By way of Transmittal No. 2316 issued on October 7, 2011, CMS clarified the claims processing procedures for hospice services when a required face-to-face encounter does not timely occur. This clarification creates additional administrative burdens to hospice providers when the required face-to-face encounter does not timely occur. Note that the…
The Centers for Medicare and Medicaid Services (“CMS”), as required by Section 6411 of the Patient Protection and Affordable Care Act (“PPACA”), must annually report to Congress “concerning the effectiveness of the Recovery Audit Contractor program under Medicaid and Medicare and shall include such reports recommendations for expanding or improving…
According to a recent report from the Medical Group Management Association and the Society of Hospital Medicine, hospitalists saw increases in their median compensation in 2010. The report, which is based on survey information from 4,633 hospitalists, found that hospitalists in adult medicine saw their compensation increase 2.6%, while pediatric…
In a press release issued September 27, 2011, the United States Department of Justice, the Department of Health and Human Services, and the FBI announced that two Miami-area residents pled guilty for their roles in a $25 million home health Medicare fraud scheme. Both defendants pled guilty to conspiracy to…
Medicare Part A and Part B providers and suppliers appealing Medicare audit decisions at the administrative law judge (“ALJ”) level or through a judicial review must meet an amount in controversy (“AIC”) threshold amount pursuant to regulation at 42 CFR 405.1006(b) and (c). The regulations require the Secretary of the…
As many already know, when a review contractor (e.g., Recovery Audit Contractors (“RACs”), Medicare Administrative Contractors (“MACs”), the Comprehensive Error Rate Testing (“CERT”) contractor, the Program Error Rate Measurement (“PERM”) contractor, and Zone Program Integrity Contractors (“ZPIC”)) identifies an improper payment, the review contractor requests medical documentation from the provider…
On September 14, 2011, the Centers for Medicare and Medicaid Services (“CMS”) published in the Federal Register a proposed rule amending the Clinical Laboratory Improvement Amendments of 1988 (“CLIA”) and the Health Insurance Portability and Accountability Act of 1996 (“HIPAA”) to specify that, upon request, a patient may gain access…
On February 2, 2011, the Centers for Medicare and Medicaid Services (“CMS”) issued its final rule regarding the new provider and supplier enrollment screening criteria for Medicare, Medicaid and Children’s Health Insurance Program (“CHIP”) pursuant to Section 6401(a) of the Patient Protection and Affordable Care Act (“PPACA”). Included in the…
In July, the HEALTH LAW ATTORNEY BLOG reported on five U.S. Senators asking the Office of Inspector General (“OIG”) and the Centers for Medicare and Medicaid Services (“CMS”) to issue guidance on physician owned distributorships (“PODs”) (or, sometimes referred to as physician owned intermediaries (“POIs”)). The OIG and CMS have…
Section 6411 of the Patient Protection and Affordable Care Act (“PPACA”) requires states to establish a Medicaid recovery audit contractor (“Medicaid RAC”) program similar to the existing Medicare RAC program. Like Medicare RACs, Medicaid RACs will be tasked with auditing claims to identify overpayments and underpayments and will be compensated…