Medicare Compliance & Reimbursement

Plus: HIPAA violation of $100,000 stuns health plan. If you've ever wondered just how vast the Medicare program is, just take a look at the new June 2008 MedPAC Data Book, which offers a glimpse into the specifics of the Medicare program. According to the MedPAC report, released on July 18, Medicare spending accounts for 22 percent of the $1.76 trillion spent annually in the U.S. on personal healthcare. In addition, the report reveals that the average age of a Medicare patient is between 65 and 74 years, although per-capita expenditures were greatest in patients between the ages of 75 and 84, at $11,026 per patient. You can read the complete MedPAC document at http://medpac.gov/document_TOC.cfm?id=428. In Other News ... • Practices that believed HIPAA was "out of sight, out of mind" are sorely mistaken. Last week, CMS announced that one health plan had to pay a $100,000 "resolution" to the Department of Health and Human Services (HHS) for violating patients' protected health information (PHI). The charge? The health system left laptops, backup tapes and optical disks unattended. The devices, which all held PHI on them, "were subsequently lost or stolen, compromising the protected health information of over 386,000 patients," according to the HHS release. After the company informed the patients of the theft, over 30 patients complained to HHS. You can read the details of this action on the CMS Web site at http://www.hhs.gov/ocr/privacy/enforcement/. • Officials from CMS, the American Academy of Family Physicians (AAFP) and the Department and Health and Human Services (HHS) offered a glimpse of where they see the e-prescription program going during a July 21 conference call. An Institute of Medicine report revealed that over 1.5 million Americans are injured annually by drug errors, and another study noted that pharmacists make more than 150 million phone calls per year to physicians to clarify what was written on a prescription, HHS Secretary Mike Leavitt said during the call. "That's a lot of people needlessly hurt and a lot of time spent trying to sort out bad handwriting." Bonus: "Beginning in 2009 and over the following four years, doctors will be eligible for additional payments from Medicare when they prescribe electronically," Leavitt said. "The first year they will get two percent extra, the next year one percent, and from 2011 and on, they will get a half a percent." By 2014, CMS will phase out the bonus payments and physicians who aren't e-prescribing will face penalties. "We expect that this will have a profound affect on the adoption and use of e-prescribing," Leavitt said. For a replay of the CMS call, dial 800-839-7073.