Monday, December 30, 2013

Top Ten Health Law Issues for Physicians,
Health Systems and Providers in 2014

Change is the one constant that physicians, health systems and other providers face in 2014 as the ACA and its myriad regulations become effective, along with increasing review and scrutiny not just from state and federal regulators, but also private companies with state and federal contracts to review and audit claims, cost reports, and billing practices. Listed below are the top ten areas that physicians and other providers should watch in 2014.

Meaningful Use Audits: Physicians, hospitals, and others that have received incentive payments to integrate electronic medical records into their practices will likely be subject to an audit from either Medicare or Medicaid to assess whether the providers have actually made meaningful use of these funds and systems. Auditors are likely to demand evidence of meaningful use of incentive monies and repayment when providers cannot back up the attestations made for Stage 1 compliance. Providers should be on the lookout for audit request letters sent via email by the contracted auditor. Make sure that whoever has the email address registered with CMS checks for an audit letter. In addition, providers should make sure that all meaningful use attestations are backed up and documentation is maintained for the six years that CMS requires. Some of the required evidence includes EHR vendor agreements, attestation reports on clinical quality measures, statements from EHR vendors, and information used to generate numerator and denominator values for reporting. If an audit letter is received, contact should be made immediately. Providers need to pay attention to these responses; a failure to respond adequately could result in more than just a request for repayment.

Friday, December 6, 2013

Controlling Compounding:
The Drug Quality and Security Act

In October 2012, a fatal meningitis outbreak killed 64 people in the United States and infected more than 750 in 20 states. The outbreak was traced back to contaminated vials of an injectable pain-killing steroid that was compounded by the New England Compounding Center (“NECC”).

Compounding – the process by which a pharmacist combines drug ingredients per a doctor’s prescription to meet the unique needs of an individual – is nothing new. In recent years, however, the practice has experienced a surge in popularity as more Americans have come to expect tailored medicine, and drug shortages create a persistent need to compound unavailable drugs.  Historically, compounding involved a relationship between the compounding pharmacist, physician, and patient – and was done at the local pharmacy.  Now, compounding facilities mix and compound mass quantities of product for interstate sale.