News From The 2011 CMS Fall Conference

The CMS Fall Conference this year can be defined with one word: improvements. The conference was designed with a series of breakout sessions, each intended to give CMS experts the ability to hear questions, concerns, and criticisms from those of us in the industry. It wasn’t a one-way conversation, however, as the experts in attendance provided plenty of information and commentary.

As I have already said, CMS made a great effort to stress their initiatives for improving Medicare and Medicaid programs. These efforts will include:

• Valuable products
• Clear benefits
• Accurate communications
• Accurate benefits
• No tricks at educational events
• Regulation-consistent marketing
• Secret shopping
• A stricter policy on misleading print ads and marketing

On a more positive note, CMS experts were enthusiastic about Part C and Part D programs. They were quick to stress that existing programs were not bad, but that they could do more. These initiatives are all intended to lead to better care, healthier communities, and conformity to ACA law.

The other major point of discussion was the CMS star rating system. A perfect five-star rating can bring many advantages to a plan, including year-round marketing to beneficiaries turning 65. A beneficiary may join or switch to a five-star plan from an MA, MAPD, or PDP plan, barring a few limitations:

• Beneficiaries can only join a plan in their area.
• They can only enroll in a 2012 plan with a five star rating.
• A beneficiary can only use this process one time per year.
• If one moves from a plan with drug coverage to a five-star plan that does not have drug coverage, they lose that coverage and cannot return to their previous plan.

CMS warned plans that deliberately structuring themselves to maximize ratings would not be an effective tactic, and that if plans stay focused on overall quality of care, and appropriate care, their star rating will be good.

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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.

The 2011 CMS Fall Conference

It's that time of year again! Halloween decorations are already for sale in malls and grocery stores, the kids are back in school, and the words on everyone's lips are 'Prescription Drug Marketing Compliance."

That last bit may be a bit of an exaggeration, but nevertheless, it is time for the CMS 2011 Medicare Advantage and Prescription Drug Plan Fall Enrollment, Marketing and Compliance Conference. As usual, I, Pamela Argeris, will be attending on behalf of Merrill Corporation. This year's conference promises to be interesting, with plenty of topics that need stronger clarification, combined with the fact that a Presidential election year will soon be upon us:

• New Annual Enrollment Period and other related Enrollment Period’s
• Medicare Advantage Disenrollment Period/ 5 Star (SEP) Special Enrollment Period
• Marketing and Enrollment
• Part D IRMAA/ Reinstatement for Good Cause
• End of Year Transition and Systems Activity
• Quality Improvement Strategy for the Medicare Advantage Program
• Changes in the Enrollment Chapters (regulations)

The conference  begins on September 20th, and will also be broadcast live on the web, for registered attendees that cannot make it to the conference. There are also planned break-out sessions covering HPMS Training, Retroactive Processing Contractor, and MARx Reports. These sessions will give CMS experts the opportunity to listen to concerns and questions about these systems.

The goal of the Fall conference is to ensure that all sponsors and marketers working within the health and pharmaceutical fields remain up-to-date on the most recent changes to prescription drug marketing compliance.

The CMS Fall Conference is always a great source of information, and Merrill Corporation looks forward to the opportunity to better perfect our health industry services.
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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.

Arguments Continue On ACA Constitutionality

Image from thefbomb.org

The Georgia Appeals Court becomes the second appellate to join the never-ending debate swirling around Obama’s Affordable Care Act. According to the court, the individual mandate – the portion of the legislation requiring all citizens to purchase health care – is unconstitutional, and “an unprecedented exercise of congressional power.” This follows a similar January ruling by US District Judge Roger Vinson, and an opposing ruling from the Ohio Appeals Court in June.

The Georgia ruling supports most of what Florida’s Judge Vinson declared in January, with a significant provision. While Vinson felt that the entire legislation was a cohesive, unchangeable unit, the Georgia court believes that the offending individual mandate can be removed from the ACA, while allowing the rest of the Act to function as law.

As pointed out in a recent news article on Medscape.com, continuing dissension will likely force the Supreme Court to re-investigate the controversy, and to pass down an official decision. Until that happens, smaller courts will likely continue the debate.

The issue of the constitutionality of the Affordable Care Act is also before a US Appellate Court in Richmond, Virginia, which is weighing appeals of two lower-court decisions in that state. A federal district judge in Lynchburg, Virginia upheld the individual mandate, whereas another in Richmond, Virginia, struck it down. A ruling from this third appellate court is expected soon.

Whatever Virginia’s decision is, we will probably not be seeing the end of this discussion any time soon.

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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.

Mobile Tech Replaces Pagers, Worries HIPAA

The cliche image of an off-duty doctor receiving an emergency page is a thing of the past. These days, many docs receive up-to-the-minute patient updates through text messages, sent unencrypted from the hospital. Obviously, there are a few problems here waiting to happen.

According to Becker's Hospital Review,

The e-mails are entered by the hospital employee, converted into a text message and sent to the physician's cellular phone. Physicians frequently request that more patient data is included in the message, such as the patient's name and room number, so the physician can look up the chart prior to returning the call. This system is frequently not encrypted, however, because of the extra expense to the hospital.

This revelation sent red flags up for HIPAA. Imagine their horror when it was learned that some hospital employees simply send these texts from personal cell phones, rather than through monitored hospital email systems.

The problems begin with the fact that this kind of communication, while expedient, is not protected by any level of security. This puts these kinds of communications in violation of the Security Standards, which "require Covered Entities to (1) ensure the confidentially, integrity and availability of the information; (2) protect against any reasonably anticipated threats or risks to the security or integrity of the information; and (3) protect against unauthorized uses or disclosures of the information." And this is just the start of the laundry list of violations.

The very fact that these communications take place on "high risk" items like cell phones and tablet computers furthers the issue. The National Institute of Standards and Technology increases the risk level for items likely to be lost, stolen, or compromised, and cell phones are right at the top of that list.

Is this just one more case of consumer technology surpassing medical technology? Perhaps, but it is still a significant issue that requires a little more thought.

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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 Quality of Care Initiatives

The Centers for Medicare and Medicaid Services has had a busy seven days, releasing information on four new initiatives since July 29^th. Three of these focus on accuracy and payment changes for Medicare in fiscal year 2012, and the last describes policy changes for inpatient rehabilitation facilities.

CMS ANNOUNCES MORE ACCURATE FY 2012 PAYMENTS FOR MEDICARE SKILLED NURSING FACILITIES

A spike in payment levels inspired this policy, which will align Medicare payments with costs, reducing Medicare skilled nursing facility Prospective Payment System payments by $3.87 billion. This reduction is a drop of 11.1% from FY 2011. In the press release, CMS Administrator Donald M. Berwick, M.D. says, “CMS is committed to providing high quality care to those in skilled nursing facilities and to pay those facilities properly for that care…The adjustments to the payment rates for next year reflect that policy.”

The 2011 spike was caused by a miscalculation when CMS attempted to restrict damage caused by the Resource Utilization Groups Version 4 (RUG-IV) classification system.

FINAL WAGE INDEX CHANGES FOR MEDICARE HOSPICES INCREASE FY 2012 PAYMENTS BY 2.5%

In an effort to improve the quality of care in hospices, CMS is increasing payments to hospices treating Medicare patients by 2.5%. The increase will come at the cost of required quality of care reporting for those patients. In further detail, the release explains that, “CMS calculates each hospice’s aggregate cap by multiplying the number of patients served by the hospice in a cap year by a cap amount. Medicare payments made to a hospice during the cap year that exceed the hospice’s aggregate cap must be refunded to Medicare.”

MEDICARE PAYMENT RULE PROMOTES IMPROVED INPATIENT CARE

CMS has also approved a similar rule, geared to improve inpatient care in general acute-care and long-term-care hospitals. “The final rule continues a payment approach that encourages hospitals to adopt practices that reduce errors and prevent patients from acquiring new illnesses or injuries during a hospital stay,” said CMS Administrator Donald M. Berwick, M.D.   “This approach is part of a comprehensive strategy being implemented across Medicare’s payment systems that is intended to reduce overall costs by improving how care is delivered.”

This rule meshes with an ACA requirement that reduces Medicare pay-outs to hospitals with high readmission levels for certain conditions.

CMS IMPLEMENTS PAYMENT, POLICY CHANGES FOR INPATIENT REHABILITATION FACILITIES

Another CMS ruling is set to increase “IRF payment rates under the IRF Prospective Payment System (PPS) by 2.2 percent and establishes a new quality reporting system authorized by the Affordable Care Act.” The rule will take effect in FY 2012, and will provide further motivation for hospitals and other health facilities to improve inpatient care practices.

In addition, the final rule will update the case-mix group relative weights using FY 2010 IRF claims and FY 2009 IRF cost report data, freeze the facility-level adjustment factors for FY 2012 at FY 2011 levels for one additional year while the agency explores ways to improve upon the accuracy and consistency of the current methodology used to calculate the facility-level adjustment factors, and allow IRF and inpatient psychiatric facility units to expand in the middle of a cost reporting period, rather than restricting such expansions to the start of a cost reporting period.

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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.

The Clock is Ticking on the Debt Ceiling

It is time to get serious in Washington. Many people throughout the United States are waiting for a deal or compromise to be reached on the debt ceiling. The most sensitive population among those is the elderly that Medicare services. It is unfair for elected officials to rely on their votes to be placed into office, and then fail them when the going gets tough, so to speak. Everyone needs to adjust their thinking and keep in mind that people's parents or grandparents are sitting at home watching this calamity unfold in the media.

Many seniors have voiced a fear of losing their Social Security - which is their only source of income in many cases - as well as their Medicare benefits. As we know, a means test has been proportioned into Medicare via the Affordable Care Act. This test increases the premiums of the well off in Medicare. Invoking any additional increase to this means test at this point is uncalled for.

The Washington crowd needs to be open minded, roll up their sleeves, and serve up a solution that will work for all, and especially for our senior citizens who are fearful of losing at every turn.

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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.

HIPAA Regulations and New Technology: HIPAA, HITECH, and Electronic Compliance

HIPAA and HITECH violations are on the rise, and as more and more technology pushes medical records into the realm of EHRs and cloud storage, things will not likely improve. Why exactly is this happening? Sarah E. Swank has a few ideas (free registration required to view article):

In the old paper world before HIPAA, people often guarded patient medical records with good old-fashioned common sense…Our HIPAA policies are stale and our workforce members receive training often created with a focus on paper medical records. In addition, the technology has not caught up with expectations of electronic health record systems to audit access in real time.

It has been said, time and time again, that HIPAA is behind the times when it comes to new forms of communication. This has been most evident in the realms of social media, where companies and facilities are forced to choose between posting what they think is OK while hoping to dodge the compliance axe, or ignoring the platform altogether. So what can medical organizations do to keep their information secure while HIPAA catches up?

Swank lists seven strategies in her article on lexology.com;

1. Conduct Regular and Routine Audits
2. Review Incident Reporting Procedures
3. Conduct Timely and Complete Investigations
4. Review and Update Policies and Procedures
5. Reevaluate Training
6. Rethink Discipline Determination
7. Mitigation

What these strategies boil down to is essentially this: Change, Vigilance, and Consistency. Organizations must step up to develop methods of tracking and protecting data in an electronic environment, which can be a complex and daunting task for a group used to handling paper records. HIPAA may have been old hat a few years ago, but we are all back in unfamiliar territory, and it is necessary to give your compliance strategies a second look.

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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.

HIPAA Regulations and New Technology: Where Does Mobile Fit In?

There are plenty of obvious compliance issues presented by healthcare’s move toward mobile technology. This recent article from Mobi Health News points out one of the less blatant struggles that any health facilities face.

The [HIPAA] Privacy, Security, and Breach Notification Rules can be a daunting challenge. Sometimes, the biggest question facing mobile application developers is not how to comply with (or make sure users are complying with) HIPAA, but rather whether HIPAA even applies.

It seems that the twisting and complex labyrinth that is HIPAA compliance has more backdoors, pitfalls, and secret exits than anyone could have predicted. The good news is that many mobile software efforts may not even fall under HIPAA’s compliance jurisdiction. The bad news is that it can be very tricky figuring out what side of that line you fall on.

In the article, Adam Greene explains that, “The HIPAA Rules only apply to HIPAA ‘covered entities’ and their ‘business associates.’ They do not apply to health care consumers or to other types of entities.” This means that the people that have access to the software are the first determinate of whether or not HIPAA compliance applies to your software. He explains further that:

A mobile application developer will need to analyze whether the software will be used by a covered entity, such as physician, hospital, or health plan, and whether it will include any protected health information: individually identifiable information about health, health care services, or payment for health care services. An application that assists a physician with following up with patients would need to be designed to allow the physician to comply with HIPAA. Likewise, a mobile application for use by health plan employees to obtain an individual’s enrollment information remotely would need to be designed in accordance with HIPAA.

The take-away here is that health facilities can distribute software that monitors medication schedules, important general health information, and other information, so long as it is not directly linked to any “covered entities.” Obviously, this is a complicated matter that should not be tackled without a lot of thought and research, but it is good to know that – on the surface, anyway – HIPAA is not preventing health facilities from helping the public get the best medical information possible.

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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.

HIPAA & EHR Security -- Can the Answer Be Found in the Cloud?

On a public website, the Department of Health and Human Services maintains an infamous list known as the “wall of shame.” The site publishes the names of facilities responsible for HIPAA violations affecting 500 or more people. But do we truly understand how the violations occur?  With so many recent news stories about online security and super-hacker group LulzSec, it is easy to blame digital recording. However, after a closer review of the HHS website information, that simply is not the case.

Most often, violations occur due to physical theft and loss. The statistics provided in a recent Software Advice article state that only 6% of the violations are attributed to hacker activities. Of the remaining incidents, 61% are linked to physical theft and loss. Why is there such a difference between public view and reality? Part of it is the media; a story about criminal elements breaking in to secure servers is more interesting than one in which an otherwise skilled employee misplaces a disc. Another part of it is fear. When the public hears about hackers gathering millions of credit card numbers overnight, they assume that all online data is up for grabs.

Whatever the reason, the facts are clear. The vast majority of HIPAA violations and data loss are due to the mishandling of physical files or equipment. With that in mind, EHR security must continue to evolve and work closely in conjunction with newer technologies that show signs of stronger security for our most sensitive personal information.

Cloud technology could allow these medical records to exist in a purely electronic form. Online banking has been commonplace for years, with hardly a second thought and as Michael Koplov, author of this Software Advice article, succinctly points out, “Just a hunch, but I bet more hackers want my credit card information than my HDL/LDL ratio.” In a comment to Merrill Corp, he goes on to say, “I analyzed this data and found that the HHS has no record of cloud-based EHRs being implicated in these large-scale security breaches.”

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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.

Microscopic Science, Big Results

Scientists in the health field have been putting a lot of effort and time into researching the genetics of common health problems, and that energy is starting to pay off. Today, some of the most debilitating common conditions are being explained at a microscopic level. These finds may seem inconsequential now, but within a few short years, the fringes of modern medicine may use this research for cures.

Migraines -- severe headaches that come bundled with hazy vision, nausea, and hyper-sensitivity -- have been traced down to three individual genes. Of those three, one occurs exclusively in women, explaining why women have always been more prone to the debilitating headaches. If scientists can target these genes and shut them off, severe headaches may be a thing of the past.

http://1.usa.gov/k7tPxr

A more universal issue is being solved thanks to breakthroughs made in chromosome research. DNA strands called telomeres cap the ends of chromosomes in living cells. When these caps wear away, due often to physical or mental stress, the cell dies. Faster cell death essentially means faster aging. Though typically linked to those that suffered childhood abuse, any extreme stress can shorten telomeres. Experts recommend the usual dose of increased activity and exercise, as even the most abused individuals were able to divert stress and increase telomere length through activity and exercise.

As science delves deeper and deeper into genetic research, we may see the genetic switches responsible for many causes of human suffering. The things we are accomplishing today were considered fringe medicine a decade ago, and the things we cannot dream of doing today may be commonplace in the near future.

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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.

Did you have Merrill winning your "Technology Innovation of the Year" Bracket?

Why should the University of Connecticut, the University of Kentucky, Butler University and Virginia Commonwealth University all hope to be like Merrill Corporation? Because next week, the leading global provider of technology-enabled services will be the only one of the five guaranteed to be holding a trophy.

While the trophy won't be presented in Houston or broadcast on national television, what it represents is nearly as highly regarded, as Xplor International, a worldwide, not-for-profit professional association that recognizes document technology solutions, has named Merrill Corporation as the recipient of their Technology Innovation of the Year Award.

Merrill was nominated for this award due to their record, page and piece level tracking and compliance-driven production environment that enables the company's healthcare clients to effectively communicate with their members. Merrill has successfully implemented an innovative, unmatched and proven Chain of Custody workflow resulting in the production of complex member communications that are accurate, timely and compliant – reducing member confusion and increasing member satisfaction.

The award will be presented at a luncheon on the final day Xplor International's 2011 Conference. Receiving the award will be Robert Cook, Director, Digital Print & Fulfillment for Merrill Corporation (who will also a panelist at the conference and reporting on it via Merrill's Twitter page).

“Merrill strives to hit specific benchmarks in the healthcare communications industry - specifically in personalization and compliance – and by being recognized by Xplor International with the Technology Innovation of the Year Award, clearly we are reaching this goal,” said Cook. “Our focus on integrating 'integrity manufacturing' and its ability to support the reporting requirements of the industries we serve was key to this award. To win this with InfoPrint Solutions, and to be listed alongside previous winners such as Adobe Systems, Inc., ADP Investor Communications and GMC Software, is truly a great honor for Merrill Corporation.”

For more information on the award, please read the press release announcement.