October 2013 Client Newsletter
HITECH – PATIENT’S RIGHT NOT TO BILL
INSURANCE
Patients now have the right to request providers not to bill their insurance. This change to the law was made in the 2010 HITECH Act and the new 2013 Omnibus regulations have confirmed the rule. This is part of the patient's right, under HIPAA, to "restrict disclosures" to certain parties. The government has made it clear that Medicare is one of the parties, along with private insurances, to whom disclosure may be restricted by the patient if payment is made in full.
These new rules were effective March 26, 2013 with compliance required by September 23, 2013.
OBAMACARE INDIVIDUAL PENALTIES
The Internal Revenue Service (IRS)
released a final rule detailing penalties mandated by the Affordable Care Act
(ACA) for certain individuals who don't have health insurance. Penalties begin
in 2014 and will be the greater of $95 or one percent of household income,
with these amounts set to increase in future years. There will be exemptions
from penalties in certain circumstances such as being uninsured for fewer than
three months, having a low income, objecting to coverage for religious reasons
or experiencing hardship. Individuals who would qualify for Medicaid
coverage through the ACA Medicaid expansion, but who live in states that choose
not to expand Medicaid, will also be exempt from the penalties. We believe the penalty is so low that it will
be ineffective in convincing people to buy insurance!
Those subject to the fine will have to pay it when they file their 2014 taxes. Beginning Oct. 1, those without coverage can purchase coverage through the new ACA insurance exchanges. To obtain more information on ACA exchange coverage, visit the CMS webpage.
G0179 & G0180
These codes may not be billed to Medicare within 60 days of each other or themselves. Medicare will deny due to frequency.
2012 PQRS and eRx feedback reports now available
2012 Physician Quality Reporting
System (PQRS) and E-Prescribing Program (eRx) feedback reports are now
available and must be requested through the CMS Communication Support Page.
Here you can create a National Provider Identifier (NPI)-level feedback report
request. The report will then be emailed to the address specified in
approximately 2-4 weeks, according to CMS. Taxpayer Identification Number
(TIN)-level reports are also available via the CMS QualityNet website.
TIN-level reports also require an IACS account.
Medicare Comparative Billing Report