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presentation

Consequences of Non-Compliance with Federal Healthcare Reforms

September 07, 2011



As if the imminent repercussions of Debt ceiling and Sustainable Growth Rate Problem are not enough, physicians across United States are in for an additional dose of disciplining by the Federal Health body, in terms of penalties – both civil as well as criminal penalties – for either negligent or willful defiance of reforms and their deadlines. Although physicians are justified in airing their reaction and treating it as too harsh, yet the move is seen as an additional shield for the imminent Federal healthcare reforms aimed at transforming the nation’s healthcare qualitatively.

Devising a multi-pronged penalty regimen, the Federal Government has identified the mandatory programs that are required to be abided by the physicians desirous of avoiding stringent penalties that can adversely impact their credibility in the medical fraternity.

One of the areas where physicians are prone to civil and criminal penalties is the failure to comply with HIPAA mandate on healthcare reporting compliance. Depending on the severity of negligence the penalty can vary from minimum of $100 to $1.5 million, and 1 year to 10 years of imprisonment. Furthermore, the ensuing Version 5010 HIPAA Compliance – which is deemed more complex than its earlier Version 4010 – could make physicians highly vulnerable.

Another area where physicians are liable to be penalized is failure to comply by Electronic Healthcare Reporting compliance as mandated by the Health Information Technology for Clinical Health, or HITECH Act. Parallel to incentives for EHR adoption, it can also penalize Medicare and Medicaid physicians who do not adopt EHRs and use them appropriately. The penalty regimen will start with penalizing Medicare physicians for not meeting meaningful criteria in 2015: at 1 percent of Medicare allowed charges in 2015, and 2 percent in 2016 and 3 percent in 2017. Such impositions can hit solo and small physician practices hard, which may lack the resources to adopt health IT.

Putting more weight into the heavy baggage are the repercussions of imminent recommendation of Affordable Care Act – which has mandated implementation of Accountable Care Organization for incentive based payments for Medicare physicians; imminent fix to perennial Sustainable Growth Rate (SGR) problem – which forecasts either an across the board 2 percent cut to Medicare physicians, or writing off of cumulative (already around a negative 22 percent) against Medicare physician payments, which would virtually render them cashless; and last but not the least, the impact of Debt ceiling, which can limit healthcare funding substantially resulting in an adverse situation for physicians.

  • HIPAA Violations and Enforcement
  • Non-adoption of Electronic Healthcare Reporting Compliance
  • Imminent Repercussions of Debt Ceiling and Sustainable Growth Rate Problem

Physicians, left with no choice but to comply by the Federal healthcare reforms, will inevitably be driven to search for the medical billing companies who can execute compliance programs as part of their comprehensive medical billing management. Medicalbillersandcoders.com who have been industry leaders for over a decade, are ideally poised to accomplish the compliance programs on their clients’ behalf with literally hundreds of AAPC-certified medical billers nationwide across all specialties who are tech-savvy, experienced, and constantly upgrade their professional knowledge and skills. Along with these services, Medicalbillersandcoders.com offer comprehensive consultancy services for operational, strategic, and financial solutions to support you in focusing on your core competencies.

 

Category : ACA / HIPAA / Reforms