The Centers for Medicare & Medicaid Services (CMS) released a final rule in February requiring the reporting of payments made to physicians or teaching hospitals by applicable manufacturers of drugs, devices, biological, or medical supplies. The increased transparency reduces the potential for conflict of interest.
Bottom line? Beginning this summer, your peers and patients can easily learn if your providers accept gifts or payments from a drug or device manufacturer. Although such relationships are not assumed to be improper, they may raise questions regarding a provider’s independence or objective judgment.
The “Medicare, Medicaid, Children’s Health Insurance Programs; Transparency Reports and Reporting of Physician Ownership or Investment Interests,” more commonly known as the Physician Sunshine Act, requires manufacturers and group purchasing organizations (GPOs) to report any ownership or investment relationships between the manufacture or GPO and physicians or physicians’ immediate family members.
Applicable manufacturers and applicable group purchasing organizations must begin to collect the required data on August 1, 2013 and report the data to CMS by March 31, 2014.
The new rule, a requirement of section 6002 of the Affordable Care Act, was delayed for more than a year while various interest groups weighed in. As a result of those comments, CMS has exempted payments or other transfers of value provided as compensation for speaking at a manufacturer’s or GPO’s continuing education event, if certain conditions are met. The final rule has met with measured praise, and AMA President Jeremy Lazarus, MD said, “Physicians’ relationships with the pharmaceutical industry should be transparent and focused on benefits to patients.”
February 26th, 2013
Professional liability insurance is a necessary part of being a physician in order to protect the provider from bearing the full cost of legal defense in case a malpractice suit is filed. AAPC Physician Services’ Vice President of Business Development Dixon Davis, MBA, MHSA, recently wrote an article for Physicians Practice in which he delineated the different types of malpractice insurance. He also elaborated on the different situations in which each different type of policy would be the most beneficial.
“An occurrence-based policy provides insurance against incidents that occurred during the term of the policy regardless of when the claim is made,” he explains. “A claims-made policy covers the insured for any incidents that occur during the policy period, as long as the claim for the incident is also filed during the policy term.”
Read the full article.
January 10th, 2013
Fraud is always a concern in practice management settings and medical coders and billers need to take note on all fraud-related suspicions. AAPC member Jen de Zayas, CPC, CPC-H wrote about fraud in the latest Diabetes Practice Options newsletter.
“Some perfectly legitimate physicians are audited when they forget to include, or don’t know about, a particular form, or incorrectly register a business,” she wrote. “Payers might interpret these mistakes as fraud, because less scrupulous offices may do these same things deliberately.”
Read the full article here.
May 24th, 2012
No doubt that many physicians are nervous about the ICD-10 implementation. AAPC member Stephanie Cecchini, CPC, CEMC, CHISP recently wrote a For the Record article highlighting five things every physician should know about ICD-10.
“Practices that haven’t started gearing up for the ICD-10 transition will lose an important advantage. Preparing now spreads the necessary work and training across nearly two years rather than facing it all at one time and sacrificing focus from patient care,” she stated.
Read the full article here.
March 21st, 2012
With the ICD-10 implementation date still up in the air many physicians now have some additional time to get other pressing issues worked out. In a recent American Medical News article, AAPC national advisory board president Cyndi Stewart, CPC, CPC-H, CPMA, CPC-I was highlighted as one of the experts on the subject.
“Practices that already have a system designed to meet ICD-10 regulations will benefit from the delay by having more time to work on identifying weaknesses and meeting the level of detail needed for proper ICD-10 coding,” she stated in the article.
Read the full version here.
March 20th, 2012