The proposed Stage 1 criteria for meaningful use focus on electronically capturing health information in a coded format, using that information to track key clinical conditions, communicating that information for care coordination purposes, and initiating the reporting of clinical quality measures and public health information. Stage 1 begins in 2011 and CMS proposes 25 objectives/measures for Eligible Professionals (EPs) that must be met to be deemed a meaningful EHR user. Furthermore there is proposed additional specialty measures of which oral and maxillofacial surgery may be included in the Proceduralist/Surgery category. All of the results for all objectives/measures, including clinical quality measures would be reported by EPs to CMS, or for Medicaid EPs to the states, through attestation. In 2012, CMS proposes requiring the direct submission of clinical quality measures to CMS (or to the states for Medicaid EPs) through certified EHR technology. Stage 2 would expand upon the Stage 1 criteria in the areas of disease management, clinical decision support, medication management, support for patient access to their health information, transitions in care, quality measurement and research, and bi-directional communication with public health agencies. CMS may consider applying the criteria more broadly to both the inpatient and outpatient hospital settings. Stage 3 would focus on achieving improvements in quality, safety and efficiency, focusing on decision support for national high priority conditions, patient access to self management tools, access to comprehensive patient data, and improving population health outcomes.

Additional information on meaningful use and the proposed rule can be found at http://www.cms.hhs.gov/Recovery/11_HealthIT.asp and http://www.healthit.hhs.gov.

For more guidance on reporting consultation services to Medicare see the January 2010 AAOMS Advocacy e-Newsletter and related article on the Practice Management pages of the AAOMS web site.

Medicare will also no longer recognize the consultation codes for purposes of determining Medicare secondary payments (MSP). In MSP cases, physicians and others must bill an appropriate E/M code for the services previously paid using the consultation codes. If the primary payer for the service continues to recognize consultation codes, physicians and others billing for these services may either:

• Bill the primary payer an E/M code that is appropriate for the service, and then report the amount actually paid by the primary payer, along with the same E/M code, to Medicare for determination of whether a payment is due; or

• Bill the primary payer using a consultation code that is appropriate for the service, and then report the amount actually paid by the primary payer, along with an E/M code that is appropriate for the service, to Medicare for determination of whether a payment is due.

Note: The first option may be easier from a billing and claims processing perspective.

AAOMS members should be aware that this is a practice choice. The decision to bill one service to two separate payers with two different codes should be made only after careful consideration of the administrative concerns associated with doing so.

CMS has stated the delay will give physicians and non-physician practitioners who order items or services for Medicare beneficiaries or who refer Medicare beneficiaries to other Medicare providers or suppliers sufficient time to enroll in Medicare or take the action necessary to establish a current enrollment record in Medicare prior to Phase 2 implementation.

A current enrollment record is one that is in the Medicare Provider Enrollment, Chain and Ownership System (PECOS) and also contains the physician/non-physician practitioner's National Provider Identifier (NPI). A physician or non-physician practitioner who orders or refers and who does not have a current enrollment record that contains the NPI will cause the claim submitted by the Part B provider/supplier who furnished the ordered or referred item or service to be rejected.

OMSs and general dentists will in fact be required to enroll in Medicare and be registered in PECOS in order to refer and / or order services, when those services are of the kind requiring ordering / referring provider information. AAOMS is encouraging all members to verify their enrollment information in the Internet-based PECOS system, regardless as to when enrolled in Medicare.

CMS has made available a downloadable PDF file of National Provider Identifiers (NPIs) and names (last name, first name) of all physicians and non-physician practitioners who are of a type/specialty that is legally eligible to order and refer in the Medicare program and who have current enrollment records in Medicare (i.e., they have enrollment records in PECOS). It is a PDF file containing approximately 800,000 records and will be updated periodically to include changes in enrollment records. Providers are encouraged to check this list to see if those from whom referrals for services are received, are in fact listed.

AAOMS members are encouraged to continue watching the latest news section of the Practice Management and Allied Staff pages of the AAOMS web site, monthly AAOMS Advocacy e-Newsletters, the AAOMS Today and other AAOMS news vehicles for updates on this issue as they become available.

For more information, please visit OSHA's Respiratory Protection page or the Department of Labor's YouTube channel.

• Practice Management Stand Alone Meeting - April 24
• Advanced Protocols for Medical Emergencies - April 24-25
• Beyond The Basics Coding Workshop - April 24-25
• Anesthesia Assistants Skills Lab - April 25
• The OMS Billing Conference - April 26

While Business associates have traditionally been bound by Business Associate Agreements with covered entities to keep PHI safe and secure, now Business associates are required by law to do so and the failure to do so can result in civil and criminal penalties and heavy fines. For further guidance on the changes to Business Associates, please see the November/December 2009 PM Notes.

In addition to the accountability of business associates, there are many changes to HIPAA under HITECH. The most significant provisions of HITECH include the following: (1) Increasing enforcement of existing HIPAA privacy and security regulations); (2) Increasing penalties for violations of existing HIPAA regulations; and (3) Adding a new federal breach notification law; Please find a summary of what has specifically changed at here. Specific timelines for HIPAA and other regulatory compliance can be found at http://www.aaoms.org/compliance.php.