News in brief - Aug. 15, 2011

Appeals court rejects doctor's lawsuit against health reform law

A U.S. appeals court has blocked a challenge by a New Jersey physician and one of his patients against the health system reform law.

Cardiologist Mario A. Criscito, MD, and a patient sued the government in 2010, alleging that the reform law, particularly the individual insurance mandate, violated their Fifth Amendment rights. The individual mandate requires citizens to obtain health insurance coverage by 2014 or face a penalty. Dr. Criscito argued in court documents that the mandate "will have a direct, substantial impact" on his practice and the manner in which he seeks payment for his services.

The 3rd U.S. Circuit Court of Appeals ruled Aug. 3 that the doctor and patient failed to show how they would be "imminently" harmed by the law. The appeals court upheld a lower court's decision denying the suit from moving forward.

Dr. Criscito's lawsuit is one of more than a dozen across the country challenging the health reform law. Most have been dismissed. Judges in Florida and Virginia have ruled the law, or portions of it, unconstitutional.

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First test of new HIPAA claims standard a success, CMS says

The Centers for Medicare & Medicaid Services reported no significant errors during its first test of a new electronic claims submission standard known as HIPAA 5010 on June 15.

The Medicare agency will transition to the new standard on Jan. 1, 2012, when electronic claims submitted under the previous standard will start to be rejected. The June test allowed 349 physicians, clearinghouses, payers and other entities to test their systems and gauge readiness for HIPAA 5010.

Almost a third of those participating said in a survey after the test that they feel ready for HIPAA 5010, and 39% said they were able to receive and process new enhancements.

CMS will give practices another chance to test their practice management and claims processing systems' level of compliance with the HIPAA 5010 standard from Aug. 22-26.

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HHS awards $29 million for health center expansions

The Dept. of Health and Human Services announced Aug. 9 that 67 community health centers had been awarded a total of $28.8 million to expand access to care.

The grants, made available through the health system reform law, are intended to allow health centers to create additional health care access points. The funding is expected to allow the centers to serve about 286,000 patients.

"We are making an investment in the health of people and the health of our communities," said Health and Human Services Secretary Kathleen Sebelius. More than 800 health centers applied for grants.

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