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Three Important Things to Know Right Now

Health care continues to undergo tremendous changes, and keeping up with the rules will be important for physicians and their staffs. Here are three things you need to know about changes in health care and their potential impact on you.

Electronic Health Records – Avoid a Meaningful Use Penalty in 2017   

Physicians who participated in the 2015 Medicare Meaningful Use (MU) program may still apply for the Medicare hardship exemption. Applying for the hardship will not prevent a physician from earning an incentive. Iif the exemption is granted, it will prevent penalties for the 2017 payment year. Medicare will accept hardship exemptions until March 15, 2016.

CDC Guidelines for treating patients with chronic pain 

The Centers for Disease Control and Prevention (CDC) has developed voluntary guidelines directed at primary care physicians treating patients with chronic pain. At the same time Medicare weighed in on the prescriber’s role and introduced a controversial proposed rule officials believe could help combat prescription drug abuse.


  • Although the CDC is not a regulatory agency, some physicians have expressed concerns that licensing board may adopt the CDC guidelines may be adopted and that the CDC guidelines might have an impact on the outcome of legal cases.
  • The proposed Medicare rule contains much about the hospital discharge process, while one very specific component is aimed at combating prescription drug abuse. It could create additional documentation requirements during the discharge process. As part of the medication reconciliation process, Medicare wants to require physicians to consult with their state’s prescription drug monitoring program (KASPER in Kentucky) on all discharges even if the physician is not going to prescribe a controlled substance.

2016 Office of Inspector General (OIG) Work Plan – ICD-10 Audits

The transition to ICD-10 should include ongoing ICD-10 compliance audits to ensure appropriate documentation and code selection. Medicare claims with a date of service on or after Oct. 1, 2015, are required to contain a valid ICD-10 code. The 2016 OIG Work Plan includes significant ICD-10 review, including:

  • CMS management of the ICD-10 implementation, which most certainly will include a review of the CMS contractors and the assistance and guidance they provided to physicians and hospitals.
  • Application of ICD-10 diagnosis codes to “selected” CMS payment rules and safeguards (e.g., national or local coverage decisions related to coverable conditions).

For more information on any of these topics, contact the KMA at

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