New Jersey - Volume XII, Number 9 - September, 2003

MEDICARE ANNOUNCES HIPAA CONTINGENCY PLAN

The Centers for Medicare & Medicaid Services (CMS), which enforces the transactions and code sets provisions of the Health Insurance Portability & Accountability Act (HIPAA), and is itself the largest covered entity under HIPAA, has announced that it will decide by September 25th whether to deploy its contingency plan should its trading partners (providers, clearinghouses, vendors) not be ready to comply with the October 16th deadline for utilizing the uniform standards. While CMS will be able to accept and process HIPAA compliant transactions, it is actively assessing the readiness of its trading partners to make sure that cash flow to Medicare fee-for-service providers will not be disrupted. CMS’ contingency plan is to continue to accept and process transactions submitted in legacy formats - as well as HIPAA compliant transactions - while their trading partners resolve problems in implementing the new standards. Physicians should document all efforts made, both before and after October 16th, to come into compliance.

MEDICARE ADOPTS FINAL EMTALA RULE GOVERNING ON-CALL LISTS

CMS has issued a final rule attempting to clarify hospital obligations under the Emergency Medical Treatment & Labor Act (EMTALA), which requires a hospital to provide an appropriate medical screening exam to any person who comes to the hospital emergency department and requests treatment. If an emergency medical condition exists, the hospital must provide either stabilizing treatment or an appropriate transfer to another medical facility. Hospitals must maintain a list of on-call physicians for providing any necessary stabilizing treatment. If an on-call physician either fails or refuses to appear when called, the hospital and the physician may be in violation of EMTALA. The new rule avoids any specific on-call requirements, but rather gives hospitals discretion (within state regulatory requirements) to develop such lists in a way that best meets the needs of their communities and permits physicians to have simultaneous on-call duties and to schedule elective surgery during on-call times. Sending and receiving hospitals continue to have specific responsibilities, under both EMTALA and state law, regarding patient transfers. The new rule does not resolve the problem of how hospitals will provide the required back-up when specialists are unavailable and the likely increase in inter-hospital patient transfers.

SEMINAR ADDRESSES PROACTIVE ASSET PROTECTION MEASURES

KACS’ Steve Holt (estate & wealth planning), Douglas Lundblad of Wachovia Wealth Management (Delaware asset protection trusts), Brian Kern of McLachlan Insurance Affiliates (malpractice market), and Paul Donnelly, Healthcare Business Planning Group (retirement & asset protection), are featured speakers in a timely and critical seminar, Preserving Your Wealth: Why Malpractice Insurance is No Longer Enough, sponsored by the Medical Society of New Jersey and the Healthcare Business Planning Group, Oct. 15th (Seacaucus), 22nd (Hightstown), & 29th (Mt. Laurel). In light of recent developments in the medical malpractice insurance market, physicians should take immediate aggressive steps to protect themselves and their families through estate and wealth planning. Learn how to take control of your financial future. Call KACS at 908-704-8585 for information; pre-registration required.

Other KACS seminars - Tort Reform:10/1, SJ Medical Office Managers, Voorhees; 11/7, NJ Ob-Gyn Society, Holmdel; 11/9, NJ Society of Medical Assistants, Piscataway; HIPAA Update: 10/2, Union, Morris, & Essex County Medical Societies, Garwood; Employment Law: 10/2, NJ Society of Oncology Managers, Atlantic City; 10/29, PAHCOM, Piscataway. Call KACS for information.  

Top of Page