May 10, 2011, the Miami Lakes, Florida council passed a zoning ordinance requiring pain clinics in its town to obtain a special permit. A pain clinic’s grand opening advertisement featuring the words “pain” and “opiates” put a Miami Lakes councilman in fear of potential pill-mill activity coming to town and…
In order to assist individuals interested in learning more about the fundamentals of health care compliance and help answer questions about what to do when compliance issues arise, the Office of Inspector General recently posted the HEAT Provider Compliance Training slide presentation and written materials which accompany its compliance training…
During late March, the Centers for Medicare and Medicaid Services (“CMS”) proposed a rule regarding Accountable Care Organizations (“ACOs”) and the Medicare Shared Savings Program, which will make payments of shared savings to ACOs (“Proposed Rule”). The Proposed Rule describes the amount of financial risk the participants will face and…
The Centers for Medicare & Medicaid Services (“CMS”) released the latest edition of its Medicare Compliance Newsletter. The publication contains examples of Medicare billing errors and guidance on how to avoid such mistakes. The newsletter may be viewed here. For more information regarding compliance or for assistance defending an audit,…
It is often instructive to review the thinking of health care decision-makers as a tool to acquire insight on the direction of health care policy. In this regard, Dr. Donald Berwick, the administrator of the Centers for Medicare & Medicaid Services (“CMS”), recently authored an Op-Ed in the Wall Street…
Healthcare providers are more frequently utilizing social media to market their practices and to dispense health information. In order to protect the patient-physician relationship and ensure a continued positive internet presence for healthcare providers, the American Medical Association (“AMA”) adopted recommendations for physician use of social media. The guidelines recommend…
Based on a recent report from the Office of Inspector General (“OIG”), Medicare permitted $38 million of improper claims for interpretation and reports of radiology services based on insufficient documentation in hospital emergency departments in 2008. This includes a 19 percent erroneous allowance of claims for interpretation and reports for…
The Centers for Medicare and Medicaid Services (“CMS”) overpayment recovery through its Recovery Audit Contractor (“RAC”) program is on the rise. CMS recovered in excess of $313 million in Medicare overpayments since October 2009, and almost half of that amount ($162 million) was collected during the first three months of…
The Centers for Medicare & Medicaid Services (“CMS”) recently proposed a rule regarding the hospice wage index for the fiscal year (“FY”) 2012 (“Proposed Rule”). The rule would result in a 2.3 percent increase in Medicare payments to hospices for FY 2012 and implement a new quality reporting system as…
On May 5, the Centers for Medicare and Medicaid Services (CMS) published in the Federal Register its final rule for telemedicine credentialing and privileging for hospitals and critical access hospitals (CAHs). Beginning July 5, 2011, hospitals and CAHs, will have the option of proxy credentialing distant-site physicians and practitioners pursuant…