CMS has issued new guidance expanding on the Fee-for-Service Reimbursement instructions detailed in CR 6960 (which HLP had blogged about here). The earlier change request explained the basic standards stemming from the Section 6404 of the Patient Protection and Affordable Care Act of 2010: services billed more than one year after they were provided would […]
As HLP reported, in April, CMS requested that the RAC for Region D remove an anesthesia care package it had posted to its website. Now, the issue has been re-posted, with some changes: Under NCCI Edit rules, the anesthesia care package consists of preoperative evaluation, standard preparation and monitoring services, administration of anesthesia, and post-anesthesia […]
As the Wall Street Journal reported on August 9th, health-insurance companies progressively are initiating programs to equip doctors with high-tech patient records. Even with all of the focus on electronic health records (“EHR”), an estimated 80% of U.S. physicians and 90%of hospitals continue to use paper records. As HLP has discussed in a number of […]
Attorney General of New York, Andre Cuomo, initiated an investigation into health care credit cards after receiving a substantial number of complaints from consumers who were convinced by doctors and dentists to sign up for them. The investigation will examine the financial incentives providers received from promoting the cards. Subpoenas have already been issued to […]
On July 30, the OIG released advisory opinion no 10-11 (the “Opinion”) which favorably reviewed a company’s proposal to encourage health care providers to use its online program for scheduling meetings with manufacturer representatives by offering the health care provider an opportunity to select a public charity to which the company would make a monetary, […]
As the HLP had previously reported, on July 16, the HHS Medicare Fraud Strike Force announced charges against 94 individuals for their alleged participation in schemes that collectively submitted more than $251 million in false claims to Medicare. The charges are based on a variety of schemes including: physical therapy and occupational therapy schemes, home […]
On July 23, CMS published a notice in the Federal Register, soliciting proposals in a new imaging demonstration created under the Medicare Improvements for Patients and Providers Act of 2008. The two-year Medicare Imaging Demonstration (MID) will test whether the use of decision supports systems (DSSs) can improve quality of care and reduce unnecessary radiation […]
Advanced Radiology of Beverly Hills has agreed to pay the federal government $647,000 to settle allegations that they filed false claims with Medicare for unnecessary radiological tests. The United States civil lawsuit alleged that Advanced Radiology engaged in a scheme to bill Medicare for unnecessary tests performed at Advanced Radiology from 1999 through 2002. As […]
For those providers and entities that think HIPAA violations are no big deal or that have yet to implement required policies and procedures, they are well advised to review the Department of Health and Human Services July 27, 2010 press release announcing a $1 million dollar settlement related to allegations of violations of HIPAA. Rite […]
The Medicare hospice benefit is a fully reimbursable Medicare Part A benefit option, which covers the multidisciplinary services addressing the physical and emotional pain associated with terminal illness through palliative treatment. To be eligible to elect hospice care under Medicare, an individual must be entitled to Part A of Medicare, and be certified as being […]
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