Important Deadlines Looming for Healthcare Providers Who Treat Medicare Patients

In this rapidly-changing healthcare environment, providers need to remain cognizant of important deadlines that could affect their bottom lines. Here are several such deadlines under the Medicare program which could significantly impact cash flow.

Saturday, June 30, 2012 – “E-Prescribing” – In order to qualify for an e-prescribing hardship exemption for calendar year 2013, eligible professionals (“EPs”) who are not otherwise exempt from Medicare’s e-prescribing program must request a hardship exemption on or before June 30, 2012. Without a hardship exemption, all EPs who are not exempt from the program are expected to be e-prescribing. If they are not, then they will be penalized by having their Medicare reimbursement rates reduced by 1.5% for all services rendered by them in 2013.

The final rule provides a number of ways in which EPs who are not otherwise exempt can avoid the e-prescribing penalty that is scheduled to begin on January 1, 2013. Below are the significant hardship exemption categories that an EP can apply for to avoid the penalty:

• His/her practice is located in a rural area without high speed internet access.
• His/her practice is located in an area without sufficient available pharmacies for e-prescribing.
• He/she is unable to electronically prescribe due to local, State or Federal law or regulation (e.g., physicians who mainly prescribe narcotics but because of State law cannot submit these prescriptions electronically can apply for this exemption category).
• He/she prescribed fewer than 100 prescriptions between January 1, 2012 and June 30, 2012.

Sunday, July 1, 2012 – “5010 Implementation” – Recently, the Centers for Medicare & Medicaid Services (CMS) announced that it will delay for 90 days any enforcement action against any HIPAA-covered healthcare provider which has failed to complete its implementation of the Version 5010 format for electronic claims submissions. The “toll” on enforcement actions by the Government will end on July 1, 2012.

During the additional 90 days in which CMS will not initiate enforcement penalties, healthcare providers should collaborate with their trading partners on appropriate strategies to resolve any remaining problems. CMS has identified two steps that providers can take to ensure a smooth upgrade. They are:

1. Establishing a line of credit: To avoid potential cash flow disruptions, providers should consider establishing or increasing a line of credit. By doing so, they can prepare for possible delays and denials in payer claims reimbursements if noncompliant Version 5010 transactions are submitted.

2. Check partner readiness: Because a provider’s Version 5010 upgrade can be dependent upon his or her billing vendor, it is important for providers to be aware of their vendor’s transition status. If a healthcare provider’s vendor is behind schedule for Version 5010 adoption, the healthcare provider should get confirmation of the vendor’s timeline to become compliant, and encourage the vendor to take action so that it will be prepared to handle the provider’s claims when the enforcement “toll” ends on July 1st.

Monday, October 1, 2012 – “EHR Incentive Program” – In order to qualify for the maximum incentive amount available under the Medicare portion of the Electronic Heath Record (“EHR”) incentive program, EPs must start participating no later than October 1, 2012. The incentive program offers up to $44,000 for those EPs participating under the Medicare portion of the program and up to $63,750 for those participating under the Medicaid portion of the program.


• To qualify for Medicare EHR incentive payments, Medicare EPs must successfully demonstrate meaningful use for each year of participation in the program.

• Incentive payments are made based on the calendar year. The reporting period for the first year is any 90 continuous days during the calendar year. The reporting period for all subsequent years is the entire calendar year.

• EPs who delay and do not qualify for Medicare EHR incentive payments until 2013 can receive up to $39,000 in total incentive payments (i.e., $5,000 less than if they qualified in 2012). Similarly, EPs who delay and do not qualify for Medicare incentive payments until 2014 can receive up to $24,000 in total incentive payments (i.e., $20,000 less than if they qualified in 2012).

For more information please contact the HLP at (248) 996-8510 or visit the HLP website.

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