The Centers for Medicare and Medicaid Services (CMS) has extended the deadline for submitting a Notice of Intent to Apply to June 29, 2012 for Accountable Care Organizations (ACO) interested in participating in the Shared Savings Program beginning January 1, 2013. CMS will be accepting applications for the January 2013…
In June 2012 the Centers for Medicare and Medicaid Services (CMS) released Recovery Audit Program appeals data for fiscal year 2011. The report indicates that of the claim denials appealed, 43.4% were returned in the provider’s favor. In fiscal year 2011, 903,372 claims were determined to be overpayments. Of those…
On June 8, 2012, Robert Vito, Regional Inspector General for Evaluation and Inspections at the U.S. Department of Health and Human Services (HHS), Office of Inspector General (OIG), testified before the House Energy and Commerce Committee: Subcommittee on Oversight and Investigations. The testimony focused on the current OIG assessment of…
On May 29, 2012 the United States District Court for the Eastern District of North Carolina overturned the Medicare Appeals Counsel’s (MAC’s) decision regarding one evaluation and management (E/M) service claim. Six years earlier, a CMS Program Safeguard Contractor audited Dr. Ojebuoboh. It was determined that the government had overpaid…
On May 31, 2012, Department of Health and Human Services (HHS) Director of the Office of Civil Rights Leon Rodriguez issued a memo to consumers regarding those consumers’ right to access their protected health information and medical records. In this memo, Rodriguez stressed that it is important for consumers and…
The Office of Civil Rights (OCR) announced yesterday that its Health Insurance Portability and Accountability Act (HIPAA) Enforcement Training tools would be available to the general public today, June 5, 2012. Since 2009, as part of the Health Information Technology for Clinical and Economic Health (HITECH) Act, State Attorneys General…
The Centers for Medicare and Medicaid Services (CMS) has announced it will release a national provider Comparative Billing Report addressing Home Oxygen Services. The release is scheduled for June 26, 2012. The CBRs are produced by Safeguard Services under contract with CMS and will provide comparative data to help show…
On May 29, 2012, Connolly added new approved issues to its Approved Issues List for providers in Region C states. The new approved issues are across five categories and include: • Medical Necessity: Other O.R. Procedure of the Blood & Blood Forming Organs MS-DRG 802, 803, 804 W/MCC, W/CC, w/o…
CMS (Centers for Medicare & Medicaid Services) expects to publish Comparative Billing Reports (CBRs) on Evaluation and Management (E/M) Services on June 4, 2012. Since 2010, CMS, through Safeguard Services (SGS), has produced national comparative billing reports in select fields. These comparative studies are designed to help providers review their…
On May 10, 2012 the United States Court of Appeals for the Ninth District decided that criminal charges under the Health Insurance Portability and Accountability Act (HIPAA) do not require that an individual have knowledge that their actions are illegal. The case, United States of America v. Zhou, is the…