In their June newsletter, The Record, Blue Cross Blue Shield of Michigan (BCBSM) recommended that physicians “consult with their legal counsel periodically.” The problem that BCBSM identified is the situation where physicians prescribe and dispense durable medical equipment and prosthetics and orthotics items in order to provide a means for their patients to be ambulatory […]
On May 18, 2012, Medicare released their 2nd Quarter Newsletter regarding the recovery efforts of each of the region’s Recovery Audit Contractors: DCS, CGI, Connolly, and HDI. CGI Federal has the lowest level of overpayment recoupments and underpayment identification. Connolly and HDI/HMS are identifying and correcting exceedingly more improper payments compared to CGI and DCS. […]
Changes to Recovery Audit Contractor (“RAC”) tracking and reporting of RAC-associated reopenings and appeals data were recently implemented. Specifically, CMS Transmittal 1093, dated May 23, 2012, deleted Business Requirement 7604.2.4, required under Change Request (“CR”) 7469, which mandated specific data transfer protocols related to the information. The Business Requirement was deleted due to RAC-data warehouse […]
The Massachusetts Attorney General’s Office announced Thursday that it has settled, for $750,000, a data breach lawsuit filed against South Shore Hospital under the Massachusetts Consumer Protection Act and the federal Health Insurance Portability and Accountability Act (HIPAA). The alleged HIPAA violation arose from unencrypted back-up tapes that South Shore sent offsite to a data […]
The New York State Department of Financial Services (“Department”) recently issued a highly critical report about out-of-network billing practices in New York State. The report stems from the Department’s receipt of frequent complaints from patients who unexpectedly receive bills from specialists or other providers who they did not know were out-of-network. The Department indicated that […]
The Centers for Medicare and Medicaid Services (“CMS”) has extended the implementation of the Physician Payments Sunshine Act Physician Payments Sunshine Act (“Sunshine Act”), which was promulgated as a result of Section 6002 of the Patient Protection and Affordable Care Act. CMS will not require manufacturers of drugs, devices, biological, or medical supplies to begin […]
In four new recently posted frequently asked questions (FAQs) (select Fraud and Abuse in the left column), the Centers for Medicare & Medicaid Services (CMS) offers new guidance regarding the CMS Voluntary Self-Referral Disclosure Protocol. On September 23, 2010, CMS published the Medicare self-referral disclosure protocol (“SRDP”) pursuant to Section 6409(a) of the Patient Protection […]
In this rapidly-changing healthcare environment, providers need to remain cognizant of important deadlines that could affect their bottom lines. Here are several such deadlines under the Medicare program which could significantly impact cash flow. Saturday, June 30, 2012 – “E-Prescribing” – In order to qualify for an e-prescribing hardship exemption for calendar year 2013, eligible […]
By an order dated March 30, 2012, the United States District Court for the Eastern District of Michigan dismissed an antitrust claim brought by the City of Pontiac against Blue Cross Blue Shield (BCBS), the largest private health insurance provider in Michigan. In the case of City of Pontiac v. Blue Cross Blue Shield of […]
On March 29, 2012, with veritably no debate and less fan-fare, the New Hampshire House of Representatives recommended for passage HB 1725. HB 1725 is broad-reaching, and would prohibit all medical practitioners from prescribing or referring any FDA class II or class III implantable device in cases where they would gain profit, directly or indirectly […]
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