Physicians First CEO Leslie Witkin to host 2012 Healthcare Policy & Coding Update conferences

As of Jan. 1, physicians who haven’t upgraded their computer system while also not working with an outside agency capable of utilizing HIPAA 5010 won’t get paid—by any payer. The change marks one of many significant adjustments hitting physician practices in 2012.

“The perfect storm brewing for years is about to have its greatest impact. Especially this year, I’ve become even more concerned with the staggering list of regulations that medical businesses face, never mind the ongoing threat for record audits and recoupments by any number of government agencies. Next year – 2012 – is a key year for practices to really get a handle on many of the initiatives because what they do or don’t do in 2013 will determine whether they’re penalized for several of the initiatives in subsequent years,” said Physicians First CEO Leslie Witkin, hostess of the 2012 Healthcare Policy & Coding Update audio conferences on Dec. 14 and Jan. 11, 2012. A graduate of the Dartmouth-Hitchcock School of Nursing in New Hampshire, Witkin founded Florida-based Physicians First Inc. in 1990. “In addition to each one of these initiatives requiring operational change, they carry a price tag. The main focus of a physician’s business has always been to take care of patients, which is time consuming.”

Witkin’s audio conference will take place from 1 p.m. to 2:30 p.m. on both Wednesdays for administrators, practice office staff, and billing and practice managers. An update on the 27.4 percent decrease to the Medicare conversion factor, an overview of critical Physician Quality Reporting System (PQRS) bonus and penalty provisions for 2012 and 2013, and an overview of CPT 2012 changes will be covered during the program.

“ICD-10 is another huge initiative,” noted Witkin. “Physicians must be compliant and use diagnosis codes as of Oct. 1, 2013. Preparing for a massive change with ICD-10, 2012 should be your year to start moving in that direction. ICD-10 carries with it expense, education, and a complete revamp of operations. It’s not an easy task.”

Other hot-button issues to be covered during the program: multiple procedure payment reductions for the interpretation of imaging services; e-prescribing bonuses and penalty provisions for 2012 and 2013; implementation of the value-based modifier to adjust physician payments, with the next two years making the greatest impact; changes to attestation in the EHR incentive program, and added requirements to Medicare’s Annual Wellness Visit (AWV) benefit.   

“We’ll also talk about expansion of the CMS initiative to review overvalued codes across all specialties and Medicare enrollment revalidation,” said Witkin, who’s heavily involved in the Medicare Part B side of the physician environment.

In planning for the year ahead, most administrative queries for Witkin center on the Sustainable Growth Rate (SGR) formula.
“Instead of allowing reimbursements to go down – a significant burden for any business – Congress has always stepped in at the last minute and said, ‘Don’t worry; we won’t allow the cut to happen.’ They’ve never fixed the formula. They’ve simply kicked the bucket down the road. Every year, the next cut is deeper, and the cost of providing a long-term solution has gone from $48 billion in 2005 to almost $300 billion today.”

For the January audio conference, Witkin will also discuss eleventh-hour changes Congress may have made by Jan. 1. 

“Usually the way it works out every year is that Congress steps in and maybe freezes payments or gives a 1 percent update,” she said. “Then sometime in July, CMS comes out with proposed regulations for the upcoming year in the Medicare program and publishes the final regulations around Nov. 1. The final regulations for 2012 came in the form of a 1,200-page document. That’s certainly not a document that anyone in a physician practice has time to read. That’s where I come in.”

PQRS, for example, is moving into a “perfect storm” that’s been brewing for years.

“Now we’re moving to the tsunami,” she said. “Starting in 2015, if a practice isn’t successfully PQRS reporting, their reimbursements will go down by 1.5 percent. CMS is going to make the decision whether to penalize people in 2015 based on what they do or don’t do in 2013. So I say to practices: 2012 is the year you’re going to have to get yourselves educated and understand PQRS. It’s not something you implement overnight.”

By the end of her programs, attendees are typically overwhelmed by burgeoning regulatory changes.

“Education is a big part of our work, especially about PQRS,” said Witkin. “If you’re starting from scratch, CMS has an excellent website with all of the details you need regarding PQRS. But it’s so voluminous that you can spend the rest of your life there trying to figure it out. I break it down so they can understand it. They’re not going to come to the end of this hour-and-a-half audio conference understanding everything related to PQRS, but they’ll know the broad strokes.”

Editor’s Note: Florida Medical News will continue Tuning In via the monthly feature, In the Know, to discuss each regulatory change more in depth throughout 2012. For additional information on upcoming audio conferences, visit www.physiciansfirst.com.   

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