Keystone “Kurrents”
3rd Edition
November 2008
As I write this email
newsletter, we have a new president, the economy is very weak, and healthcare
challenges abound! We have reason to
hope that the next administration will take up healthcare reform, but with
money needed to prop up the sagging economy – healthcare dollars especially for
reform - may be in short supply.
Here are some
updates:
FTC Red Flag Rules
By now, you’ve
probably all gotten the news that the red flag rules implementation has been
delayed until May 1, 2009. However, we
should all continue with our efforts to set up policies and procedures to
protect, detect and mitigate identity theft.
At the very least,
you should have procedures in effect that you are checking ID at time of
registration; that electronic transactions with personal information are
secure; and what actions you will take if identity theft is expected or
reported.
Medicare Recovery
Audit Contractors (RAC) Program
Likewise, you’ve
probably heard that the RAC program roll-out is also being delayed. Because one of the contractors who bid to
become a permanent RAC contractor (PRG Shultz) was not chosen – the company is
challenging CMS’s selection of the other RAC contractors. Although this will delay RAC by a few months,
we would still be wise in continuing our RAC preparations for go live some time
in calendar year 2009. Don’t miss Day
Esquiza’s presentation on RAC at the December 10 Christmas meeting…..
HIPAA transactions
version 5010 – April 1, 2010
April 1, 2010 –
sounds very “far away” – but it is not too soon to start working on how you
will adopt 5010 standards for your claims, remittances, claims status, and
eligibility/verification transactions.
AAHAM has several
published letters on their website that were sent to Secretary Michael Leavitt
of Health and Human Services – reflecting AAHAM’s views on adoption of the 5010
standards. If you would like copies of
the letters, let me know and I will provide them to you.
I am also asking Jim
Whicker for a crosswalk of version 4010 to 5010 changes so that we have that information
for future reference. If and when I
receive that, I will forward it on.
PA Medicaid and
APR DRG’s
Please be sure to
attend the December 10 Keystone Christmas meeting, and we’ll get an update from
Tom Peifer on this topic. If you are not
aware, DPW is proposing to change the IP reimbursement from DRG’s modeled after
Medicare – to APR DRG’s (all payer DRG’s).
Not sure what this would mean to providers for grouping/pricing software
or reimbursement levels – but stay tuned.
That’s all the
updates I have for now…….just a word of encouragement: In this time of economic turmoil, there are
folks losing their jobs, in ill health, or down on their luck. Please take this time to support your local
charities and food kitchens—they suffer from lower donations during economic
downturns too. And don’t forget to bring
your food items or donations to our annual Keystone Christmas meeting December
10 in
All the best—
Linda Sheaffer, CPAM
CCAM
WellSpan Health
System
Legislative Chair –
Keystone AAHAM