Preparing For PPACA Pt. 1

It seems like not too long ago, we were still talking about whether or not the Affordable Care Act would even see the light of day. Now, as we approach the last quarter of 2012, the ACA’s grip on healthcare is starting to take hold. Tax and compliance law regulations have already taken effect, and companies large and small are shifting the way they do business.

WithumSmith + Brown’s CEO, Bill Hagman, explored the way that some of these businesses are changing in a lengthy article on CEOthinks.com. Here are a few choice excerpts from the article.

In the months and years ahead, this legislation as we know it today will likely change, but most likely will not disappear in it entirety, as it is expected that certain provisions contained within the healthcare reform act will continue even in the event the act is overturned in the future.  Regulations and additional implementation guidance will be issued; new initiatives will be proposed; and those that have already passed may be adjusted or withdrawn. As professional service providers and advisors, it is imperative that our views be both bipartisan and neutral, preparing our clients for whatever may come post-election.  At this point, however, there is much more clarification to be provided by the IRS on definitions and compliance rules, so we cannot advise on too many specifics just yet.  However, we do have some guidance to share in times like these…

…The most important piece of advice we can share with our business clients is to be proactive in running a lean and mean company, focusing on the areas of employee utilization, operational efficiencies and expense cutting, getting the most value out of every dollar.

Hagman’s expertise is in tax law, and the article’s opinions reflect that. However, any major health facility can certainly appreciate his advice on “getting the most value out of every dollar.”

The ACA will bring a massive change to health care, there is no question about it. The only thing we can hope to do is keep up with those changes, and rely on partners that can provide the support necessary to stay compliant.

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Pam Argeris is a thought leader in the Healthcare Industry and possesses extensive, hands-on experience with CMS compliance, and multiple regulatory bodies such as NCQA, JACHO, and DOI. In her role at Merrill Corp., Pam focuses on developing solutions for compliance and quality assurance, delivered in a cost effective manner to improve beneficiary and prospect communications. You can contact Pam at Pamela.Argeris@merrillcorp.com.

Revisiting the Role of IT in Healthcare

Since this blog started, in 2009, we have devoted a lot of words to the idea of improving healthcare with information technology. These days, the role of IT in health facilities is commonly understood. When we first wrote about the idea of a ‘Bring Your Own Device’ hospital, it was still a controversial topic. Todd Boucher is an expert in IT and Data Centers, and he took some time to put together a lengthy blog on Health IT, and the future of both industries. Today, we’ll be looking at a few of his points, and providing some commentary on how Health Care and IT have grown up together.

BYOD

Strategies for supporting “Bring Your Own Device” vary, but the necessity to support these mobile technologies is expanding rapidly. Practitioners are already using use their mobile devices for video conferencing, clinical tools, and accessing online patient data, and the technologies available to increase functionality of mobile devices in hospitals is expanding exponentially.

Doctors and surgeons of today have a nigh-infinite library of information at their fingertips, in the form of iPads, smartphones, and even laptops. All of these devices have found a new home in the operating room, the office, and more. Of course, the danger of a data breach is ever-present, but the safety of these devices can only improve as they continue to find more widespread use.

Taking Advantage of the Latest and Greatest

The use of these technologies represents a major change in data center requirements, and healthcare organizations need to evaluate the ability of their existing data centers to deliver the associated availability. Too often, the technology is procured and the implementation planned prior to answering the questions about whether the data center can provide the physical infrastructure (power, cooling, floor space, etc) necessary to support the technology.

Second only to perhaps the military, medical technology is often the most innovative in the United States. Many organizations and companies exist to develop new, improved, and more efficient pieces of medical hardware. The downside to this is that hospitals and private practices are often expected to upgrade pieces of a system that might lack the infrastructure required to keep things running smoothly. It is all too easy to step outside of the capable range of any given facility, and rapidly-improving tech is not helping things.

If you work in a health facility or hospital, we would love to hear your opinions on IT in the workplace. Leave a comment below, and we might respond to some of the most insightful in a future blog!

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Pam Argeris is a thought leader in the Healthcare Industry and possesses extensive, hands-on experience with CMS compliance, and multiple regulatory bodies such as NCQA, JACHO, and DOI. In her role at Merrill Corp., Pam focuses on developing solutions for compliance and quality assurance, delivered in a cost effective manner to improve beneficiary and prospect communications. You can contact Pam at Pamela.Argeris@merrillcorp.com.

Can Medicare Learn from Private Insurers?

Anyone that has spent long enough working in the health industry knows that Medicare can be a slow and difficult animal. The system we are used to today is built on infrastructure from 1965, and many experts are now questioning whether it has become too cumbersome and expensive to continue in its current state.

Avik Roy is one of those experts. As an adviser to presidential candidate Mitt Romney, he has been working closely with Medicare’s more controversial aspects. “When we speak about Medicare’s problems, we usually talk about how much the program costs,” says Roy. “Medicare is, along with the other government-run health care programs, the biggest driver of the federal deficit. But Medicare also is a big driver of the inefficiencies in our health care system: wasteful spending, inappropriate procedures, and outright fraud.”

Roy’s radical solution involves treating Medicare more like modern private insurers.

One such approach would be to learn from the way insurers help administer health-care claims for large companies who “self-insure” their workers…

…Typically, these large companies will outsource the administrative function of these self-insured plans to what are called administrative services organizations or ASOs. ASOs, which are often run by actual health insurers, also tend to be much cheaper than conventional insurance.

What’s the pay off? Private insurers would now handle Medicare’s health claims, allowing them to negotiate with providers, which would bring lower prices, or improved care. For now, Roy admits, it’s just a waiting game. “It’s all speculation for now, because we don’t know what the policy possibilities will look like after November. But…We owe it to ourselves to think through the possibilities.”

Click here to read the full detail of Avik Roy’s plan on Forbes.com

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Pam Argeris is a thought leader in the Healthcare Industry and possesses extensive, hands-on experience with CMS compliance, and multiple regulatory bodies such as NCQA, JACHO, and DOI. In her role at Merrill Corp., Pam focuses on developing solutions for compliance and quality assurance, delivered in a cost effective manner to improve beneficiary and prospect communications. You can contact Pam at Pamela.Argeris@merrillcorp.com.

CMS Announces New Marketing Regulations (Part 4)

CMS has approached the 2013 Marketing Regulations with a critical eye, and an editorial focus. In an effort to simplify and clarify the rules, CMS has removed around 70 pages from the document. Over the next few weeks, we’ll look at some of those changes, and explore what motivated CMS to make such drastic edits.

We’ll be wrapping up these regulations this week, so let’s dive right in with a list of the regulations from past years that are still in effect.

• Annual Enrollment Period Changes (AEP)
• 5% Translation Rule
• ANOC EOC, Formulary, LIS Rider due to members by September 30
• ANOC EOC must be mailed in the same envelope for the September 30 deadline
• Mailing Statements on Envelopes: ”Important Plan Information, This is an Advertisement, Health and wellness Information, Non-health or non-plan Information”
• 508 Compliance
• CMS 5 STAR Rating Plans can enroll members year round
• Must maintain records for 10 years
• Standardization of Plan Name Type
• SBC does not apply to Medicare beneficiaries

So, there you have it! CMS’ 2013 Medicare Marketing Guidelines in 4 simple blogs. Let’s wrap it up and look at the overall key takeaways.

• Multi-Language Insert
• ANOC EOC can be manufactured once filed
• Mailing to addresses with multiple members
• CMS Plan STAR Ratings - 15 days once released
• Marketing Material Identification font size/date no longer required
• Health Plan ID Cards Part C - New Medicare Number
• Health Plan ID Cards – Part D
• Call Center Hours of Operation listed only once
• Mailing Statements on Envelopes
• Disclaimers
• Directories – change pages no longer required
• 5 % Translation Rule
• 508 Compliance

Join us next week, as we leave Medicare marketing behind, and return to our normal discussions.

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Pam Argeris is a thought leader in the Healthcare Industry and possesses extensive, hands-on experience with CMS compliance, and multiple regulatory bodies such as NCQA, JACHO, and DOI. In her role at Merrill Corp., Pam focuses on developing solutions for compliance and quality assurance, delivered in a cost effective manner to improve beneficiary and prospect communications. You can contact Pam at Pamela.Argeris@merrillcorp.com.