September 2013
The essential resource for your practice
Volume XXI, Number 9

Essential Steps for HIPAA Omnibus Rule Compliance

On September 23, 2013, the updated Health Insurance Portability and Accountability Act (HIPAA) Omnibus Rules go into effect and your practice could be subject to fines for failure to make adjustments in your policies and procedures to protect the privacy and security of your patient’s protected health information (PHI). Participation in many of the Medicare incentive programs involves compliance with HIPAA regulations. Your practice can be at risk for not only fines, but also lost incentive payments if sufficient attention is not paid to these important changes.

Table of Contents


Coding Corner:

Reimbursement Alert: Transitioning to Jurisdiction 6 (J6)

CMS Quality Resource Use Reports Available This Week

On September 16, 2013, the Centers for Medicare & Medicaid Services (CMS) will make available the 2012 Quality Resource Use Reports (QRURs) to group practices with 25 or more eligible professionals (EPs). These reports  demonstrate how a group would fare under the policies CMS has finalized for the Physician Value-Based Payment Modifier. This CMS program, mandated in the Patient Protection and Affordable Care Act (ACA),provides comparative performance information to physicians as part of Medicare's efforts to improve the quality and efficiency of medical care. CMS notes that this can be achieved by providing meaningful and actionable information to physicians so they can improve their care, and by moving toward physician reimbursement that rewards value rather than volume.

Authorized representatives of groups can access the QRURs here using an Individuals Authorized Access to the CMS Computer Services (IACS) account with one of the following group-specific Physician Value-Physician Quality Reporting System (PV-PQRS) Registration System roles:

  • Primary PV-PQRS Group Security Official
  • Backup PV-PQRS Group Security Official
  • PV-PQRS Group Representative

If a group has already registered and selected its 2013 PQRS group reporting mechanism in the PV-PQRS Registration System, then that same person who registered the group can access the group's QRUR using their IACS User ID and password. If a group does not yet have an authorized representative with an IACS account, then one person representing the group must sign up for an IACS account with the primary Group Security Official role. If a group has a representative with an existing IACS account, but does not have one of the three group-specific Registration System roles listed above, then ensure that the account is still active and add a group-specific Registration System role to that person's existing IACs account.

For The Record

The Centers for Medicare & Medicaid Services (CMS) has released a new fact sheet on how to participate in the 2013 Physician Quality Reporting System (PQRS) Medicare Electronic Health Record (EHR) Incentive Pilot Program. The PQRS-Medicare EHR Incentive Pilot Program allows eligible professionals to meet the clinical quality measure (CQM) reporting requirements for the Medicare EHR Incentive Program, while also reporting for the PQRS program by submitting their CQM data electronically.

United Healthcare Limits Number of Pathology Specimens

United Healthcare changed its Maximum Frequency Per Day reimbursement  (link removed) policy to limit the number of units CPT code 88305 Level IV - Surgical pathology, gross and microscopic examination that may be reimbursed. In this policy, United Healthcare specifically states that they will limit reimbursement of 88305 to 6 units. After receiving inquiries on the Practice Management Listserv regarding the limited reimbursement of prostate biopsy specimen examinations, the AUA’s Reimbursement and Regulation (R&R) Department immediately contacted the Chief Medical Director (CMD) of United Healthcare. According to the CMD, as long as documentation supports separately identified specimens, Modifier 59 can be used to report additional billed units. The R&R team noted that not all United Healthcare affiliates are limiting reimbursement to six units. Research the appropriate policy by the United Healthcare affiliate in your area to ensure accurate coding, billing and reimbursement. For further questions or concerns regarding this issue, please contact the Reimbursement and Regulation Department at R&