AHA calls for CMS to fix its own glitch

Health information technology promoter, heal thyself, the American Hospital Association is telling
the CMS concerning a claims processing flaw that the AHA says is preventing some physicians working with critical-access hospitals from receiving electronic health-record incentive payments under the American Recovery and
Reinvestment Act.

In a two-page letter from AHA Executive Vice President Richard
Pollack to CMS Acting Administrator Marilyn Tavenner, the AHA called on the
federal agency to fix “a claims processing limitation” that could
inappropriately exclude hundreds, if not thousands, of physicians who treat
patients at as many as 780 critical- access hospitals, according to an AHA
analysis.

The exclusions affect
the Medicare and Medicaid EHR incentive payment programs, the AHA said.

Pollack’s request is a follow-up to an AHA letter about the same problem sent
Dec. 16.

“The physicians in question are those for whom bills are submitted via the
optional or ‘Method 2’ billing approach,” Pollack wrote. Under this method, a
critical-access hospital bills Medicare on behalf of the physician for
outpatient services covered under the Medicare Physician Fee Schedule. Thus,
physician bills are submitted on the hospital’s UB-04 form instead of the Form 1500
typically used for physician claims, he said.

“Due to system constraints, the CMS does not include these Method 2 claims when
it identifies which physicians are eligible for the incentive programs,
resulting in Method 2 physicians being inappropriately excluded from both
incentive programs (Medicare and Medicaid) because they are designated as
‘hospital-based’ when they are not,” Pollack said.

He noted that in response to his December letter, Tavenner acknowledged the
problem was due to claims processing limitations, “but stated that CMS does not
plan to resolve this issue until 2014.”

This is a multifold problem, Pollack noted, because of timing constraints placed on the program by the CMS.

Under Medicare, physicians “must attest to meaningful use for 2012 in order to
receive the full benefit of the Medicare incentives.” That full benefit drops
from $44,000 for those physicians who achieve meaningful use in 2012 to $39,000
for those who do so in 2013, and continues to drop in subsequent years.

Physicians and other “eligible professionals” must have had 90 consecutive days
of meaningful use of a certified EHR in 2012 to be eligible for the Medicare
EHR incentive payment, but they still have until Feb. 28 to complete the
attestation process, Pollack noted. “Therefore, the issue is very time
sensitive,” he said.

If a physician or other eligible professional (collectively known as EPs) must
wait until 2014 for the CMS to fix the glitch, “his or her total incentive
payment would drop to $24,000—a loss of $20,000, or almost half of the total
incentive,” Pollack said. “Those EPs who are ready to attest already have
incurred the costs associated with implementing their EHRs and should receive
timely incentive payments.”

The AHA estimates the total impact of the glitch will be substantial. An AHA
analysis of claims data indicates that about 60% the roughly 1,300
critical-access hospitals use Method 2, according to Pollack’s letter.

“If we assume that each CAH (critical-access hospital) is billing for an
average of 20 EPs, a $20,000 loss per physician would amount to missed
incentives of $312 million,” Pollack said. “This is an unacceptable loss for
financially strapped rural providers who maintain access to care in underserved
areas. Therefore, we respectfully request timely action to address this issue.”

By Joseph Conn
Posted: January 14, 2013 – 11:45 am ET
Tags: Information Technology, Marilyn Tavenner, Medicaid