On February 23, 2012, CMS issued an email notification to all Fee-for-Service (“FFS”) providers, which states the following: CMS has received reports that providers are receiving denials for advanced diagnostic imaging (ADI) services they are accredited to perform. We have taken action to correct the situation. CMS has instructed all…
In response to concerns raised by the American Physical Therapy Association (APTA) and other associations, the Centers for Medicare and Medicaid Services (CMS) has revised interpretative guidelines (Transmittal 72) to eliminate the requirement that rehabilitation services furnished in outpatient hospital settings be ordered by a practitioner with medical staff privileges.…
Section 6402(a) of the Patient Protection and Affordable Care Act (PPACA) established a new section in the Social Security Act mandating that providers timely report and return Medicare overpayments. Since PPACA’s passage, the healthcare community has awaited clarification on several ambiguities contained in the statute. On February 16, 2012, CMS…
As we reported in a previous blog entry, HHS recently encouraged prescription drug plans to delay the payment of suspicious claims and to take proactive measures to prevent prescription drug fraud such as requiring pre-authorizations and limiting payment of controlled substances beyond a thirty-day supply . Now, it seems that…
OIG recently issued an alert for physicians who reassign their right to bill the Medicare program and receive Medicare payments by executing the CMS-855R application, which says they may be liable for false claims submitted by entities to which they have reassigned their Medicare benefits. OIG has advised physicians to…
On February 8, 2012, the Office of Inspector General published the November and December Recovery Act Oversight Monthly Reports. The most recent figures indicate that in November 2011, $12,589,859.00 dollars of Recovery Act funds were used on Recovery Audit activities. In December 2011, $13,161,164.00 dollars of Recovery Act funds were…
Recently the OIG released the 7th of 11 videos that cover major health care fraud and abuse laws, the basics of health care compliance programs, and what to do when a compliance issue arises. The videos are from the Health Care Fraud Prevention and Enforcement Action Team (HEAT) Provider Compliance…
When a patient presents at an emergency department of a hospital, they are evaluated by a ER physician to determine whether they should be admitted as inpatient or outpatient observation. An inpatient admission occurs when a person is admitted to a hospital for bed occupancy for purposes of receiving inpatient…
Modern Healthcare reports that two anti-fraud demonstration projects announced in November by CMS were delayed after they drew heavy provider opposition. The first project would require pre-authorization for scooters and power wheelchairs prescribed to Medicare beneficiaries in any of the seven states with the highest concentration of fraud or billing…
On December 30, 2011, CMS issued an informational bulletin CPI-B 12-01 entitled, Affordable Care Act Program integrity Provisions – Guidance to States – Section 6411(a) – Expansion of the Recovery Audit Contractor (RAC) Program to Medicaid (“Bulletin”). By way of brief background, Section 6411(a) of the Patient Protection and Affordable…