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• The PPACA requires the creation of a protocol for physicians to self-disclose violations of the physician self-referral (Stark) law. Given that most Stark law violations are inadvertent and constitute merely technical violations of the law, the College is urging CMS to develop a disclosure protocol that provides “leeway for those who have attempted to comply; believed to a reasonable degree of certainty that they were, in fact, in compliance; and reasonably seek to remedy the situation when they determine a violation has been committed.”
• The PPACA requires physicians making self-referrals for magnetic resonance, computed tomography and positron emission tomography services to inform their patients at the time of referral about their ownership or other financial interest in imaging equipment, as well as provide them with the option of obtaining the service elsewhere. Physicians will need to provide a written list of other imaging centers that provide the service in the area in which the patient lives. The ACC is urging CMS to create a standardized notice with information on how physicians should disclose ownership interests and how lists of alternate providers are to be compiled. The ACC believes it is critical that the list of alternate sources be for the same service for which the patient has been referred, and that CMS develop a standardized, consistent method for providing accurate information to patients.
As this issue of Cardiology went to press, Congress was expected to vote any day on new legislation that could provide a short-term fix to the Sustainable Growth Rate (SGR) formula and stop the 21 percent cut slated for June 1. The fate of this bill was far from certain, particularly in the Senate, where leadership still was working to muster enough votes. The ACC continues to support a permanent solution to the flawed SGR formula, but also believes Congress must take action to avert the June 1 cuts. Stay tuned to the ACC Advocate newsletter and/or CardioSource.org for the most up-to-date information and calls to action. Meanwhile, the subject of payment reform will also be an important component of this year’s Legislative Conference, Sept. 12 – 14 in Washington, D.C. Visit the “Meetings” section of CardioSource.org to register for this event and take advantage of an opportunity to not only learn more about this issue, but also educate your members of Congress about the impact of continued Medicare cuts on cardiovascular practices and patients.
At a national level, the ACC has met with Sen. Rockefeller’s Commerce Committee staff to address the College’s concerns with the current prior authorization process, highlight the importance of properly using appropriate use criteria and guidelines and identify opportunities to assist with the congressional investigation. ACC members and practices in Delaware are strongly encouraged to notify the Delaware ACC Chapter and submit stories to the insurance commissioner if patients are inappropriately denied by this prior authorization process. Send your cases to Elliott Jacobson, Office of Delaware Insurance Commissioner at Elliott.jacobson@state.de.us. Under the law, the Centers for Medicare and Medicaid Services (CMS) must expand the current Medicare provider enrollment process to include additional methods of screening practitioners starting in 2011. CMS is required to conduct licensure checks and is permitted to conduct criminal background checks, fingerprinting, unscheduled and unannounced site visits, and other mechanisms that can be used to screen potential providers of Medicare services for fraudulent or otherwise criminal behavior. While the law originally also required the collection of an application fee for both individual and institutional providers, such as hospitals or skilled nursing facilities, the fee is no longer required for individual providers. Currently enrolled practitioners making changes to their enrollment application will be subject to the new screening process beginning in 2012. The new health reform law also permits CMS to require certain sectors or categories of enrolled providers to establish compliance programs as a condition of Medicare enrollment.