Monday, December 13, 2010

Congress Determines Red Flags Rule Does Not Apply to Physicians

Both the House and Senate have passed the Red Flag Program Clarification Act of 2010, which provides additional information on who is determined a "creditor" under the rules.

The rule clarifies the definition to state that a "creditor" does not include an entity that "advances funds on behalf of a person for expenses incidental to a service provided by the creditor to that person." This means that physicians and healthcare institutions are no longer held subject to the red flags rule.

The red flags rule would have required these entities to take precautionary measures to prevent identity theft. Groups such as the American Medical Association fought enforcement of the rule on healthcare providers, stating that the rule would be burdensome and redundant if enforced along with HIPAA protections.

The red flags rule is scheduled to go into effect on December 31, 2010.

To read more, click here:


Friday, December 10, 2010

President's Advisory Council Releases Report on Health IT

The President's Council of Advisors on Science and Technology has released a report titled, "Realizing the Full Potential of Health Information Technology to Improve Healthcare for Americans: The Path Forward." The report includes an assessment of the current health IT landscape as well as six major conclusions, which are:

  • HHS’s vigorous efforts have laid a foundation for progress in the adoption of electronic health records, including through projects launched by ONC, and through the issuance of the 2011 “meaningful use” rules under HITECH.

  • In analyzing the path forward, we conclude that achievement of the President’s goals requires significantly accelerated progress toward the robust exchange of health information.

  • National decisions can and should be made soon to establish a “universal exchange language” that enables health IT data to be shared across institutions; and also to create the infrastructure that allows physicians and patients to assemble a patient’s data across institutional boundaries, subject to strong, persistent, privacy safeguards and consistent with applicable patient privacy preferences. Federal leadership is needed to create this infrastructure.

  • Creating the required capabilities is technically feasible, as demonstrated by technology frameworks with demonstrated success in other sectors of the economy.

  • ONC should move rapidly to ensure the development of these capabilities; and ONC and CMS should focus meaningful use guidelines for 2013 and 2015 on the more comprehensive ability to exchange healthcare information.

  • Finally, as CMS leadership already understands, CMS will require major modernization and restructuring of its IT platforms and staff expertise to be able to engage in sophisticated exchange of health information and to drive major progress in health IT.

To read the full report, click here:

Article Highlights Legal Challenges to Health Care Law

The New York Times features an article on Ian Gershengorn, the Justice Department attorney in charge of defending the health reform law against states that are challenging it as unconstitutional. These states claim that Congress is overstepping its powers under the Commerce Clause of the Constitution, which allows Congress to regulate matters related to interstate trade and commerce.

To read the full article, click here:

Tuesday, November 16, 2010

NAHAM Joins HIMSS Patient Identity Integrity Work Group

NAHAM is pleased to announce that it has joined the Healthcare Information and Management Systems Society’s (HIMSS) Patient Identity Integrity (PII) Work Group.

The Work Group’s goal for 2011 is to call on the members of Congress to pursue a study for an informed patient identity solution. The Work Group will educate lawmakers using a whitepaper that identifies the complex issues that surround accurate identification of an individual’s information within and across systems, as well as the business processes that must be in place to support and maintain data integrity for quality of care.

By joining the coalition, NAHAM joins other leading organizations in the healthcare information field including HIMSS, the American Health Information Management Association (AHIMA), Health IT Now! Coalition, Association of Medical Directors of Information Systems (AMDIS), and the College of Healthcare Information Management Executives (CHIME).

NAHAM will keep you updated on the PII Work Group's activities. For more information on HIMSS, visit:

Friday, November 5, 2010

What Could the GOP Win Mean for Health IT?

Following the Republican takeover of the House of Representatives and many states on November 2nd, many began to wonder what effect it will have on health reform. A recent article in InformationWeek addresses this question.

Despite campaign talk from the GOP, the author of the article believes that health reform will not be repealed; however, it may be hindered. She believes that health IT will be one area that might suffer. Healthcare providers are just beginning to implement health IT as part of accountable care organizations (ACOs) and state health insurance exchanges. If healthcare reform, or at least provisions of it, appear to be in jeopardy, the author believes that hospital CIOs and CFOs will be more hesitant to continue investing in health IT.

During this lame-duck session, it will be interesting to see what actions the Democrats will take to preserve health reform as is, before they lose control of the House. Meanwhile, many will be watching to see if the Republicans truly take an aggressive approach at overhauling the plan once they are sworn in. NAHAM Government Relations will continue to monitor developments in Washington and report them to you. In the meantime, share your thoughts and comments on the election results in the comment field and in the poll on the NAHAM News homepage.

Source: InformationWeek

Monday, October 25, 2010

State Insurance Commissioners Vote to Approve More Stringent Rules

The National Association of Insurance Commissioners voted unanimously to endorse standards requiring that "80 percent of premium revenue be spent on medical care and 'activities that improve health care quality' for patients." This requirement was set in place by health reform legislation.

The standards set limits on what revenue spending is defined as improvements to health care quality, and what is considered to be compensation or administrative spending. The goal of the standards is to make insurance companies function more as providers of healthcare and less as for-profit companies.

Secretary of Health and Human Services Kathleen Sebelius is expected to take the recommended standards and propose them as a new regulation for insurance companies. Opponents of the recommendations argue that they will negatively disrupt the insurance industry by forcing companies out of business and reducing consumer choice.

Source: The New York Times

Tuesday, September 28, 2010

HHS Announces Completion of Nationwide System to Assist with EHR Adoption

David Blumenthal, M.D., the national coordinator for health information technology, has announced that the final Regional Extension Centers (RECs) have been selected. The RECs are organizations that will be responsible for assisting healthcare entities with the transition from paper-based medical records to electronic health records (EHRs).

The RECs were created through the HITECH Act, which set aside $677 million to fund the RECs for two years. The RECs are focused on helping rural facilities and small practices that may not have the resources needed for the smooth adoption of EHRs. The RECs will provide assistance to physicians in these settings to ensure that EHRs are adopted nationwide.

For more information and a list of the RECs, click here:

Source: US Department of Health and Human Services

Thursday, September 23, 2010

Six Major Health Reform Provisions Effective Today

Today, six of the major provisions of the Affordable Care Act go into effect. They are:

  • Extended coverage for young adults under their parents' plan
  • Plans must offer free preventative care services
  • Insurance companies are prohibited from rescinding coverage if a person becomes sick
  • The ability for Americans to select between two appeal processes when challenging an insurance decision
  • Elimination of lifetime caps on coverage
  • Regulation of insurers' ability to set dollar limits on coverage

To read more details about these provisions, click here:

Curious about when the other provisions of the Affordable Care Act will go into effect? Click here to see a full timeline of changes that will occur:

Sources:, EmblemHealth

Tuesday, September 21, 2010

Secretary Sebelius Urges Insurers to Stop Blaming Premium Increases on Health Reform

Secretary of Health and Human Services Kathleen Sebelius has written a letter to America's Health Insurance Plans (AHIP), urging their members "to stop using scare tactics and misinformation to falsely blame premium increases for 2011 on the patient protections in the Affordable Care Act."

According to the Secretary, several companies have already started informing customers that increases in premiums were occurring due to health reform provisions. Her letter provides a summary analysis of how the Affordable Care Act will have a minimal impact on plan costs.

Text of the Secretary's letter can be found here:


Monday, September 13, 2010

HHS Prepares for Insurance Changes by Emphasizing "Health Literacy"

An article in Bloomberg Businessweek discusses one step that the Department of Health and Human Services (HHS) is taking to ensure that Americans are prepared for the health insurance exchanges scheduled to begin in 2014 by promoting "health literacy."

The article defines health literacy as "the capacity to obtain, process and understand basic health information to make appropriate health decisions." The article also mentions that only about one-third of American adults possess what is considered a basic level of health literacy.

HHS has developed a National Action Plan to Improve Health Literacy by 2014. Strategies include improving access to health information and using more basic terminology when communicating health issues to the public.

The Bloomberg Businessweek article can be found here:

The National Action Plan to Improve Health Literacy can be found here:

Source: Bloomberg Businessweek

Tuesday, August 24, 2010

AHA Spends $4.2 Million in Lobbying in Second Quarter

The American Hospital Association (AHA) boosted its lobbying budget this year, spending $4.2 million in the second quarter. The AHA lobbied on a diverse range of issues, including health reform, patient access to services, and malpractice reform.

As healthcare reform is implemented, it is expected that the AHA and other advocacy groups will continue to boost their lobbying efforts.

To read more about the AHA's efforts, click here:

Source: Bloomberg Business Week

Wednesday, August 18, 2010

States Receive over $46 Million to Monitor Insurance Costs

The Department of Health and Human Services has awarded over $46 million to 45 states and the District of Columbia in order to better monitor hikes in insurance premiums.

The grants were awarded under the Patient Protection and Affordable Care Act. The funds will allow states to create and upgrade technology to better monitor proposed insurance premium increases. The goal is to promote competition in the insurance market by making information more transparent and accessible to consumers. There are also 26 states, plus the District of Columbia, that have the authority to reject excessive and unfair premium rates. A monitoring system will help these jurisdictions enforce this power.

To read more about this grant program, click here:


Wednesday, August 4, 2010

Patient Access Should Prepare for the Rise of Preventative Care

A major provision of healthcare reform is the expansion of preventive care. Americans will be encouraged by their health plan to receive care to prevent illness. Currently, many patients have felt pressured to forgo needed, preventive care, due to high co-pays, deductibles, and coinsurance. Finally, these financial barriers to care are being eliminated through The Patient Protection and Affordable Care Act.

Effective September 23, 2010, new plans from private insurers will be required to eliminate co-pays, deductibles, and coinsurance for preventive services. Medicare and Medicaid will follow suit on January 1, 2011. This provision will have a positive impact on the heath of our communities.

Patient Access leaders can prepare for this provision in a number of ways:

1. Analyze current volumes of preventive services/screening exams and develop methods to track new volumes, beginning January 1, 2011. Some examples are screening exams for: cardiac conditions, diabetes, cancer, prostate illness, prenatal care, and wellness for women and infants.

2. Educate staff that collections are not necessary for preventive care/screening exams and exclude these services from identified opportunity.

3. Increase competency, through training and education, on interpreting on-line eligibility data, benefits and identifying preventive care exams.

AAFP American Academy of Family Physicians
Agency For Healthcare Research and Quality

Michael Sciarabba MPH, CHAM is a member of the NAHAM Government Relations Committee.

Monday, August 2, 2010

Insurers Continue Debate on Health Care Reform

Under the health care reform plan, insurers are required to spend a minimum of 80% of each dollar collected in premiums on patient welfare. Insurance groups are currently battling with regulators as to what this requirement should translate into when written into rules.

Some insurers argue that credentialing and other quality improvement costs should be included in the 80% amount since they help to improve the delivery of care to patients. Meanwhile, consumer groups argue that this is an attempt by the companies to get away with charging consumers high administrative costs.

The following article in the The New York Times details the sides in the debate and provides a picture of the current landscape as regulators work to enact health care reform:

Source: The New York Times

Friday, July 23, 2010

Medicare Fraud and its Implications

This week, dozens of indviduals were arrested for Medicare fraud totaling $251 million.

Ending Medicare Fraud is a top priority for the government and a critical component to paying for healthcare reform. The far reaching impact of this fraud (across five states) should have Hospitals on high alert. Patient Access leaders need to continue their efforts to ensure Medicare compliance i.e., accurate screening processes for eligibility, secondary payer, and medical necessity.

To read the full article in The New York Times, click the link below.

Tuesday, July 13, 2010

Study Highlights Primary Care Shortage

A George Washington University study shows that medical schools are continuing to produce more graduates going into research and specialty professions and not enough primary care doctors. The study also found that graduates of public medical schools were more likely to promote a "social mission," encouraging graduates to go into primary care, especially in underserved communities.

Many analysts believe that the continued shortage of graduates entering the primary care field is due to the low reimbursement rate. After graduating with massive debt, graduates are hesitant to select a field that pays an average of $124,000 a year, the lowest rate among physician specialties.

The new health reform law sets aside $1.5 billion in funding for primary care physicians who work in underserved areas. Some hospitals are also working to attract physicians into primary care, fearing that without first-line care, patients will flood their emergency rooms with minor and preventable conditions. This study and others that have been released, continue to serve as indicators that improvments to the delivery of care are needed to support an increased patient population.

The full George Washington study can be found here:

Monday, June 28, 2010

21 Percent Physician Reimbursement Cut Delayed

On June 25, President Obama signed The Preservation of Access to Care for Medicare Beneficiaries and Pension Relief Act of 2010.

The law cancels a 21 percent physician Medicare reimbursement cut that CMS began enforcing on June 18. The law also increases physician reimbursement by 2.2 percent through November.

The temporary increase is a sign that Congress still needs to take action to address the sustainable growth rate, which factors into the reimbursement rates. There have been estimates that the physician payment cut may reach as high as 30% by January if Congress does not find a long-term solution, or implement another "patch" when the reimbursement increase expires in November.

CMS will begin processing all claims at the new rate by July 1.

Source: BNA

Wednesday, June 23, 2010

President Obama Urges Insurance Companies to Control Costs

On Tuesday, President Obama urged insurance companies not to increase the price of premiums despite the rising cost of healthcare and health reform. Health reform does not allow the government to regulate the cost of insurance; however, there are safeguards in place such as requirements that companies be transparent with cost increases, and exchanges that allow for competitive markets.

This warning from the President is a reminder that the health reform plan passed by Congress will not be the final solution to solve current problems with healthcare costs and access. In addition to the government, insurance companies, hospitals, healthcare professionals, and everyone involved in the delivery of care must work together to create a better healthcare system.

Source: The New York Times

Monday, June 21, 2010

FTC Expected to Grant Temporary "Red Flags Rule" Exemption to Health Care Providers

An attorney from the Federal Trade Commission's (FTC) Office of General Counsel says that the agency is close to completing an agreement that would give health care providers a temporary exemption from the "red flags rule."

The exemption would remain in place until the U.S. District Court for the District of Columbia makes a decision in the AMA v. FTC case. The American Medical Association brought the suit against the FTC, to prevent the agency from enforcing the rule against health care professionals.

The attorney for the FTC stated that the agency should reach an agreement on the temporary exemption in the next few days.

Source: BNA

Wednesday, June 16, 2010

AMA and GWU Focus on Need for More Physicians

The American Medical Association (AMA) adopted new measures to address the growing physician workforce shortage. The AMA is pushing for public and private payers to increase the number of residency positions for new graduates. The new policies will also focus on attracting students from underserved areas into the medical profession, with the hope that they will return to their communities to provide needed care.

The AMA's announcement comes as a George Washington University (GWU) study is released, stating that medical schools are not producing enough primary care doctors to meet patient needs. The study noted that public medical schools were more likely than prestigious private schools to produce primary care physicians, since the public schools were more likely to advocate a "social mission" or community care mission. The study also notes that the primary care shortage is mainly rooted in the fact that medical school graduates with massive debt are more likely to choose research or specialty positions over a low-paying primary care profession.

The health reform plan sets aside $1.5 billion for primary care doctors interested in working in underserved areas. Hospitals are in support of efforts to boost the primary care field, fearing that their emergency rooms will be flooded with patients if they are unable to access primary care treatment.

Sources: PRNewswire

The Baltimore Sun,0,6289224.story

Thursday, June 3, 2010

Expect Questions on Medical Coverage for New Graduates

One of the popular provisions of the health care reform plan allows young adults to stay on their parents' health plans until age 26. Currently, many young adults are removed from their parents' plan when they complete school. This has posed a problem for many new graduates who were unable to find employment immediately after school, or who were offered jobs or internships without coverage.

Although many are excited about this new provision, there are some who may be ineligible due to a coverage gap. An article in the New York Times states that the law goes into effect on September 26 of this year, but employers are not legally required to comply until January 2011. As a result, this year's graduates hoping to rely on their parent's coverage may have to wait if their parents' employers do not revise their plans immediately.

Patient Access staff may see an increase in questions from parents and patients regarding whether or not adult children are eligible under their parents' plan. This will include answering questions about whether or not the child is eligible for coverage under a parents' plan if he or she is employed, and if and when children would be eligible to rejoin their parents' plan if they were employed but lost their job.

Financial counselors and other access staff will need to work with patients and their families to determine eligibility in coverage, and if gaps in coverage do occur, what can be done to cover those gaps.

Source: New York Times

Brenda Sauer, CHAM is the Chair of the NAHAM Government Relations Committee.

Tuesday, June 1, 2010

"Red Flags Rule" Delayed Again until December 31

Implementation of the "red flags rule" has been delayed by the Federal Trade Commission (FTC) until December 31, 2010. The delay gives Congress time to determine whether or not healthcare providers should be subject to the rules.

There are currently two bills in Congress that would create exemptions for healthcare providers. S. 3416 has been introduced in the Senate. H.R. 3763 would exempt providers with 20 or fewer employees from the rule.

This most recent delay follows a challenge by the American Medical Association and several other medical groups, claiming that healthcare providers should not be defined as "creditors" subject to the rule.


Monday, May 24, 2010

AMA and Others Challenge "Red Flags Rule"

On May 21, the American Medical Association (AMA), American Osteopathic Association (AOA), and the Medical Society for the District of Columbia (MSDC) filed a lawsuit against the Federal Trade Commission (FTC), challenging the FTC's definition of "creditors," under the "red flags rule," which currently includes licensed health care professionals because they usually defer payment for services until insurance reimbursement is received.

The "red flags rule" requires creditors to implement procedures to prevent and monitor identity theft by June 1. Application of this rule would require financial investment and changes in current policies and procedures. In January, health professional organizations sent a petition to the FTC, arguing for the removal of licensed health care professionals from the rule. The medical groups argue that the rule is intended to apply to banks, large creditors, and other groups, not to medical professionals.

Implementation of the rule has been delayed several times due to various challenges from other affected professions. The American Bar Association has already obtained a decision from the US District Court for the District of Columbia, stating that lawyers are exempt from the rule. Congress has also taken action, exempting small businesses. The current implementation date for the rule is June 1. In the meantime, the AMA will provide physicians with information on how to comply with the rule until a decision in the lawsuit is reached.

Source: BNA

Friday, May 21, 2010

Are You Ready for Point of Origin Codes?

New Point of Origin codes go into effect on July 1, 2010. Anissa Fabrizio, RHIA, CCS, of St. Anthony Central Hospital in Denver, CO wrote a piece on how her facility is preparing for the change with training for registration and coding staff.

To read the full article, click here:

The CMS Transmittals on the Point of Origin codes can be found here:

Source: MIC Monitor

Monday, May 17, 2010

Dartmouth Physicians Stress Importance of Coordinated Care

In a Washington Post column, Jim Yong Kim, president of Dartmouth College, and James M. Weinstein, president of the Dartmouth-Hitchcock Clinic, believe that the next test of health reform is how the healthcare system will provide cost-effective quality care to the millions of Americans who now have coverage.

Kim and Weinstein believe that the solution lies in the way healthcare is delivered, calling for fixes to the delivery system. Among the changes suggested include a universal patient medical record that will ensure that healthcare professionals receive up to date, accurate information on a patient's conditions and medications as he or she is moved through the continuum of care.

Dartmouth has established the Center for Health Care Delivery Science to bring together researchers who can help find a way to improve the delivery of care so the goals of health care reform can be achieved.

To read the Washington Post column, click here:

To learn more about the Dartmouth Center for Health Care Delivery Science, click here:

Tuesday, May 11, 2010

Recurring Outpatient Registration Implemented in Ohio Hospital

The News Messenger reports that Bellevue Hospital in Bellevue, Ohio has implemented the Recurring Patient Registration System in response to a patient's request for an easier outpatient registration process. The system allows patients coming to the hospital for recurring lab or Family Birthing Center visits to register once per quarter with the Patient Access Department. Once registered, patients can go directly to the lab or Family Birthing Center for their services without registering each visit.

According to director of revenue cycle and quality management Marianne Schoen, the program was created because a patient visiting the hospital several times a week for an ultrasound to monitor her pregnancy asked why she had to register each time if the hospital already knew the reason for her recurring visits and had her information.

The article reports that 300 patients have registered in the program.

Source: The News Messenger

Thursday, May 6, 2010

HHS Requests Information on Disclosures of Protected Health Information

In the May 3, 2010 issue of the Federal Register, the Office of Civil Rights of the Department of Health and Human Services has issued a request for information regarding the implementation of the Heath Information Technology for Economic and Clinical Health Act (HITECH Act). HHS requests information to help them understand the interests of individuals regarding the disclosure of their protected health information (PHI) and the administrative burdens that would be placed on healthcare and business entities covered under the act in order to account fro such disclosures.

HIPAA-covered entities are currently required to provide an account of certain PHI disclosures to a patient upon request. The HITECH Act would expand this rule to require covered entities to account for certain disclosures of PHI contained in a patient's electronic health record. HHS is seeking information from the public to assist in the drafting of this expanded rule.

The Federal Register announcement includes 9 questions that they would like commenters to answer. A list of the questions, along with information on how to submit comments can be found here:

Comments are due by May 18, 2010

Monday, May 3, 2010

New HIT Implementation Goals Announced

David Blumenthal, national coordinator for health information technology for the Department of Health and Human Services, announced that the agency will be selecting 15 communities as pilot sites that will work with HHS and the states in implementing health information technology and regulations.

This spring, CMS will issue the final regulation on "meaningful use" and the Office of the National Coordinator will issue regulation on certification standards for electronic health records (EHRs). CMS and ONC are currently reviewing comments collected last winter, which urge the agencies to consider the pace at which health IT and EHRs must be adopted and held to a high-functioning standard of use since there is not a solid infrastructure in place yet.

Blumenthal indicated that HHS is also working on regulations to ensure the flow of data and to ensure that penalties are in place when patient data is breached.

Source: BNA

Friday, April 30, 2010

Summary of Major Health Reform Provisions

After months of heated deabate, Congress passed a health reform package which was signed into law by President Obama in March.

NAHAM has provided a summary of the major provisions included in the final health reform plan. Most of the changes affect changes to the payment system and do not have a direct impact on the daily work of healthcare access managers. However, now that health reform has passed in Congress, there is still much work to be done by the federal agencies in order to put the rules and regulations of health reform into place.

The plan expands access to care, but contains few provisions on the need for more administrative staff and better technology that will help improve efficiency, reduce admission wait times, and move patients through the continuum of care. These are issues that will need to be addressed as facilities will likely see an increased patient load. NAHAM will communicate with policymakers to ensure that these issues are addressed as health reform is implemented.

To read the NAHAM Health Reform Summary, click here:

Welcome to the NAHAM News Blog!

Staying on top of what’s happening in healthcare is the best way to ensure that we are prepared for the latest standards, regulations, and policies that will affect our work as healthcare access managers.

On behalf of the NAHAM Government Relations Committee, I would like to welcome you to the NAHAM News blog! The NAHAM Government Relations Committee has developed the NAHAM News blog to provide you with a one-stop resource for the latest news relevant to healthcare access management.

The blog will provide updates on regulatory updates, accreditation agency announcements, federal legislation, and general health care news. The blog will also feature commentary on issues from members of the NAHAM Government Relations Committee. Below each post, you will find a comment field. I encourage you to use this field to post your thoughts on the latest issues, engage in conversation with patient access managers across the country, and to ask questions to the members of the NAHAM Government Relations Committee.

In the coming year, NAHAM will continue building our presence as a healthcare leader by establishing relationships with like-minded industry groups and new policy-makers in Washington, and by taking proactive steps to make an impact on developing healthcares standards and regulations. I hope you will be able to see that NAHAM will not just deliver the news, we’ll be making news.

We hope you find the NAHAM News blog to be a valuable resource and we welcome any comments, questions, or news tips at

Brenda Sauer, CHAM is the Chair of the NAHAM Government Relations Committee.