Health Law

Published on: May 15, 2013 | by The Health Law Partners

American Orthotic and Prosthetic Association Files Lawsuit Alleging Unlawful Changes in Medicare Standards Resulting in Unfair RAC/Prepayment Audits

On May 13, 2013, the American Orthotic and Prosthetic Association (“AOPA”) filed suit in the federal district court for the District of Columbia against the Centers for Medicare and Medicaid (“CMS”), alleging that payment denials by CMS and its Recovery Audit Contractors (“RAC”) are invalid. The lawsuit states that CMS rules call for denial of […]

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Published on: May 9, 2013 | by The Health Law Partners

OCR Releases HIPAA Privacy and Security Education Tools

On April 30, 2013, the Department of Health and Human Services (“HHS”) Office for Civil Rights (“OCR”) announced the availability of new tools to educate health care providers and consumers about the Health Insurance Portability and Accountability Act (“HIPAA”) Privacy and Security Rules. Specifically for health care providers, three HIPAA education modules (offering free CME […]

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Published on: May 1, 2013 | by The Health Law Partners

New Michigan Law Permits Reporting of Unsafe Drivers by Physicians and Optometrists

The state of Michigan joined more than two dozen states in passing legislation to permit reporting of unsafe drivers by healthcare providers. Pursuant to Michigan Public Acts 354 and 355 of 2012, signed into law in late December of 2012, physicians and optometrists may now report information regarding a patient’s mental or physical qualifications to […]

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Published on: May 1, 2013 | by The Health Law Partners

UPDATE TO OIG’s PROVIDER SELF-DISCLOSURE PROTOCOL

The Department of Health and Human Services Office of Inspector General (“OIG”) issued an Updated Provider Self-Disclosure Protocol (“SDP”) on April 17, 2013 which supersedes the original SDP published in 1998 and three later-released open letters that provided additional guidance. The SDP clarifies that it is only available for “all health care providers, suppliers, or […]

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Published on: April 30, 2013 | by The Health Law Partners

CMS Announces Release of Additional FAQs Regarding the State Implementation of the ACA

On April 25, 2013, the Centers for Medicare and Medicaid (“CMS”) announced the release of additional information for states on implementation of the Affordable Care Act (“ACA”), part of a series of FAQs addressing the subject. The new FAQ provides information on three topics: 1. The availability of the federal match (75%) for maintenance and […]

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Published on: April 26, 2013 | by The Health Law Partners

CMS Announces Delay to PECOS Phase 2 Ordering or Referring Provider Denial Edits

On Thursday, April 25, 2013, the Centers for Medicare and Medicaid Services announced that it would delay implementing Phase 2 of its Ordering and Referring Physician Claims Editing program due to technical difficulties. CMS has delayed implementing phase 2 of the program before and it is unclear when it will resolve the technical issues. The […]

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Published on: April 12, 2013 | by The Health Law Partners

Obama Administration Budget Request for Fiscal Year 2014 Proposal Would Exclude Certain Services from the In-Office Ancillary Services Exception to Stark and Require Prior Authorization for Advanced Imaging Services

On Thursday, April 11, 2013, the Obama Administration released its Budget Request for Fiscal Year 2014 (“FY 2014”) that begins at the beginning of October. If implemented, the Budget Proposal would include approximately $1.8 trillion in savings over the next ten years, enough to replace the automatic sequestration that took effect last month and was […]

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Published on: March 28, 2013 | by The Health Law Partners

CMS Acquiesces to Hospital Pressure, Allows Part B Billing of Hospital Services Following Part A Denial of Inpatient Hospital Claims for Medical Necessity: Is It Enough?

Jessica Gustafson, Esq. and Abby Pendleton, Esq., co-chairs of the firm’s Medicare and RAC department authored an ABA Health eSource article titled “CMS Acquiesces to Hospital Pressure, Allows Part B Billing of Hospital Services Following Part A Denial of Inpatient Hospital Claims for Medical Necessity: Is It Enough?” To view this article click here. Continue […]

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Published on: March 27, 2013 | by The Health Law Partners

HHS Office of Inspector General Issues Special Fraud Alert Regarding Physician Owned Distributorships

On March 26, 2013, the Office of Inspector General (“OIG”) of the United States Department of Health and Human Services (“HHS”) issued a Special Fraud Alert (“SFA”) regarding the potential for Physician-Owned Distributorships (“PODs”) to violate the federal Anti-Kickback Statute (“AKS”). While the OIG has provided guidance previously on the potential for physician-owned entities to […]

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Published on: March 15, 2013 | by The Health Law Partners

CMS Speaks: The Future for Payment of Part B Services Post-RAC Denial – CMS’ Long-Term Solution Too Limiting!

On March 13, 2013, the Centers for Medicare and Medicaid Services (“CMS”) concurrently issued Ruling CMS-1455-NR (the “Ruling”) and a proposed rule for revising Medicare Part B billing policies in the event of Part A payment denials (the “Proposed Rule”). BACKGROUND Since the conclusion of the Recovery Audit Contractor (“RAC”) demonstration program and prior to […]

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