The Recovery Audit Contractor (“RAC”) vendor for Region C, Connolly Consulting (presently acting in South Carolina and Florida), has published its initial approved audit issues. Medicare providers and suppliers in these states can expect RAC auditing to begin soon in following areas, including: • Blood Transfusions • Untimed codes • IV Hydration Therapy • Bronchoscopy […]
HHS turns HIPAA over to the Office for Civil Rights. Today, Kathleen Sebelius–Department of Health and Human Services (HHS) Secretary–transferred the Health Insurance Portability and Accountability Act of 1996 (HIPAA) Security Rule’s delegation from the Centers for Medicare and Medicaid Services (CMS) to the Office for Civil Rights (OCR). The HHS contends that this “will […]
OIG issued Advisory Opinion 09-10 permitting “network hospitals to discount the Medicare inpatient deductible for the Requestors’ policyholders….” Requestors are offer Medigap policies in a majority of US states. The Arrangement would allow for the Medigap policyholders to receive a 100% discount on Medicare Part A, inpatient deductibles received at participating hospitals and preferred provider […]
OIG issued Advisory Opinion 09-08 allowing Requestor–“a pharmaceutical and healthcare company that develops, manufactures, and markets pharmaceutical products–to develop a Program “that will make available at no charge certain of its drug products to indigent patients without prescription drug coverage.” The OIG determined that the Program falls under the umbrella of a Bulk Replacement Model, […]
OIG permitted joint venture of Ambulatory Surgery Center (ASC) by a hospital and LLC. In its Advisory Opinion 09-09 released yesterday, the Office of Inspector General (OIG) analyzed a situation in which a Hospital and an LLC (Surgeon LLC), owned by seven orthopedic surgeons (Surgeon Investors), would jointly own a company that will own and […]
FTC postponed Red Flags. As many entities have been scrambling to get their anti-identity theft programs in place by August 1, the Federal Trade Commission (FTC) announced that it would be pushing back enforcement of the Red Flags Rule until November 1. The purpose of this is to continue to educate entities regarding the Red […]
Get ready: the Centers for Medicare and Medicaid Services (CMS or Medicare) Recovery Audit Contractor (RAC) program has been made permanent and is expanding nationwide. All Medicare providers and suppliers should begin to prepare now for increased Medicare scrutiny. Hospitals and health systems nationwide can expect RAC auditing activity and overpayment requests beginning in 2009, […]
This article is the second part of a 2 part series addressing recent federal regulatory action targeting diagnostic imaging arrangements. Part 1 (published in the January/February 2009 issue of Radiology Management) focused solely on some of the more significant changes to the federal Stark regulations. Part 2 will summarize some of the significant regulatory actions […]
In recent years, the diagnostic imaging services industry has been intensively scrutinized by the federal government, as evidenced by heightened regulatory action targeting certain diagnostic imaging arrangements, such as changes to the federal Stark Law (that restrict the flexibility of structuring diagnostic imaging arrangements), expansion of the federal anti-markup prohibition, changes to the independent diagnostic […]
Recent legislative initiatives to restrict (or eliminate) the Stark Law’s In-Office Ancillary Services Exception (IOASE) are by no means a new phenomenon. Rather, over the last few years, the Centers for Medicare and Medicaid Services (CMS) has introduced several significant proposals targeting the provision of diagnostic imaging (and other ancillary services) in the physician office […]
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