CMS Will Accept Noncompliant Claims After HIPAA Deadline, Oct. 16 In September the Centers for Medicare and Medicaid Services (CMS) announced that after Oct. 16 it would continue to accept claims in formats not compliant with the transaction requirements of the Health Insurance Portability and Accountability Act (HIPAA). “Implementing this contingency plan moves us toward the dual goals of achieving HIPAA compliance while not disrupting providers’ cash flow and operations, so that beneficiaries can continue to get the healthcare services they need,” said CMS Administrator Tom Scully. The contingency plan permits CMS to continue to accept and process claims in the electronic formats now in use, giving providers additional time to complete the testing process. CMS will regularly reassess the readiness of its trading partners to determine how long the contingency plan will remain in effect.
GAO Study Evaluates the Impact of Rising PLI Premiums on Access to Care On Aug. 29 the General Accounting Office (GAO) released a new study, Medical Malpractice: Implications of Rising Premiums on Access to Health Care. The GAO confirmed that in several “crisis” states increases in professional liability insurance premiums have contributed to reduced access to emergency and obstetrical services. The report also concluded, however, “that many of the reported provider actions taken in response to malpractice pressures were not substantiated or did not widely affect access to healthcare.” The AANS and CNS provided the GAO with survey data demonstrating the impact that the crisis is having on patient access to neurosurgical care, but the GAO essentially rejected this information. The full report is available at www.gao.gov. See the cover story in this issue of the Bulletin for in-depth information on the medical liability crisis and how it affects neurosurgery.
CMS Publishes Revisions to EMTALA Regulations In September the Centers for Medicare and Medicaid Services (CMS) published its regulation revising current Emergency Medical Treatment and Labor Act (EMTALA) rules, making substantial changes that will benefit neurosurgeons. The CMS adopted nearly all of the AANS and CNS recommendations, particularly those related to the requirements for on-call physicians. The revised EMTALA rule clarifies that neurosurgeons will be permitted to be on call simultaneously at more than one hospital and that they may schedule elective surgery or other medical procedures during on-call times. The rule also states that neurosurgeons are not required to provide on-call services 24 hours per day, 7 days per week, 365 days per year, and that hospitals have flexibility to structure their call lists in a manner that reflects the limited number of neurosurgeons available to take call. The final rule was published in the Federal Register on Sept. 9 (www.gpoaccess.gov/fr).
Neurosurgeons’ Medicare Fees May Fall by 4 Percent in 2004 On Aug. 15 the Centers for Medicare and Medicaid Services (CMS) published the proposed Medicare Physician Fee Schedule regulation for 2004. The proposed regulation includes a CMS estimate that there will likely be an across-the-board 4.2 percent reduction in payments to all physicians unless Congress intervenes to prevent the payment cut. The U.S. House of Representatives’ version of the Medicare reform legislation contains a provision requiring a minimum of 1.5 percent increase in 2004 and 2005, but without a corresponding allocation of money to fund the increases, Medicare fees in years 2006 and beyond would need to be reduced to pay for this stop-gap measure. The proposed regulation also recommends various changes to reflect the recent increases in professional liability insurance premiums, which would have a some positive benefit, resulting in a combined net-payment reduction of 4 percent for neurosurgeons in 2004. The proposed regulation can be found at www.cms.hhs.gov/providerupdate/newregs.asp; once there, scroll down to Medicare Program; Revisions to Payment Policies Under the Physician Fee Schedule for Calendar Year 2004.
Report Says CCI Is Working Ninety-eight percent of services targeted by the National Correct Coding Initiative (CCI) edits were paid appropriately by Medicare in 2001, according to a recent report by the Office of the Inspector General (OIG). Medicare carriers are required to apply the CCI edits to the Part B services they process for payment when a provider bills for more than one service for the same beneficiary on the same date of service. https://oig.hhs.gov/oei/reports/oei-03-02-00770.pdf
For frequent updates to legislative news, see the Legislative Activities area of www.AANS.org.