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Your Top Healthcare Reform Questions Answered

Physician practices know there is a lot to understand about the various healthcare reform policies. With so many changes—from reform to ICD-10 to value-based care models—it can often be overwhelming to work through all of the updates. You’re not alone if you’ve found the details to be a little complicated and hard to work through. To help you and your practice understand some of the major changes from recent reform, we’ve answered some of your top questions.

Does mandatory repayment refer exclusively to CMS and not to private insurance?

The proposed mandatory repayment rule only refers to Medicare/Medicaid payments and does not cover overpayments by private payers. Contracts between your practice and each payer should cover similar rules that align with individual payer policies to safeguard your practice.

Does Meaningful Use (MU) include University Student Health Centers?

Potentially—eligible professionals, hospitals and critical access hospitals can receive MU incentives, even if they are part of a University. If you work at one of these organizations, the best next step, in our opinion, is to review the eligibility requirements for Medicare and Medicaid MU incentives and then determine which individual practitioners in your organization are eligible for the program.

In regards to MU, if a physician left our practice in November 2012 and their National Provider Identification (NPI) was terminated with our facility, where will the incentive payments go?

The payments will go to the individual physician who has completed the certification and proper forms, so payment status will depend on the information the physician provided. If he or she has received the payment, you may have a difficult time getting the money back unless the physician’s employment agreement explicitly provided that the practice was entitled to the funds.

Can specialty practices create an ACO? Why might physician offices join other practices?

Specialty practices can create an ACO; however, they should consider that in order to be an ACO, they must have 5,000 primary care Medicare patients. Therefore, they need to make sure they have an adequate number of primary care physicians to serve this population. It could be helpful for individual specialty practices to join together to help with the high cost of running a practice and to help ensure each patient can be cared for within the ACO.

Do you have additional questions about healthcare reform or other industry-wide changes? Let us know in the comments section below.