MACRA Released

On Friday, CMS released the MACRA final rules, its innovative payment system for Medicare replacing the sustainable growth rate formula and the EHR Incentive Program for Medicare providers.

MACRA creates the framework for providers to participate in the CMS Quality Payment Program through either the Advanced Alternative Payment Models (Advanced APMS) or the Merit-based Incentive Payment System (MIPS). The goal of these models is to reward value and outcomes, specifically supporting CMS’ goal of paying for quality and value. The MIPS program importantly consolidates components of PQRS, the Physician Value-based Payment Modifier (“VM”), and the EHR Incentive Program (aka meaningful use).

“As prescribed by Congress, MIPS will focus on: quality – both a set of evidence-based, specialty-specific standards as well as practice-based improvement activities; cost; and use of certified electronic health record (EHR) technology (CEHRT) to support interoperability and advanced quality objectives in a single, cohesive program that avoids redundancies. Many features of MIPS are intended to simplify and integrate further during the second and third years.”

Though the new rule becomes effective on January 1st, 2017, clinicians will be given a transition period in which to prepare for MIPS, with negative payment adjustments not occurring until January 1, 2019. MACRA will sunset payment adjustments under the Medicare EHR Incentive Program, PQRS and VM after CY2018. For those clinicians not ready to start on January 1st, 2017 they have until October 2, 2017 to commence participation. Regardless of when a clinician starts he/she needs to submit performance data by March 31, 2018.

CMS’ Quality Payment Program has the following strategic objectives:

(1) to improve beneficiary outcomes and engage patients through patient-centered Advanced APM and MIPS policies;

(2) to enhance clinician experience through flexible and transparent program design and interactions with easy-to-use program tools;

(3) to increase the availability and adoption of robust Advanced APMs;

(4) to promote program understanding and maximize participation through customized communication, education, outreach and support that meet the needs of the diversity of physician practices and patients, especially the unique needs of small practices;

(5) to improve data and information sharing to provide accurate, timely, and actionable feedback to clinicians and other stakeholders; and

(6) to ensure operational excellence in program implementation and ongoing development.

CMS also launched a new website with graphics to aid in understanding the MACRA regulations. The view the interactive website click here.

CMS has also provided a 24-page executive summary. Click here to view the executive summary.

If you have questions about MACRA please contact Elana Zana.


PSBJ Article on HIPAA Interviews OMW Attorney David Schoolcraft

The Puget Sound Business Journal issued an article today on HIPAA and the impact on business associates.  The article interviewed Ogden Murphy Wallace Attorney David Schoolcraft because of his expertise in healthcare privacy law and health information technology.  The article focuses on the impact HIPAA has on health IT start-ups and their relationships with HIPAA covered entities.  To read the article click here (subscription required).

Increase in Costs for Copies – But Don’t Forget HIPAA (Updated)

Effective July 1, 2013, medical providers in Washington may increase their charges for searching and duplicating medical records.  The Department of Health (“DOH”) recently released the updated fee schedule for providers. The revised charges are as follows:


Current Fee Schedule

Fee Schedule Effective
July 1, 2013

Copying for First 30 Pages



Additional Pages



Clerical Fees
(for searching and handling records)




Providers who personally edit confidential information from the record are allowed to charge their usual fee for a basic office visit.  Pursuant to HIPAA, this fee may be charged when the medical record is validly requested by someone other than the individual.

HIPAA Limitations Relating to Medical Record Requests by Patients

Though the WAC allows certain charges, HIPAA limits these charges when a patient requests duplication of his/her medical record.  Fees charged by providers may only include:

  1. Labor for copying the protected health information (whether electronic or paper form);
  2. Supplies for creating the paper copy or electronic media;
  3. Postage fees (when the individual has requested the copy by mail); and
  4. If, agreed to in advance by the patient, the cost of preparing an explanation or summary of the protected health information.

Applying both the WAC and HIPAA in combination, the clerical fee of $24.00 cannot be charged to a patient requesting a copy of his/her medical record; but a reasonable clerical fee for the labor of copying the medical record may be assessed.  Providers may not charge a fee equal to a basic office visit to the patient, but may charge a reasonable fee if a summary is provided.  Copying fees up to the maximum allowed by the WAC are permissible.  In addition, the HITECH Act amends HIPAA to allow a provider to impose a fee for the labor costs associated with copying an electronic medical record.

ICD-10 – Delayed

HHS announced yesterday its intent to delay the ICD-10 requirement.  Entities covered under HIPAA were required to comply with ICD-10 by October 1, 2013, HHS will now delay that date by a new compliance deadline yet to be announced.  To read the complete press release click here.

OIG Launches Series on Provider Compliance

In December, the Office of Inspector General (OIG) launched a webcast series on provider compliance. Currently there are six short (approximately five minutes) webcasts on topics such as fraud and abuse, the anti-kickback statutes and the physician self-referral law (aka the Stark law).    These webcasts provide a short overview of these important compliance laws.  The OIG also has sixteen webcast modules that go into further depth on fraud and abuse enforcement.  The OIG plans on posting additional webcasts on a weekly basis over the next few months.

To access the webcasts click here.  Slides and handouts are also available on the OIG compliance training website.

ACO Final Rule On Its Way

CMS has sent the Medicare Shared Savings Program regulations to the Office of Management and Budget, one of the last stops prior to being published in the Federal Register.  The Medicare Shared Savings Program will govern the administration of Accountable Care Organizations (“ACOs”). The proposed rules, issued in March, contained 127 pages of details and 65 measures related to the formation of an ACO.  Based on the backlash from industry leaders, it is expected that the final rule will contain significant changes.

Delay of Stage 2 of Meaningful Use

The Office of the National Coordinator announced yesterday at the HIT Policy Committee meeting its agreement that the Stage 2 meaningful use requirements should be delayed until 2014.  This would mean that eligible professionals and hospitals participating in the Medicare EHR Incentive Program can attest to the Stage 1 meaningful use requirements in 2011, 2012, and 2013 and will only have to begin attesting to the Stage 2 requirements in 2014.  This shift does not necessarily have an effect on participants in the Medicaid EHR Incentive Program, considering the advantage of attesting to “adopt, implement or upgrade” during the first year of the program.

To see the proposed Stage 2 requirements by the HIT Policy Committee click here.

Portion of Schedule H of Form 990 Optional For Hospitals

On June 9th, 2011 the IRS announced that it was making Part V.B. of Schedule H of Form 990 optional for the 2010 tax year.

First the IRS asked all tax-exempt hospitals to wait until at least July 1, 2011 to file their 2010 returns instead of the usual May 15 deadline. The stated purpose for the requested delay was to allow the IRS additional time to finalize their forms as well as systems to be better prepared to receive the additional information required to be submitted by charitable hospitals.  Now the IRS announces (2011-37) that they are making the newly redesigned Schedule H Part V.B., which focuses on each facility’s (1) community health needs assessment practice, (2) financial assistance policies, (iii) billing and collection practice, and (iv) charges for medical care, optional for the tax year 2010.  However, just because it all of a sudden became optional and therefore allows tax-exempt hospitals more time to analyzed the new questions and better prepare for future disclosures, it DOES NOT alleviate the fact that tax-exempt hospitals still must demonstrate how they comply with Section 501(r)’s requirements or  otherwise risk losing their tax-exempt status.

It is important to note that only a portion of Schedule H is optional and that all tax-exempt hospitals must still complete section A and C of Part V, in addition to the other parts of Schedule H.  The optional section is Part V.B., which specifically deals with Facility Policies and Practices.

Finally, the announcement continues to invite the public to comment on how to improve the clarity and reduce the burden of reporting the information related to these additional requirements.

If you have further questions regarding Schedule H of the Form 990 please contact Monica Langfeldt.

Hospital Deadline for Medicare EHR Incentive Payments Near

For those hospitals interested in applying for the Medicare EHR Incentive Payments for 2011, the last day to begin the 90-day reporting period is July 3rd.  Hospitals and CAHs must demonstrate meaningful use for 90-days during the 2011 fiscal year (which ends September 30, 2011).  Hospitals and CAHs have until November 30, 2011 to register and attest to meaningful use.

Proposed Rule on Accounting of Disclosures Issued

Following much anticipation, the Office of Civil Rights released today the proposed rules on HIPAA Accounting of Disclosures implementing the new HITECH provisions.  To access the proposed rules click here.  The proposed rules were printed in the federal register on May 31st and comments will be accepted for sixty days thereafter.