The AHA and the AMA are at odds over two provisions in a final Medicare rule that give physicians more influence over hospital decisions. The final rule, which specifies how hospitals must meet the Medicare program's Conditions of Participation, requires the following: That a hospital or healthcare system cannot have a single integrated medical staff serving more than one hospital, but that each hospital must have its own medical staff, and that every hospital's governing board include a member of that hospital's medical staff.

Dual eligibles-patients eligible for both Medicare and Medicaid-could be a good target population for a physician practice if you are ready to accommodate them. Going after this pool of patients could be good strategy, but know what you're getting into.

The Supreme Court is expected to decide at the end of June whether the Patient Protection and Affordable Care Act (­PPACA) is constitutional, and whether the healthcare reform law should be overturned in full or in part, or remain intact. (The decision had still not been rendered at press time.) But regardless of the outcome, many physicians and healthcare executives emphasize that the current efforts to improve care coordination and quality and reduce costs should remain the focus of the healthcare industry going forward.

Two years after the debut of the iPad®, the devices are making inroads in all aspects of society, and healthcare is no exception. Tablets and other larger-screen devices are often able to fit into the IT picture with relatively little work. Those who are benefiting now had a virtual desktop strategy already in place.

It will take longer for vendors and healthcare IT leaders to truly leverage the power and ease of use of these devices, and for now there may be a bit of cat-and-mouse game. Rogue innovator-clinicians are being tempted by an ever-increasing number of cloud and device apps available over the Web outside traditional IT approval, while network managers rely on increasingly clever network application monitoring tools to identify protected health information being inappropriately captured, analyzed, and transmitted by these new apps.

The lingering effects of the economic recession and a modest growth in personal income are expected to continue to constrain healthcare spending through 2013. But look for a jump in spending as more provisions of the Patient Protection and Affordable Care Act (PPACA) are enacted. U.S. spending on healthcare is expected to increase by an average of only 4% between 2011 and 2013, which is slightly ahead of the historically low 3.8% experienced in 2009. Total national health expenditures for 2013 are estimated at $2.9 trillion.

The stage 2 meaningful use final rule makes it official that the second phase of attestation for electronic health records (EHR) incentive payments will begin no sooner than 2014. CMS also finalized that eligible providers (EPs) must register and attest for stage 1 meaningful use by Oct. 1, 2014, to avoid a penalty in 2015.  

Ask key questions of your practice management software vendor now to find out whether you can take advantage of a just-released final interim rule on electronic funds transfer (EFT) and electronic remittance advice (ERA). The rule, effective Jan. 1, 2014, forces payers to remove barriers and inconsistencies that cause you major EFT and ERA transaction headaches.

Eliminate days or even weeks of time it takes your providers to enroll with Medicare by uploading supporting documents to the Provider Enrollment Chain Ownership System (PECOS) website rather than sending paper copies by mail. CMS went live with this latest PECOS upgrade this month and has instructed all Medicare administrative contractors (MACs) to accept supporting documentation online.

Clustering levels of E/M services is not new but continues to be a hot topic for CMS and the HHS Office of Inspector General (OIG). Clustering means billing all of your E/M services among one or two middle-level E/M services because you reason that some will be higher and some lower and the payments will average out in the long run -- that raises two big problems for you.

Codes with similar descriptions for care plan oversight 99374-99380, physician supervision of home health services and non-face-to-face physician services 99441-99444 can make billing proper codes confusing.This chart simplifies the process of choosing the right code by breaking it down by where the patient lives, who the payer is, how much time is involved and what services the doctor performs.