CMS Proposes Rule To Address MU Eligibility Of Hospital-Based EPs
By Katie Wike, contributing writer
Changes would affect hospital-based physicians who assign their reimbursement and billing to a Method II CAH for the EHR Incentive Programs
A new rule proposed by CMS in the Federal Register would implement a two-step process for vetting claims and the eligibility of hospital-based physicians to receive reimbursement payments from Medicare and Medicaid. Following is a summary of the proposed rule as presented on the Office of the Federal Register Website:
According to EHR Intelligence, “CMS admits of several discrepancies in its own rules for meaningful use regarding hospital-based eligible professionals (EPs), particularly in the rule for Stage 2 Meaningful Use wherein the payment adjustment year used to determine a physician’s hospital-based status differs from previous rulings.” Following is text from the proposed rule:
CMS also acknowledged its inability to “account for the services furnished by EPs in Method II CAH outpatient departments (including emergency departments) due to limitations in our information systems,” a problem EHR Intelligence notes it tried to fix earlier this year.
The newly proposed rule will determine eligibility in two steps. According to EHR Intelligence article, “Step one involves assessing Method II CAH claims and using Two-step process ‘that data to identify which EPs had Method II CAH service billings during that year, and we would make a special hospital-based determination for that subset of EPs for payment year 2013,’ which would give nonhospital-based EPs the opportunity to receive incentives as early as payment year 2013.
"Step two entails checking ‘the hospital-based determination we have already for that EP under the existing regulation using the FY 2012 file’ and holding harmless all EPs ‘found to be nonhospital-based on the basis of the FY 2012 claims data (which do not include Method II CAH claims).’”
Wachler & Associates, P.C. writes of the proposed rule change on its health law blog, “CMS's proposed rule will affect a wide range of providers and ways in which the proposed bill changes hospital billing is multi-faceted. A comprehensive APC system would provide all-inclusive payments by bundling the different device installation services. CMS is proposing that comprehensive APCs would 'improve the accuracy and transparency of our payments for these services where the cost of the device is large compared to the other costs that contribute to the cost of service.' CMS believes that this proposed system would support their goal of increasing flexibility and efficiencies.”
CMS is soliciting comments on all sections of the proposed rule which must be received no later than 5 p.m. EST on September 6, 2013, at one of the following addresses:
- Electronically - http://www.regulations.gov. Follow the instructions under the “submit a comment” tab.
- Regular mail - Centers for Medicare & Medicaid Services, Department of Health and Human Services, Attention: CMS-1601-P, P.O. Box 8013, Baltimore, MD 21244-1850.
- Express or overnight mail - Centers for Medicare & Medicaid Services, Department of Health and Human Services, Attention: CMS-1601-P, Mail Stop C4-26-05, 7500 Security Boulevard, Baltimore, MD 21244-1850.
More details of the CAH Method II Physician Participation in the Medicare EHR Incentive Program are available on this factsheet created by CMS.