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Wachler & Associates Health Law Blog

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CMS Releases Last Quarter’s Data on Medicare RAC Collections

The Centers for Medicare and Medicaid Services (CMS) has recently released the Medicare RAC collections data for the last quarter of 2011 fiscal year. Recovery auditors identified $277.1 million in overpayments and $76.6 million in underpayments, for a total claims’ correction of $353.7 million, which was 22 percent higher than…

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CMS Releases Part A to B Rebilling Demonstration Program Enrollment Application

This week CMS released more information regarding the Part A to Part B Rebilling Demonstration Program. Now available on CMS’ website is the enrollment application for hospitals to complete to seek to participate in the program. The enrollment application includes language which reiterates that participation in the Demonstration Program is…

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OIG Releases Report Highlighting ZPIC Oversight Issues

Recently, the Department of Health and Human Service’s Office of Inspector General released a report which found that the workload data used by the Centers for Medicare and Medicaid Services (CMS) to oversee its Zone Program Integrity Contractors (ZPICs) were inaccurate and lacked uniformity. The study was conducted by collecting…

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CMS to Release Comparative Billing Reports for Nerve Conduction Studies

The Centers for Medicare and Medicaid Services (CMS) recently announced it will release a national provider Comparative Billing Report (CBR) addressing Nerve Conduction Studies on December 6, 2011. The CBRs are produced by Safeguard Services under contract with CMS and will provide comparative data to help show how these individual…

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CMS Announces Special Open Door Forum for Part A to Part B Rebilling Demonstration Program

On Friday, November 18, CMS released a Q&A about the Part A to Part B Rebilling Demonstration Program. Although the Q&A does not answer many of the questions that arose from the Fact Sheet released on November 15, it does give insight into when those answers could be provided. CMS…

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CMS Announces RAC Pre-Payment Review Demonstration Program

The Centers for Medicare & Medicaid Services announced a Recovery Audit Contractor (“RAC”) Pre-Payment Review Demonstration Program on November 15, 2011. The announcement of this program is a major shift in the RAC program because previously RACs were only allowed to conduct post-payment reviews of providers. Although the program is…

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CMS Announces Part A to Part B Rebilling Demonstration Program

Yesterday, the Centers for Medicare & Medicaid Services (“CMS”) announced the Part A to Part B Rebilling Demonstration Program (“Demonstration Program”). The Demonstration Program will allow a select number of hospitals to receive 90 percent reimbursement of the Part B payment for Part A inpatient short stay claims that are…

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Physician Payment Sunshine Act Rules Delayed

HHS this week announced that it would again delay publishing rules implementing the Physician Payments Sunshine Act (“PPSA”), established in last year’s Patient Protection and Affordable Care Act (“PPACA” or “health reform”). PPSA requires drug and medical device manufacturers to publicly report gifts and payments made to physicians and teaching…

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