A report published in the February 2, 2011 edition of the Journal of the American Medical Association, compared the patient diagnoses, length of stay, and location of service for hospice patients receiving care from for-profit and not-for-profit hospices. The researchers found that for-profit hospices had a higher percentage of patients with non-cancer primary diagnoses, and […]
CMS has issued revised Interpretive Guidelines for the Hospital Conditions of Participation. The revised Interpretive Guidelines, which are effective immediately, contain significant changes affecting anesthesia providers, including the following: • Labor Epidurals. CMS removed language exempting labor epidurals from the physician supervision requirements. The revised Interpretive Guidelines note that, “there is often no bright line, […]
During the Recovery Audit Contractor (“RAC”) demonstration program, a significant number of the claims denied were denied for the reason that an inpatient hospital admission was not medically necessary. The RACs regularly based these denials not upon published Medicare guidance, but based upon the criteria of private companies, such as InterQual. In an effort to […]
The New York regulations related to the credentialing of medical staff personnel have been revised, effective December 22, 2010. In particular, the regulations have been revised to reduce the required “look-back period” for medical staff credentialing from 10 years to five years. During this “look-back period,” hospitals are mandated to query all hospitals at which […]
The FY 2010 Health Care Fraud and Abuse Control Program Report was issued on January 24, 2011 by the Office of Inspector General (“OIG”). This report summarizes the health care fraud prevention and enforcement efforts that yielded results during fiscal year (“FY”) 2010. According to the Report, the federal government recovered more than $4 billion […]
The American Hospital Association (AHA) expressed its concerns with numerous regulations adversely impacting hospitals, by way of letter dated January 14, 2010 to Darrell Issa, the Chairman of the Committee on Oversight and Government Reform in the U.S. House of Representatives. Among numerous other regulations causing strife for hospital providers (e.g., the Federal Stark law, […]
CMS announced on December 30th a new feature to enhance its Physician Directory tool, called Physician Compare, which expands and updates the existing Healthcare Provider Directory. The new site, www.medicare.gov/find-a-doctor, was mandated by the Patient Protection and Affordable Care Act. In the first phase of the roll-out, the categories of information on the Physician Compare […]
With the onslaught of the new Patient Protection and Affordable Care Act (PPACA) provisions making it a false claim to retain known overpayments and the new CMS guidance on the newly-reinstated Voluntary Self-Referral Disclosure Protocol (SRDP), Wisconsin Physician Services (WPS)–the Medicare Part B Contractor for Illinois, Michigan, Wisconsin, and Minnesota–released its revised overpayment notification and […]
For over a year, the Health Law Attorney Blog has reported on many of the electronic health records (EHR) incentive payment updates (the most recent entry from July 13, 2010). Beginning today, eligible professionals, hospitals and critical access hospitals may begin registering for incentive payments for demonstrating meaningful use of certified EHR technology. Certified EHR […]
On December 28,2010, the Office of Inspector General (“OIG”) published Advisory Opinion 10-26, wherein the OIG concluded that an ambulance provider offering discounted rates to skilled nursing facilities (“SNFs”) could violate the Anti-Kickback Statute (“AKS”). In Advisory Opinion 10-26, Requestor is a nonprofit Medicare and Medicaid certified ambulance supplier providing emergency and non-emergency transportation services, […]
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