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Medicare Eliminates Use of Consultation Codes

In the new 2010 physician fee schedule, the Centers for Medicare and Medicaid Services (CMS) has replaced consultation codes with an increase in work relative value units (RVUs). Effective January 1, 2010, CMS will no longer recognize consultation codes that reflect various places of service (with the exception of telehealth…

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Physician Disruptive Behavior Can Lead to Staff Privileging Actions

In a recent survey by the American College of Physician Executives, 97% of respondents–doctors and nurses–reported behavior problems between doctors and nurses. This disruptive behavior, which over 55% of respondents reported happens at least monthly, included degrading comments or insults, inappropriate joking, and refusing to speak to or work with…

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Compliance Update: Teaching CRNAs and Two Concurrent Cases

Those monitoring regulations effective January 1, 2010 related to CMS payment policy for teaching CRNAs involved in two (2) concurrent anesthesia cases with student nurse anesthetists were likely confused by a November 20, 2009 CMS MLN Matters article that appeared to contradict the new regulatory language and CMS Transmittal 1859.…

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Sixth Circuit Affirms Conviction and Sentence of Anesthesiologist for Fraud and Endangering Patients

On December 1, 2009, the Sixth Circuit affirmed the conviction of Dr. Jorge A. Martinez, an anesthesiologist, who was charged with illegally distributing controlled substances, mail fraud, wire fraud, and healthcare fraud, including two counts that resulted in the death of patients. In 2002, the FBI began investigating Dr. Martinez’s…

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Medicare Makes Major Changes to Coverage Requirements for Inpatient Rehabilitation Services

Requirements for Medicare coverage of Inpatient Rehabilitation Services will undergo a number of changes, effective January 1, 2010. Centers for Medicare and Medicaid Services (CMS) released a transmittal on October 23, 2009 detailing these changes, which include several new requirements for the patient admission process and ongoing recordkeeping. Admission will…

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Michigan Supreme Court Deciding HIPAA’s Impact in Liability Cases

Oral arguments began on November 3, 2009 in a case that will test whether defendants in medical liability lawsuits are permitted under HIPAA to conduct informal interviews with plaintiffs’ other treating doctors. The federal Health Insurance Portability and Accountability Act (HIPAA) protects private health information and preserves patient confidentiality. In…

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HIPAA Violation Results in Sixteen Firings in Houston

The Harris County Hospital District of Houston fired 16 employees last month for a major violation of the Health Insurance Portability and Accountability Act (HIPAA), which protects confidential patient information. The hospital district has not disclosed additional details about the violation, instead issuing a statement saying, “The Harris County Hospital…