It looks like the days of “voluntary” compliance programs for the health care industry are coming to an end. Specifically, Section 6401(a)(7) of the Patient Protection and Affordable Care Act (“PPACA” or the “health care reform bill”) included provisions mandating compliance programs as part of the Medicare enrollment process. According…
CMS has released their proposed disclosure requirements for In-Office Ancillary Services (IOAS) Exception. Section 1877 of the Act or the physician self-referral law (Stark) prohibits a physician from making referrals for certain “designated health services” (DHS) payable by Medicare to an entity with which he or she has a financial…
CMS has released the proposed physician fee schedule and other Medicare Part B payment policies to ensure their payment systems reflect the changes in medical practice and relative value services. This update also addresses certain provisions of both the Affordable Care Act and Medicare Improvements for Patients and Providers Act…
On June 14, 2010, CMS published a report entitled, “The Medicare Recovery Audit Contractor (RAC) Program: Update to the Evaluation of the 3-Year Demonstration Program.” This report contains statistics through March 9, 2010 and includes updated appeals data. The new report reveals a much lower number of appeals than had…
A final rule establishing the temporary certification program for electronic health record (“EHR”) technology was released today by the Office of the National Coordinator for Health Information Technology (“ONC”). As explained by the HHS press release and in a previous HLP blog about the proposed rule, the HITECH Act of…
The New York State Legislature has approved about $775 million in spending cuts for healthcare as part of a budget “extender” package on June 7, 2010. The legislation, in addition to requiring the State to save $300 million in Medicaid fraud costs, also presents considerable financial challenges for healthcare providers…
In President Obama’s weekly national address on Saturday, Mr. Obama called for Congress to quickly take action to ensure that a planned 21 percent decline in Medicare reimbursement for physicians, which is set to take effect this week, is averted. Proposals to address this draconian cut for doctors who see…
In Notice 2010-44, the Internal Revenue Service (IRS) outlined the tax credit for employee health insurance expenses available to certain small businesses under Section 45R of the Internal Revenue Code. Effective for taxable years beginning in 2010, the 45R credit is available to an employer when (1) the employer has…
On June 9, 2010, the Office of Inspector General (OIG) published a report regarding inpatient rehabilitation facility (IRF) payments made in 2006 and 2007. According to this report, over half of the claims reviewed (i.e., 113 out of 200 claims) resulted in overpayments, because the providers failed to submit patient…
At this juncture, healthcare providers, to a greater or lesser extent, have begun to acquire at least a basic understanding of the recent federal health reform legislation, commonly known as the Patient Protection and Affordable Care Act (PPACA). At the same time, many in the provider community are looking beyond…