What new physicians need to know about navigating regulations
Transitioning from residency or fellowship into practice is a stressful time, and it’s not made any easier by the many regulatory issues physicians face on a daily basis. Fortunately, new physicians have help in navigating the complicated regulatory environment.
Preparing to comply is important because many federal programs can bring financial penalties or other serious consequences if not carefully followed. Here are some of the main things new physicians need to know:
- Physician Payments Sunshine Act: Manufacturers of drugs and medical devices must report certain payments and items of value given to physicians and teaching hospitals, and this data will be made available to the public on a yearly basis. Physicians will have the opportunity to review the data reported about them and dispute it with the reporting organization each year.
- Health Insurance Portability and Accountability Act (HIPAA): The security aspect of HIPAA can be challenging. The U.S. Department of Health and Human Services Office for Civil Rights will be implementing random HIPAA audits, so compliance is crucial. Physicians must ensure all electronic patient information is encrypted and should perform security risk assessments for all health IT, not just their electronic health record (EHR) systems. Get more information on the AMA’s HIPAA Web page.
- Meaningful use program: The Medicare/Medicaid meaningful use EHR incentive program isn’t mandatory, but physicians who want to accept Medicare or Medicaid will be subject to financial penalties if they don’t meet the requirements each year. Learn how to demonstrate meaningful use, avoid penalties and navigate the program.
- Physician Quality Reporting System (PQRS): Physicians who accept Medicare patients must participate in the PQRS, which involves transmitting data on quality measures to the Centers for Medicare & Medicaid Services. Physicians who accept Medicare and do not participate in PQRS will be docked a percentage of their Medicare payments. Information about the program, how to participate and how the PQRS aligns with the meaningful use program is available on the AMA’s PQRS Web page.