April 2010 Archives

April 28, 2010

Updated Signature Guidelines for Medical Review Purposes

Medicare requires that services provided/ordered must be authenticated by the author with either a hand written or electronic signature (stamps are not acceptable), although there are a few exceptions: (1) facsimiles of original written/electronic signatures are acceptable for the certification of terminal illness for hospice; (2) some orders do not need to be signed, for example, clinical diagnostic tests are not required to be signed; (3) in cases where other regulations and CMS instructions have signature requirements, those requirements take precedence.

On March 16, 2010, CMS published CR 6698, which updates signature requirements and adds E-Prescribing language. As of April 16, 2010, the signature requirements are applicable for reviews; however, the requirements are effective retroactively for Comprehensive Error Rate Testing (CERT) for the November 2010 report period.

According to CR 6698, AC, MAC, and CERT reviewers shall proceed to signature assessment only if the criteria in the relevant Medicare policy cannot be met but for a key piece of medical documentation which contains a missing/illegible signature. ACs, MACs, RACs, PSCs, ZPICs, and CERT contractors shall give deference to other regulations and CMS instructions regarding signatures, and if the relevant regulation is silent on whether the signature must be dated, the reviewer shall ensure that the documentation contains enough information to determine the date on which the service was ordered.

Keep in mind that a handwritten signature is a mark/sign by an individual on a document to signify knowledge, approval, acceptance, or obligation. If the signature is illegible, ACs, MACs, PSCs, ZPICs, and CERT shall consider evidence in a signature log or attestation statement. If the signature is missing, the order shall be disregarded. If the signature is missing from any other medical documentation, a signature attestation from the author of the medical record entry shall be accepted.

At this time, AC, MAC, CERT, PSC, and ZPIC reviewers shall NOT accept as a valid order any controlled substance drugs that are ordered through any E-Prescribing system (reviewers shall only accept hardcopy pen and ink signatures in that case). However, reviewers will accept as a valid order any Part B drugs, other than controlled substances, ordered through a qualified E-Prescribing system. Also, AC, MAC, CERT, PSC, and ZPIC reviewers shall accept as a valid order any drugs incident to DME, other than controlled substances, ordered through a qualified E-Prescribing system.

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April 27, 2010

Detroit-Area Man Pleads Guilty to Conspiracy to Commit Health Care Fraud in Kickback Scheme

A Detroit-area man plead guilty last week to conspiracy to commit health care fraud in an elaborate kickback operation to recruit Medicare beneficiaries to a clinic owned by his co-conspirators. According to the U.S. Departments of Justice ("DOJ") and Health and Human Services ("HHS"), Melvin Young recruited Medicare beneficiaries to become patients at Ritecare, LLC, and provided transportation for those patients to the clinic. Young's co-conspirators, the owners and operators of Ritecare, provided Young with funds he then used to pay the patients he recruited. Ritecare typically paid Young a kickback of $100-150 per Medicare beneficiary, and Young passed on about half to the patient, keeping $50-75 for himself.

Perhaps more startling, patients were required to submit to medically unnecessary testing in order to receive their kickback. Young admits tutoring the patients to claim certain symptoms they didn't actually experience, which false symptoms were included in their medical records to justify the tests to Medicare.

The case was brought as part of the Medicare Fraud Strike Force, and investigated by the FBI and HHS-Office of Inspector General.

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April 26, 2010

HHS-OIG Adds MCFUs Section to Website

The U.S. Department of Health and Human Services Office of Inspector General ("HHS-OIG") has revealed a new section to its website dedicated to the state Medicaid Fraud Control Units ("MCFUs"). MCFUs are intended "to investigate and prosecute fraud by Medicaid providers as well as patient abuse and neglect." While MCFUs are administered by the states, the majority of their funding comes from the federal government.

The new site explains:

The MFCUs' authority to investigate patient abuse and neglect extends to Medicaid-funded facilities as well as to "board and care" facilities that do not receive Medicaid funding. MFCUs may, in certain circumstances, also investigate program fraud involving Medicare or other Federal programs, upon the approval of the Department of Health & Human Services Office of Inspector General (HHS/OIG) or another relevant agency Inspector General.

The site includes a growing archive of state enforcement actions, policy transmittals, and other helpful links.

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April 23, 2010

St. Vincent's in Manhattan Begins Selling Real Estate

St. Vincent's Hospital Manhattan, which filed for bankruptcy just two weeks ago with liabilities of over $1 billion, is putting one of its many buildings on the market this week, according to the New York Times. St. Vincent's owns a number of properties in Greenwich Village. So far, it isn't clear--at least publicly--what will happen with the rest of the hospital's Greenwich Village campus.

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April 22, 2010

Carriers Recouping Overpayments Identified by RACs Must Follow Precise Reporting Instructions

Centers for Medicare and Medicaid Services ("CMS") reported yesterday that it realizes that fiscal intermediaries haven't been providing sufficient detail on remittance advices (RAs) when recouping overpayments identified by RACs to allow providers to track and update their financial records. In response to that complaint, CMS issued CR 6870 and the corresponding MLN Matters 6870, which outlines clear protocols for how carriers must report when an overpayment has been identified, and when recoupment begins.

Providers can familiarize themselves with this protocol by reading the MLN Matters, and understand how to review their RAs for RAC activity and accurate financial records.

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April 20, 2010

April 2010 Monthly Review Reiterates HHA Accreditation and Change of Ownership Updates

In February, we blogged on the recent changes in home health agency (HHA) accreditation. In April 2010, NGS issued its Medicare Monthly Review, and reiterated the same HHA accreditation and change of ownership provisions. Particularly, the article discusses the requirements a deactivated HHA must meet in order to reactivate its billing privileges. It also discusses that an HHA may not undergo a change of ownership or transfer of ownership if the effective date of the change or transfer occurs within 36 months of: (1) the effective date of the provider's enrollment in Medicare, or (2) the effective date of the last ownership change or transfer for the HHA. The provider must instead enroll as a new HHA, undergo a state survey or obtain accreditation from a CMS-approved accrediting organization, and sign a new provider agreement.

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April 19, 2010

Meaningful Use of EHR Technology Expanded

Meaningful use of electronic health records (EHR) technology has recently been expanded to include physicians providing services in outpatient facilities, according to the Continuing Extension Act of 2010. Initially, Congress had intended that only those physicians who purchased and implemented EHR technology would be eligible for the incentive payments, which would leave hospital-based physicians without an opportunity to collect on those incentive payments as the hospital provided the EHR technology for them. We will continue to keep you apprised of any further updates regarding the implication of this new expansion.

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April 16, 2010

Congress Extends 0% Update to Medicare Physician Fee Schedule

The Continuing Extension Act of 2010 was signed into law on April 15. This law reinstates the March 31 Medicare Physician Fee Schedule (Fee Schedule) rates for physicians, postponing, yet again, the anticipated-21.3% cut. The zero percent (0%) update to the Fee Schedule has been extended to May 31 will apply retroactively to claims that have been held since April 1.

Please refer to our previous blog entry on this topic for more background.

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April 14, 2010

House Bill doubles Penalties for Medicare Fraud

Yesterday, the U.S. House of Representatives proposed a bill that ups the ante on Medicare fraud. The bill, the Medicare Fraud Enforcement and Prevention Act, will double prison sentences from 5 to 10 years and fines from $25,000 to $50,000 for Medicare fraud-related crimes, and creates a new crime for illegally distributing patients' Medicare and Medicaid IDs or billing information (with a maximum 3-year sentence). Also, the bill requires HHS to provide law enforcement officials with real-time access to Medicare data and to immediately alert them to suspicious activity.

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April 13, 2010

New York AG's Office Recovers More Than $283 Million In Medicaid Fraud

The New York state attorney general's office announced yesterday that it recovered more than $283 million and obtained a record of 148 Medicaid fraud convictions in 2009. This information is detailed in an Annual Report submitted to the Secretary of the U.S. Department of Health and Human Services. The report highlights the cases, settlements, and convictions of the AG's office, including civil settlements with licensed home health care services and certified home health care agencies totaling $51.7 million and 25 criminal convictions; settlements with pharmaceutical companies for off-label marketing, kickbacks, misreporting prices, and other fraud; and a $15.6 million judgment against two dentists who operated a mobile dentist business and who knowingly employed an individual with a prior felony conviction.

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April 8, 2010

Physicians Providing MRI/CT/PET Services In-office Must Provide Written Disclosure to Medicare Patients

Pursuant to the healthcare reform bill that was signed into law by President Obama on March 23, 2010 ("the Patient Protection and Affordable Care Act" or "the Act"), physicians who furnish MRI, CT or PET tests within their practices for their patients are now required to provide their patients with a written disclosure at the time of the referral.

By way of brief background, the Stark Law prohibits physicians from referring Medicare patients for certain "designated health services" (including MRI, CT, and PET) to an entity with whom the referring physician (or any of his/her immediate family members) has a direct or indirect financial relationship, unless an exception is met. Physicians and entities who furnish designated health services within their practices typically rely upon Stark's In-Office Ancillary Services Exception (the "IOASE") in order to avoid running afoul of the Stark Law.

Notably, Section 6003 of the Act adds a requirement that physicians who furnish MRI, CT or PET testing services for their Medicare patients in reliance on the IOASE inform the patient in writing at the time of the referral that the patient may obtain the MRI, CT or PET test from other suppliers of the services. Physicians are also required to provide a written list of suppliers who furnish those services in the area where the patient resides. Section 6003 allows the Secretary of Health and Human Services to require similar notices for other categories of imaging services that fit within the definition of designated health services.

This new disclosure provision of the Act applies to services furnished on or after January 1, 2010 (but the disclosure requirement appears to have taken effect on March 23, 2010, the date President Obama signed the bill into law). Section 6003 of the Act contemplates that regulations will be issued which implement the new disclosure requirement.

However, physicians who furnish MRI, CT, or PET tests pursuant to the IOASE, should immediately begin to provide the required written disclosure to their Medicare patients.

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April 7, 2010

CMS Announces Series of Nationwide RAC 101 Calls

On Monday, April 6, 2010, CMS updated its RAC website by announcing a series of nationwide calls as detailed below:

April 28, 2010, 1:00pm - 2:30pm EST: Nationwide RAC 101 Call, 1-877-251-0301
May 4, 2010, 1:00pm - 2:30pm EST: Nationwide RAC 101 Call for Home Health and Hospice Providers, 1-877-251-0301
May 5, 2010, 1:00pm - 2:30pm EST: Nationwide RAC 101 Call for DMEPOS, 1-877-251-0301
May 12, 2010, 1:00pm - 2:30pm EST: Nationwide RAC 101 Call for Physicians, 1-877-251-0301

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April 6, 2010

U.S. Justice Department joins lawsuit against Georgia hospital

The Feds joined a False Claims Act lawsuit against Satilla Regional Medical Center, a Georgia Hospital. The lawsuit, filed by a nurse in 2007, alleges that the hospital allowed an unqualified physician, Najam Azmat, to perform endovascular procedures, leading to the death of at least one patient and injuries to several others. The hospital, which has faced numerous medical malpractice lawsuits due to Azmat's care, defends itself and its credentialing process. Although the Justice Department has not filed its version of the allegations, according to the complaint filed by the nurse, the hospital and Azmat violated the False Claims Act by billing for procedures that were substandard or medically unnecessary (including dangerous procedures that Azmat lacked the requisite training and experience to perform).

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April 6, 2010

John Muir Health data breach

Today, John Muir Health began notifying its 5,450 patients about a possible breach of their personal and health information. The notifications came two months after two laptop computers were stolen from the John Muir Physician Network Perinatal office in Walnut Creek, California.

Although the laptops were password protected, and there is no evidence that the information has been accessed or used inappropriately, the Hospital decided to notify its patients, as the laptops contained personal and health data going back more than three years.

As a result of the data breach, the Hospital is taking additional safeguards to protect its patients: (i) it is recommending that affected patients place fraud alerts on their credit files; (ii) it will provide its patients will no-cost identify theft protection for one year, and (iii) it has started implementing additional safety measures.

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April 3, 2010

IRS To Honor Medical Resident FICA Refund Claims

The Internal Revenue Service (the "IRS") recently published News Release IR-2010-25 (the "Release") announcing that it made an administrative determination to accept the position that medical residents are excepted from FICA taxes based on the student exception for tax periods ending before April 1, 2005 (the "4/1/05 Rule Change Date"), when new IRS regulations went into effect. According to the Release, the IRS will, within 90 days, begin contacting hospitals, universities and medical residents who filed FICA (i.e., Social Security and Medicare tax) refund claims for these periods with more information and procedures.

The FICA refunds discussed in the Release represent an issue on which the interests of hospitals and physicians are clearly aligned. Physicians who were residents in the 4/1/05 Rule Change Date period can receive a refund for any FICA amounts that were withheld when they were residents during such time. Hospitals likewise have an incentive to see physicians avail themselves of these refunds insofar as they, too, will be entitled to refunds for the matching FICA contributions that they made on behalf of the residents.

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April 1, 2010

RAC Vendor For Region D Removes Anesthesia Care Package Issue from Approved List

In a recent development for the anesthesia community, HealthDataInsights ("HDI"), the RAC for Region D, removed the anesthesia care package issue from its approved issues list. In January of 2010, the RAC vendor posted the following issue:

Under NCCI Edit rules, the anesthesia care package consists of preoperative evaluation, standard preparation and monitoring services, administration of anesthesia, and post-anesthesia recovery care. Anesthesia CPT codes 00100 to 01999 (except 01996) include Evaluation & Management (E&M) services rendered on the day before anesthesia (pre-operative day), the day of the anesthesia and all post-operative days. CPT code 01996 includes E&M services on the same day as the 01996 service only. Physicians can indicate that E&M services rendered during the anesthesia period are unrelated to the anesthesia procedure by submitting modifiers 24, 25, 57 and/or 59, depending on claim specific circumstances, on the E&M service. Only critical care E&M services are payable during the anesthesia post-operative period. The post-operative period is defined as the day immediately following the anesthesia service and any subsequent days during the same inpatient hospital admission as for the anesthesia service.

Today, HLP partner Abby Pendleton noted that the issue was no longer posted on the approved issues list and spoke with the CMS RAC project coordinator for HDI, who confirmed that CMS directed the removal from HDI's approved issues list. CMS couldn't provide additional details about why this information has been removed, but anesthesia providers should stay tuned.

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