Support Page” (at the bottom of the top box on the left side of the page) and fill out the exemption request form per individual NPI. 

Should you have issues accessing the actual form (I did, but the QualityNet Help Desk, walked me through setting preferences to access the document), follow these steps: 

• Click Tools drop down
• Select Internet Options (bottom of list)
• Select “Advanced” tab (far right)
• Scroll down to the bottom and check the box “Use TLS 1.0″
• Click APPLY
• Then try accessing the page again…  it should work

I was advised that only the individual associated to the NPI is available to complete the exemption form…  office staff are NOT allowed to do this on the behalf of the doctors.  The email must be the individual provider’s own email address and the requestor relationship field must have Health Care Provider marked when filing for an eRx Hardship Exemption.  The other options on the requestor relationship field are there merely because anyone can request a feedback report. 

Providers failing to either e-prescribe or submit an exemption are at risk of incurring a 1% Physician Medicare Fee Schedule payment penalty on all claims.