Health Law Attorney Blog

Published on: March 16, 2012 | by The Health Law Partners

Medicare Redesigns Claims and Benefits Statement to Empower Seniors with Clearer Information on Health Services Used

The Acting Administrator of the Centers for Medicare & Medicaid Services (CMS), Marilyn Tavenner, announced the redesign of the statement that informs Medicare beneficiaries about their claims for Medicare services and benefits. The announcement comes as a part of National Consumer Protection Week. The redesigned statement, known as the Medicare Summary Notice (MSN), will be […]

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Published on: March 2, 2012 | by The Health Law Partners

Highmark Medicare Services Now Novitas Solutions

Effective January 1, 2012, Highmark Medicare Services (“Highmark”) was acquired by Diversified Service Options, Inc. (a wholly-owned subsidiary of Blue Cross and Blue Shield of Florida, Inc.). As a result of the acquisition, Highmark changed its name to Novitas Solutions, Inc. (“Novitas”). Novitas will continue Highmark’s role as the Medicare Administrative Contractor (“MAC”) for J12 […]

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Published on: February 24, 2012 | by The Health Law Partners

CMS Releases Email Alert Regarding Advanced Diagnostic Imaging Accreditation

On February 23, 2012, CMS issued an email notification to all Fee-for-Service (“FFS”) providers, which states the following: CMS has received reports that providers are receiving denials for advanced diagnostic imaging (ADI) services they are accredited to perform. We have taken action to correct the situation. CMS has instructed all contractors to review each ADI […]

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Published on: February 21, 2012 | by The Health Law Partners

CMS Revises Interpretative Guidelines for Rehabilitation in Outpatient Hospitals

In response to concerns raised by the American Physical Therapy Association (APTA) and other associations, the Centers for Medicare and Medicaid Services (CMS) has revised interpretative guidelines (Transmittal 72) to eliminate the requirement that rehabilitation services furnished in outpatient hospital settings be ordered by a practitioner with medical staff privileges. The new guidance issued to […]

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Published on: February 21, 2012 | by The Health Law Partners

Congress Passes Legislation to Avoid SGR Cuts for Ten Months

The House and Senate passed a revised version of H.R. 3630, the Middle Class Tax Relief and Job Creation Act of 2012, which guarantees that physicians will avoid a 27.4 percent cut in Medicare reimbursement for an additional ten months. Instead of the schedule cuts which were expected to be enacted on March 1, physician […]

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Published on: February 20, 2012 | by The Health Law Partners

CMS Issues Proposed Rule on Reporting and Refunding Medicare Overpayments

Section 6402(a) of the Patient Protection and Affordable Care Act (PPACA) established a new section in the Social Security Act mandating that providers timely report and return Medicare overpayments. Since PPACA’s passage, the healthcare community has awaited clarification on several ambiguities contained in the statute. On February 16, 2012, CMS released a proposed rule implementing […]

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Published on: February 14, 2012 | by The Health Law Partners

CMS Releases Details of Fee-for-Service Recovery Audit Prepayment Review Demonstration and Prior Authorization Demonstration

On February 7, 2012, The Centers for Medicare and Medicaid Services (CMS) released a Request for Comments regarding two demonstration programs it intends to conduct. The first, the Recovery Audit Prepayment Review Demonstration, will allow CMS and its agents to request additional documentation, including medical records, to support submitted claims. In Chapter 3 of the […]

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Published on: February 13, 2012 | by The Health Law Partners

Did CVS Go Too Far?

As we reported in a previous blog entry, HHS recently encouraged prescription drug plans to delay the payment of suspicious claims and to take proactive measures to prevent prescription drug fraud such as requiring pre-authorizations and limiting payment of controlled substances beyond a thirty-day supply . Now, it seems that CVS has decided to take […]

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Published on: February 10, 2012 | by The Health Law Partners

OIG Alerts Physicians to Exercise Caution When Reassigning Their Medicare Payments

OIG recently issued an alert for physicians who reassign their right to bill the Medicare program and receive Medicare payments by executing the CMS-855R application, which says they may be liable for false claims submitted by entities to which they have reassigned their Medicare benefits. OIG has advised physicians to use increased scrutiny of entities […]

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Published on: February 8, 2012 | by The Health Law Partners

RAC Audits: OIG Releases Recovery Act Oversight Monthly Reports

On February 8, 2012, the Office of Inspector General published the November and December Recovery Act Oversight Monthly Reports. The most recent figures indicate that in November 2011, $12,589,859.00 dollars of Recovery Act funds were used on Recovery Audit activities. In December 2011, $13,161,164.00 dollars of Recovery Act funds were used on Recovery Audit activities. […]

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