Red Flags Rule

NOTE: The rule has been delayed until June 1, 2010. Under the rule, many physicians will be required by federal law to assist the government in detecting, preventing and mitigating "red flags" of identity theft. The Federal Trade Commission (FTC) implemented the so-called Red Flags Rule, which will impose certain duties on financial institutions and "creditors with the goal of curtailing the growing issue of consumer identity theft.

• What you need to know about the Red Flags Rule

Recovery Audit Contractors (RACs)

In October 2008, CMS announced the award of contracts to four national recovery audit contractors, or RACs. The program’s goal is to identify improper payments made on claims of health care services provided to Medicare beneficiaries. Health care providers that might be reviewed include hospitals, physician practices, nursing homes, home health agencies, durable medical equipment suppliers and any other provider or supplier that bills Medicare Parts A and B. The RAC for Region D which includes South Dakota, is HealthDataInsights.

• Click here for more information on the RAC program
• Click here for a PowerPoint that offers background on the program, as well as a review of the appeals process

What can providers do to get ready?

• Visit the RAC Web site - http://www.cms.hhs.gov/RAC/
• Look to see what improper payments have been found in OIG reports reports: www.oig.hhs.gov/reports.asp; and
• CERT reports: www.cms.hhs.gov/cert

Medicare Updates

Providers are often faced with uncertainty when it comes to keeping up with changes in Medicare policy. It is our goal to provide you with timely information that will help you keep abreast of changes in policy that affect your practice. For more detailed information, visit the CMS Physician Center.

• Click here for the latest information on Medicare

Health Information Technology

The AMA provides information that clearly explains the world of health information technology, including the benefits, risks, challenges and costs to physicians should consider when making decisions about these new tools.

• Click here to access this resource.

Pay for Performance (PFP, P4P)

Pay for performance is a method of linking pay to a measure of individual, group or organizational performance, based on an appraisal system. These types of bonus incentive schemes are based on the idea that work output, determined by some kind of measuring system, varies according to effort and that the prospect of increased pay will motivate improved performance.

• Click here to read the AMA's official P4P policy.
• Click here to read more about the five principles for P4P programs.
• Click here for the AMA's physician guide to evaluating incentive plans.

Physician Quality Reporting Initiative (PQRI)

On December 20, 2006 the President signed the Tax Relief and Health Care Act of 2006 (TRHCA). Section 101 under Title I authorizes the establishment of a physician quality reporting system by CMS. CMS has titled the statutory program the Physician Quality Reporting Initiative (PQRI). PQRI establishes a financial incentive for eligible professionals to participate in a voluntary quality reporting program. Click here for more information and resources for PQRI.

South Dakota Risk Pool

The South Dakota Risk Pool was created to provide coverage for individuals who lose their health insurance and are unable to qualify for an individual health insurance policy. Click here for more information..