November 2009 Archives

November 25, 2009

2010 Medicare Fee Schedule Announced

Medicare published the 2010 Fee Schedule in the Federal Register today. This new final rule reflects changes to the physician fee schedule and other Medicare Part B payment policies. The full text of the rule can be found here.

For more information on how these changes might affect you, contact Adrienne Dresevic, Esq. at (248) 996-8510.

November 24, 2009

Health Care Data Breach

Health Net became the latest company that lost data containing personal, financial and medical information of hundreds of thousands of Connecticut residents. The data disappeared from Health Net in May, but the company never informed consumers (or authorities) about the breach of privacy until about two weeks ago (a six-month delay).

A spokeswoman for Health Net, said they were initially unable to determine what information was on the lost drive, forcing the company to conduct a lengthy investigation, which included a detailed forensic review by computer experts. To date, the company said it has not had any reports of misused data.

This is not the first data breach impacting Connecticut residents. Earlier this month, the Attorney General demanded answers and identity-theft protection for nearly 19,000 health professionals in the state whose confidential data was on a stolen laptop computer taken from the Blue Cross and Blue Shield Association in the Chicago area. The laptop disappeared in August, but Anthem did not notify the affected doctors, therapists and other professionals about the breach until October, a move that also drew criticism from the Attorney General.

As previously outlined in this blog, a Final Rule was recently published, clarifying covered entities' and business associates' liabilities for breaches of patients' unsecured PHI. The Final Rule was effective September 23, 2009. In summary, the Final Rule clarifies that when a breach occurs:

- A covered entity must notify each individual whose unsecured PHI has been, or is reasonably believed by the covered entity to have been, accessed, acquired, used or disclosed as a result of such breach;

- A covered entity must notify the media in the event of a breach of unsecured PHI involving more than 500 residents of a State or jurisdiction;

- A covered entity must notify HHS in the event of a breach of unsecured PHI involving 500 or more individuals.

- A business associate must notify the covered entity of any breach of unsecured PHI.

Continue reading "Health Care Data Breach" »

November 23, 2009


On November 23, 2009, CMS sent a notice delaying implementation of its registration requirements for the Medicare Provider Enrollment, Chain and Ownership System (PECOS) which affects physicians and non-physician practitioners who order items or services for Medicare beneficiaries or who refer Medicare beneficiaries to other Medicare providers or suppliers, providing them additional time to enroll in Medicare or take the action necessary to establish a current enrollment record in Medicare. A current enrollment record contains the physician/non-physician practitioner's National Provider Identifier (NPI). As of April 5, 2010, a physician or non-physician practitioner who orders or refers and who does not have a current enrollment record will cause the claim submitted by the Part B provider/supplier who furnished the ordered or referred item or service to be rejected. Information regarding enrollment may be found on The Health Law Partners, P.C. website.

Continue reading "CMS Delays PECOS" »

November 10, 2009

2010 Home Health PPS Final Rule Addresses Program Integrity Issues

On November 10, 2009, the Centers for Medicare & Medicaid Services (CMS) issued a final rule to update the Medicare Home Health Prospective Payment rates for the 2010 calendar year (the "Final Rule"). The Final Rule continues with the previously promulgated 2.75 percent reduction to the home health prospective payment rates in calendar year 2010 (to account for the increase in case-mix not due to the underlying condition of the home health patient), and updates the home health prospective payment rates by a 2.0 percent home health market basket update.

Further, as part of its efforts to address potential fraud and abuse regarding outlier payments to home health agencies, CMS revises its outlier policy by capping outlier payments at 10 percent of total home health prospective payment rate payments, updating the fixed dollar loss ratio to 0.67, and targeting outlier payments to be no more than 2.5 percent of total home health prospective payment rates payments. Further, CMS will also require the submission of OASIS as a condition for payment, and is implementing a new version of OASIS (OASIS-C) beginning January 1, 2010.

Lastly, CMS is also adding payment safeguards to improve the enrollment process, improve quality of care, and reduce fraud. For example, as of January 1, 2010, a home health agency that has been in existence for less than three (3) years cannot have its provider agreement transferred as part of a CHOW. Instead, the new owners will need to reapply as Medicare providers and undergo an accreditation survey or a state survey. Accordingly, investors are not permitted to start up a Medicare home health agency with the idea of later selling it as a "turn-key" agency, unless the agency is operating for at least thirty six (36) months from the "effective date of enrollment in Medicare." The Final Rule specifically provides that this prohibition on transfers applies to stock or asset sales. The comments to the Final Rule state CMS' belief that the rule applies not only to CHOW's submitted after January 1, 2010, but also to CHOW's pending on January 1, 2010. Another change in the Final Rule was that CMS will require home health agencies whose billing privileges have been deactivated due to inactivity to undergo a state survey or an accreditation survey before the privileges are reactivated. This means that if the home health agency has not billed Medicare in the previous twelve (12) months, it will need to undergo a survey before it can bill.

Continue reading "2010 Home Health PPS Final Rule Addresses Program Integrity Issues " »

November 5, 2009

Red Flags Rule Deadline Extended...Again

At the request of certain members of Congress, the Federal Trade Commission (FTC) has extended the enforcement date of the Red Flags Rule to June 1, 2010. Originally intended to be enforced on November 1, 2008, the FTC has delayed the enforcement date a number of times to ensure that those affected entities have adequate education regarding Red Flags compliance.

Continue reading "Red Flags Rule Deadline Extended...Again" »