Many safety net
providers don’t
meet a threshold
of 30 percent of
their patients being covered under Medicaid, so
they aren’t able
to participate
in the Medicaid
electronic health
records program.
That would
change under
legislation Sen.
John Kerry has
introduced in the
U.S. Senate. The
bill, S. 3539 and
titled “The Medicaid Information
Technology to
Enhance Community Health
Act of 2012,”
would enable
such providers
to qualify for
the Medicaid
meaningful use
program. The bill
would require
the Department
of Health and
Human Services
to promulgate
regulations no
later than Jan. 1,
2015, to establish a procedure
for the safety
net clinics to
demonstrate
meaningful use.
Senate Bill
Would MU to
Safety Net
match the complicated rules, and physicians are able to
confidently bill for the actual services they provide.
• “Obamacare is, as has been predicted, going to be prov-
en an economic disaster, and it appears that will happen
even sooner than the original fairly pessimistic forecasts. CMS
is afraid that they will (rightfully) be made the scapegoat as
costs continue to skyrocket, and the current anti-fraud stance
is as much (if not more) about positioning for failure as it is
about any real concern over rising costs. The government
has designed the system of conflicting rules and confounding
complexity which we call health care, but Secretary Sebelius
and her co-conspirators don’t seem willing to either accept re-
sponsibility for the consequences nor to have any willingness
to reverse course and stop the regulatory steamroller. It is de-
liciously ironic that they now find themselves in this position,
and that we have EMRs to thank for it.”
• “CMS as usual makes the rules so complex that it
takes a computer to follow the rules and if they are fol-
lowed, then fine everybody and see what sticks. Why not
base payment on pathways, ICD- 9 diagnoses and CPT
4 procedures performed? Or, maybe just add more gar-
bage to meaningful use and waste more time and money.
Health care strike anyone? Let’s take back health care and
spend money for care and not paper-pushing.”
TRANSACTIONS
CORE Gets OK for More Operating Rules
Department of HealtH anD Human ServiceS
Secretary Kathleen Sebelius has named the committee
on operating rules for information exchange, known as
core, as the authoring entity for rules to further standardize six Hipaa administrative/financial transactions.
The affordable care act mandated adoption of op-
erating rules, which have been under development and
voluntarily adopted for several years. The reform law
called on the national commit-
tee on vital and Health Statis-
tics, an HHS advisory body, to
recommend an authoring en-
tity. ncvHS previously recom-
mended core as the author-
ing entity for eligibility, status
and eft/era transactions,
which HHS accepted. The eligi-
bility and claim status operating rules have a compli-
ance date of January 1, 2013, with eft/era mandated
for use a year later.
ncvHS later again recommended core to author the
remaining operating rules. now, the new authority from
Sebelius means core will develop operating rules—with
a January 1, 2016, compliance date—for claims/encoun-
ters, coordination of benefits, enrollment/disenrollment,
premium payments, attachments, and referral certifica-
tion/authorization. Some of this work has been proceed-
ing in anticipation of core being the authoring entity, as
no other viable candidate presently exists.
in recommending core to complete the operating
rules, ncvHS also recommended that core explicitly collaborate with the Workgroup for electronic Data
“HHS expects
that CORE
will collaborate with all
relevant
industry stakeholders.”
—Kathleen Sibelius
interchange. While acknowledging the request was in-
tended to ensure a base level of industry participation,
HHS declined to accept the recommendation. “However,
HHS expects that core will collaborate with all relevant
industry stakeholders; HHS typically does not designate
specific organizations in this way,” Sebelius explained in
a letter accepting ncvHS’ recommendation of core.
“HHS urges independent participation by all other in-
dustry stakeholders.”
Health level Seven has been leading the work to de-
velop standards for claims attachments, with the Digital
imaging and communications in medicine coalition
doing the work for medical imaging attachments. But
the attachments work for Hl7 has gone slowly. asked if
there is concern that the 2016 compliance date could slip
for attachments, core managing Director Gwendolyn
lohse says, “There’s no doubt there’s a lot of work to do,
but it’s doable.”
