Becker's Spine Review

50 HEALTHCARE NEWS CMS releases proposed physician payment rule for 2019: 5 things to know By Ayla Ellison C MS issued its annual update to the Medicare Physician Fee Schedule July 12, which includes a proposal to pay physicians for their time when they check in with Medicare beneficiaries via telephone or other telecommunications devices to decide if an office visit or other service is needed. Here are five key takeaways from the pro- posed rule: 1. Physician payment rates. CMS pro- posed increasing physician payment rates by 0.25 percent in 2019, as required by the Medicare Access and CHIP Reauthorization Act. Aer applying the budget-neutrality ad- justment required by law, CMS estimated the 2019 physician fee schedule conversion factor is $36.05, up from $35.99 this year. 2. Coding and payment changes for evaluation and management. CMS proposed several coding and payment changes aimed at reducing administrative burden and improving payment accuracy for evaluation and management visits. For example, the proposed rule would allow practitioners to review and verify certain information in a patient's medical record that is entered by ancillary staff or the patient, rather than re-entering the information. e agency also proposed implementing a multiple- procedure payment adjustment that would apply when evaluation and management visits are furnished in conjunction with other procedures. 3. No changes to site-neutral pay- ment policies. CMS plans to continue site-neutral payment policies under Section 603 of the Bipartisan Budget Act. Under the proposed rule, off-campus facilities would be paid 40 percent of the Outpatient Prospective Payment System amount for 2019. Section 603 requires, with the exception of dedicated emergency departments, services furnished in off-campus provider-based departments that began billing under the OPPS on or aer Nov. 2, 2015, to be paid under another appli- cable Part B payment system. 4. Telehealth services. In addition to paying physicians for their time when they check in with beneficiaries via telephone or other telecommunications device, CMS also proposed paying physicians for the time it takes to review a video or image sent by a pa- tient to assess whether a visit is needed. 5. American Hospital Association weighs in. "Today's proposed policies from CMS will provide opportunities and challeng- es for hospitals and health systems and the patients and communities they are proud to serve each day," said AHA Vice President Tom Nickels. Specifically, the AHA applauded CMS for proposing to expand physicians' ability to serve patients through telehealth, but the group expressed disappointment with CMS' policies regarding site-neutral payments. n Healthcare CEO gets prison time for role in $19.4M kickback scheme By Ayla Ellison T he former CEO of American Senior Communities, an Indianapolis-based skilled nursing and rehabili- tation provider, was sentenced June 29 to nine and a half years in prison for his role in a fraud, kickback and money laundering conspiracy, according to the Depart- ment of Justice. Federal agents began their investigation into James Bur- khart three years ago. In September 2015, agents execut- ed search warrants of his residence and ASC office. About a year later, Mr. Burkhart and three others — Daniel Benson, the former COO of American Senior Communities; Steven Ganote, an associate; and Joshua Burkhart, Mr. Burkhart's younger brother — were indicted by a federal grand jury. All of the defendants, including Mr. Burkhart, had pleaded guilty to federal felony charges by January 2018. Mr. Burkhart and his co-conspirators were accused of cre- ating shell companies that would inflate vendors' bills and submit them to ASC as if the shell companies were the real vendors. He also caused vendors or shell companies to submit false bills to ASC for fictitious services that were never provided, and, in some cases, demanded vendors pay him kickbacks in exchange for allowing them to service ASC's large number of facilities. In addition, Mr. Burkhart had vendors inflate their bills to ASC, which he would pay with money from Health & Hos- pital Corp. of Marion County, the public health department that operates several Indianapolis hospitals. The vendors would allegedly kick the overage back to Mr. Burkhart and his co-conspirators. According to the DOJ, Mr. Burkhart and his co-conspira- tors funneled nearly $19.4 million to themselves through the scheme. The majority of the funds came from Health & Hospital Corp. of Marion County. Mr. Burkhart was sentenced to prison after pleading guilty to three felony offenses: conspiracy to commit fraud, con- spiracy to violate the healthcare Anti-Kickback Statute and money laundering. n

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