In February of 2009, President Obama signed the American Recovery and Reinvestment Act (ARRA) into law. Legislation for this $789 billion economic stimulus package includes the Health Information Technology for Economic and Clinical Health Act or HITECH. Under HITECH $19 billion will be allocated to hospitals and doctors for qualified use of certified Electronic Health Records (EHR). What does this exactly mean? Does your practice qualify? The Q&A Segment below may shed some light on the matter.
- Who Qualifies for This Healthcare Stimulus?
The HITECH Act specifies that physicians can qualify for up to $44,000 (or more depending on where you practice) in economic stimulus incentives for adopting an EHR.
- Are EHR incentives per physician or per office?
EHR incentives are paid on a per provider basis. For example, a practice with two physicians and a nurse practitioner using an EHR could qualify for $132,000 in Medicare incentives.
- What types of health care providers can qualify for EHR incentives?
The American Recovery and Reinvestment Act of 2009 states that the following all qualify for HITECH incentives:
Skilled nursing facilities
Home health entities
Long term care facilities
Health care clinics
Community mental health centers
Renal dialysis facilities
Ambulatory surgical centers
Emergency medical service providers
Federally qualified health centers (FQHC)
Physicians (See below)
Practitioners (See below)
Indian Health Service providers
Rural health clinics
- What types of physicians qualify for EHR incentives?
The following types of practices can all qualify for $44,000 or more in EHR stimulus incentives according to the definitions in the Social Security Act, section 1861(r):
Doctor of Medicine or Osteopathy – M.D. or D.O.
Doctor of Dental Surgery or Medicine – D.D.S or D.D.M
Doctor of Podiatric Medicine – D.P.M.
Doctor of Optometry – O.D.
Chiropractor – D.C.
- What types of medical practitioners are included in EHR?
In addition to the list above, ARRA references “providers as defined in the Social Security Act, section 1842” as qualifying for HITECH incentives. This includes:
A physician assistant, nurse practitioner, or clinical nurse specialist
A certified registered nurse anesthetist
A certified nurse-midwife
A clinical social worker
A clinical psychologist
A registered dietitian or nutrition professional
- Which geographic areas qualify for EHR incentives?
ARRA specifies the following regions and territories as qualifying for EHR incentives:
All 50 US states
The District of Columbia
The Virgin Islands
The Northern Mariana Islands
- What types of medical practices do not qualify for EHR incentives?
The following types of practices do not qualify for incentives based on our current understanding of the program:
Free clinics that don’t bill Medicare or Medicaid
Hospital-based physicians such as pathologists, anesthesiologists or emergency physicians
Acupuncturists and other holistic providers
Any practice not eligible for Medicare or Medicaid payments
- What are the advantages of electronic health records?
Transformed Health Care Electronic Health Records (EHRs) are the first step to transformed health care. The benefits of electronic health records include:
Better health care by improving all…
- How will using electronic health records help me meet my business goals?
The Basics Using electronic health records (EHRs) can help your organization build a sustainable medical practice. While EHRs do require investments for technology and training, a fully functional –
- What will happen if Medicare and Medicaid Eligible Professionals don’t switch to electronic health records (EHR)?
The Recovery Act allows for adjustments to the Medicare physician fee schedule for Medicare providers who do not adopt and successfully demonstrate meaningful use of a certified electronic health…
- How will adopting electronic health records improve my ability to care for patients?
Moving Beyond the Paper Record With electronic health records (EHRs), patients’ health information is available in one place, when and where it is needed, so you can do a better job of managing.
- When will ICD10 be mandated?
Effective October 1, 2015, the Department of Health and Human Services (HHS) has mandated the replacement of the ICD-9-CM codes used by medical professionals to report health care diagnoses and procedures with ICD-10 codes. ICD-10 implementation will change the way coding is done.
Are you ready? Call Madrelle Medical Billing today for more information: (561) 469-6717.
- How will ICD 10 affect my Personal Injury and Workers Compensation practice?
Workers compensation and auto insurance are not required to comply with the ICD-10 mandate, to determine when personal injury and workers compensation insurance companies will require ICD-10, call the payer to make sure they are accepting ICD10 claims. Plan ahead to submit claims to them in the appropriate manner.
- Will we have access to ICD-9 codes after the deadline has passed?
IF a payer is not ready or does not qualify as a HIPAA-covered entity, you may need to submit a subset of your claims in ICD-9. Because some payers are not qualified as a HIPAA entity your software vendor should make ICD-9 codes available after October 1st 2015. To make the transition easier for you, you should be able to operate and code diagnoses in ICD-10, with your vendor converting claims to ICD-9 on your behalf for any payers not qualified to accept ICD-10.
FL PIP LAW (HOUSE BILL 119)
1. Effective July 1st 2012, an insurer may limit payment for charges only if the insurance policy includes a notice at the time of issuance or renewal that the insurer may limit payment pursuant to a schedule of charges specified in the bill.
2. An entity is deemed to be a health care clinic and must be licensed under the Heath Care Clinic Act in order to received reimbursement under the FL Motor Vehicle No-Fault Law unless exempted under FL Statute section 627.735(5)(h): Exemption if the clinic is wholly owned:
a) entities wholly owned by a medical doctor or an osteopath or the physician and the spouse, parent, child or sibling of the physician
b) entities wholly owned by a dentist or the dentist and the spouse, parent, child or sibling of the dentist
c) entities wholly owned by a chiropractor or the chiropractor and the spouse, parent, child or sibling of the chiropractor
d) a hospital or ambulatory surgery center
e) an entity that wholly owns or is wholly owned, directly or indirectly by a hospital
f) an entity that is a clinical facility affiliated with an accredited medical school.
- WHEN DOES THE HB 119 TAKE EFFECT?
January 1, 2013 is the date on which the most of the PIP changes take effect. The bill is written to automatically apply to PIP policies in effect on January 1, 2013 regardless of how a policy is written. Various parts of the bill take effect on different dates. The current PIP statute remains in effect until that time and massage therapy remains a covered benefit.
- HOW IS MASSAGE THERAPY EXCLUDED FROM PIP?
HB 119 provides that “medical benefits do not include massage as defined in s. 480.003 or acupuncture as defined in s. 457.102, regardless of the person, entity, or licensee providing massage or acupuncture, and a licensed massage therapist or licensed acupuncturist may not be reimbursed for medical benefits under this section.” This intends to deny payment for massage or acupuncture services regardless of who performs the services.
- HOW LONG MAY PIP BE BILLED FOR MASSAGE SERVICES?
Massage services may be billed until December 31, 2012. Massage therapy services will not be paid effective January 1, 2013.
- WILL NEW POLICIES HAVE TO BE WRITTEN TO REFLECT THE CHANGES?
HB 119 clearly states at lines 616 – 627 that the legislature intends that these provisions and procedures has full force and effect regardless of their express inclusion in an insurance policy form, and a specific provision or procedure authorized by the PIP statute as amended by HB 119 that shall control over general provisions in an insurance policy.
- WHAT ARE THE CONSTITUTIONAL ISSUES ATTENDANT TO EXCLUDING MASSAGE THERAPY SERVICES?
There is nothing in the Florida Constitution prohibiting the legislature from excluding a health care discipline from any statute. There are many statutes that limit a service to a particular health care discipline. There are many statutes that require action, such as a physical, that limit the performance of the physical to an allopath, osteopath or nurse. There are statutes, such as Workers’ Compensation, that limit treatment or participation of health care providers. None of these statutes have been successfully challenged as violating a provision of the Constitution.
- IS MASSAGE THERAPY THE ONLY HEALTH CARE SERVICE EXCLUDED BY HB 119?
No. Massage therapy and acupuncture are specifically excluded and chiropractic services are limited to payment of up to $2,500 for treatment of “non-emergency medical conditions,” Podiatric physicians are completely excluded from the PIP statute, as are occupational therapists and other health care professions. Those health care professions have been excluded from PIP since the 2007 rewrite of the PIP statute effective January 1, 2008.
Prior to 2008 any necessary remedial treatment or service recognized and permitted by Florida law including faith healing was included as a medical benefit under the PIP statute. This provision captured all health care providers without restrictions. The 2008 PIP statute was rewritten to exclude direct access to many health care providers.
- ARE THERE ANY CONSTITUTIONAL ISSUES CREATED BY THE HB 119 CHANGES?
ISSUE 1: IMPAIRMENT OF CONTRACTS:
Article I, Section 10 of the Constitution of the State of Florida prohibits any law that impairs the obligation of contracts. Section 8 of HB 119 imposes the full force and effect of the changes to the PIP statute regardless of their express inclusion in an insurance policy form and that shall the changes control over general provisions in an insurance policy. This means that PIP policies in effect on January 1, 2013 will be amended by the fiat of HB 119. A PIP policy is a contract between the insurer and the insured providing for certain described coverage. A PIP contract is for one-year duration, renewable at the expiration of the policy year. HB 119 changes the terms of the PIP policies in effect on January 1, 2013.
These are terms to which the parties agreed and for which the insured paid. Therefore, a strong argument exists that HB 119 impairs the obligations of PIP contracts in derogation to Article 10, Section 10 and Constitution of the State of Florida.
There may be an argument that HB 119 has the effect of denying access to courts making it invalid.
Article I, Section 21 of the Constitution of the State of Florida provides that “the courts shall be open to every person for redress of any injury, and justice shall be administered without sale, denial or delay.” Prior to enactment of the Automobile No-Fault Law in 1972 a person injured in a car crash by the negligence of another driver had the right to file suit against the driver responsible for the injuries and seek compensation for the effects of the injuries. The No-Fault Law changed that. The law mandates every private passenger vehicle owner to maintain a Personal Injury Protection policy under threat of losing the driver’s license. The law requires the PIP policy to pay for the medical treatments of car crash injuries of the passengers in the policyholder’s vehicle without regard to fault or who caused the injuries. This guarantee is in exchange for giving up the right to sue the driver who caused the injuries. The at-fault driver could only be sued for bodily injuries if stated thresholds were met as to permanency of injuries, thereby preserving the right of access to the courts. HB 119 requires a determination of the existence of a defined emergency medical condition or a “nonemergency medical condition” and services and care for the condition within 14 days of the car crash. The remedies available to an injured person who fails to obtain services and care within 14 days of an accident remain speculative until the courts resolve questions pertaining to those remedies. It may be that a bodily injury suit may be filed against the at fault driver causing the injuries. However, access to the courts would be denied if the injured person were not permitted to file suit for failure to seek services and care within 14 days of the accident. It is speculative as to whether a person permanently injured with a “non-emergency medical condition” may file a bodily injury suit against the at fault driver upon exhaustion of the $2,500 limit or await exhaustion of the full $10,000 PIP limit. Again, access to the courts is denied if it is impossible to exhaust the full $10,000 PIP benefit available to emergency medical conditions that cannot be accessed by a person qualifying only for the $2,500 limit.
- WHAT STEPS IS THE FSMTA TAKING TO CHALLENGE THE VALIDITY OF HB 119?
The FSMTA general counsel is in communication with the lawyers for the Florida Justice Association (the trial lawyers), the FCA and other members of a PIP coalition examining the constitutional issues that may be created by this complicated bill. A measured plan will result. The bill has not become law and no suit has been filed. Lawsuits to different aspects of the bill may have to wait until portions of the bill take effect. Recommendations will be submitted to the FSMTA Executive Committee on options to take at the appropriate time.
- WHAT ARE THE MAJOR EFFECTS OF HB 119?
Effective January 1, 2013 any person injured in an automobile accident will be required to obtain a determination, within 14 days of the accident, of the existence of an emergency medical condition (EMC) or a “non-emergency medical condition.” The determination of an emergency medical condition allows for up to $10,000 in PIP benefits to treat the injuries. Only MDs, DOs, ARNPs, physician assistants or hospital owned facilities are authorized to determine the existence of an EMC, chiropractic physicians are not authorized to make that determination. However, MDs, DOs, ARNPs, physician assistants or hospital owned facilities and chiropractic physicians may make the determination of a “non-EMC” Only $2,500 is provided to pay for treatment of a non-EMC.
It is unknown how an injured person who fails to obtain a determination of an EMC or non-EMC will be treated or what redress will be available, including filing a bodily injury suit against the driver causing the injuries.
- WHAT IS AN EMERGENCY MEDICAL CONDITION?
HB 119 defines EMC as: “Emergency medical condition” to mean a medical condition manifesting itself by acute symptoms of sufficient severity, which may include severe pain, such that the absence of immediate medical attention could reasonably be expected to result in any of the following:
(a) Serious jeopardy to patient health.
(b) Serious impairment to bodily functions.
(c) Serious dysfunction of any bodily organ or part.
- WILL MASSAGE THERAPISTS BE ALLOWED TO TREAT AN INJURED PERSON UNDER ANY CIRCUMSTANCE?
Yes. The exclusion of massage therapy applies only to PIP claims. A person exhausting PIP benefits may continue medically necessary treatment either under health insurance or upon filing a bodily injury suit against an at-fault driver. There are no exclusions under bodily injury claims. Massage therapy is subject to the provisions of health insurance policy or plan for people seeing treatment of their injuries using health insurance.