Attention physicians, according to the WPS website, they are conducting a widespread Service-Specific Prepayment Probe on CPT code 99213, using samples obtained from Wisconsin, Illinois, Michigan and Minnesota for all specialties. This probe arises after a Medical Review analysis of claims in the May 2009 sample period revealed 217 CERT…
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…
On May 28, the Centers for Medicare and Medicaid Services (CMS) issued Transmittal 128, which clarifies CMS policies regarding physician supervision of diagnostic and therapeutic services provided to hospital outpatients. The transmittal, effective on July 1, 2010, updates the Hospital Outpatient Prospective Payment System (OPPS). In the transmittal, CMS specifies…
On May 26, 2010, CMS published a proposed rule revising the Medicare Conditions of Participation (CoPs) to give hospitals and critical access hospitals (CAHs) more flexibility in credentialing and privileging telemedicine physicians and practitioners (while not prohibiting hospitals from continuing to use traditional credentialing and privileging process if they please).…
Today, the Texas Spine & Joint Hospital and Physicians Hospitals of America jointly filed suit in U.S. Federal Court, Eastern District of Texas, challenging the constitutionality of Section 6001 of the Patient Protection and Affordable Health Care Act. Section 6001 prohibits physician-owned Medicare hospitals from expanding after March 23, 2010,…
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…
In a not surprising turn of events, days before the June 1st deadline, the Federal Trade Commission (“FTC”) announced that it is again delaying the enforcement of the identity theft regulations through December 31, 2010. This latest delay came at the request of certain members of Congress while Congress considers…