September 2010 Clinical Laboratory News: Regulatory Profiles

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September 2010: Volume 36, Number 9 

Meaningful Use Rules for EHRs Announced

he Department of Health and Human Services (HHS) announced final rules that put in place critical regulations for rolling out new requirements for electronic health records (EHR). Under the Health Information Technology for Economic and Clinical Health (HITECH) Act of 2009, eligible healthcare professionals and hospitals can qualify for Medicare and Medicaid incentive payments when they adopt certified EHRs. Providers face a cut in Medicare payments in 2015 if they’re not onboard by then. With the announcement of these final rules, a concentrated 5-year national initiative to adopt and use EHRs is now underway.

One regulation, issued by the Centers for Medicare & Medicaid Services (CMS), defines the minimum requirements that providers must meet through their use of certified EHR technology in order to qualify for the payments. The other rule, issued by the Office of the National Coordinator for Health Information Technology (ONC), identifies the standards and certification criteria for the certification of EHR technology, so eligible professionals and hospitals may be assured that the systems they adopt are capable of performing the required functions.

According to HHS, as much as $27 billion may be expended in incentive payments over 10 years. Eligible professionals may receive as much as $44,000 under Medicare and $63,750 under Medicaid, and hospitals may receive millions of dollars for implementation and meaningful use of certified EHRs under both Medicare and Medicaid.

A CMS/ONC fact sheet on the rules is available at Technical fact sheets on CMS’s final rule are available online. A technical fact sheet on ONC’s standards and certification criteria final rule is available online.


CMS Releases New Lab Codes for 2011

The Center for Medicare and Medicaid Services (CMS) recently released its listing of the new CPT codes for 2011. The agency held a public meeting on July 22 in Baltimore, Md. to receive public input on the appropriate payment levels for the new test codes, which include one for drug testing, five for chemistry, one each for immunology and transfusion medicine, five for microbiology, and four temporary “G” codes. Final determinations on the pricing of the new codes are due out in October.

A detailed list of the new codes is available from the CMS website.


Health Subcommittee Holds Hearing on Medicare Fraud and Abuse

On June 15, Rep. Pete Stark (D-Calif.), chair of the House Ways and Means Subcommittee on Health, conducted a hearing on reducing fraud, waste, and abuse in the Medicare program. The hearing coincided with the Obama administration’s goal to cut fraud and abuse in federal insurance programs by half.

The Government Accountability Office (GAO) has estimated that improper payments for Medicare fee-for-service (FFS) totaled $24.1 billion in calendar year 2009, or 7.8% of the overall Medicare budget. GAO recommended five changes to the current payment process: checking the background of providers at the time they apply to become Medicare providers; improving pre-payment review of claims; improving oversight of contractors; focusing post-payment claims review on most vulnerable areas; and developing a robust process for dealing with vulnerabilities.

According to the Office of the Inspector General (OIG), federal programs to combat fraud and abuse have recovered nearly $16 billion in fraudulent payments over last decade, resulting in a return of $4 for every $1 invested by the government. The Obama administration plans to boost spending for this program by $250 million in 2011. 

Testimony from the hearing is available on the subcommittee website.


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