If the rumors are true, tomorrow the Centers for Medicare and Medicaid Services, the Office of the Inspector General and the Federal Trade Commission will be releasing voluminous regulations governing the formation of Accountable Care Organizations (“ACO”) and the Medicare Shared Savings Program. But before we receive all the minutiae…
Thirteen medical societies and several senior citizen advocacy groups have requested that CMS delay the enforcement of the new face-to-face encounter requirement. These groups are seeking to delay the effective date to no sooner than July 1, 2011. This new requirement stipulates that physicians, or a nurse practitioner working with…
A Republican Senator out of Iowa, Chuck Grassley, has introduced a new bill to the Senate. This bill, which is entitled the Strengthening Program Integrity and Accountability in Health Care Act of 2011, seeks to amend the Social Security Act in a way that prevents improper billing, either through fraud or…
The Department of Health and Human Service’s Office for Civil Rights will be conducting a series of workshops to help educate and train state Attorney Generals in enforcing the Health Insurance Portability and Accountability Act of 2009 (HIPAA). These workshops will include reviews of HIPAA and state privacy laws and…
The Government Accountability Office released a report on March 2, 2011, which concludes that inefficiencies and duplication in Government Programs are costing taxpayers billions every year. This report, entitled “Opportunities to Reduce Potential Duplication in Government Programs, Save Tax Dollars and Enhance Revenue,” was issued to aid lawmakers in setting the federal…
The Justice Department is seeking clarification on a ruling made by U.S. District Court Judge Roger Vinson. Judge Vinson, in his ruling on the implementation of the Patient Protection and Affordable Care Act, suggested that the government was enjoined from implementation of the Act. The DOJ now wants the Judge…
CGI, the Recovery Audit Contractor (RAC) for Region B, recently removed four DRG validation issues from its list. This means that providers in Region B will no longer be subject to RAC audits on these particular procedures. Connolly has added several new RAC issues to its CMS approved list. One…
Effective February 14, 2011, CMS has limited the number of records RACs may request when reviewing Medicare claims from Physicians and other practitioners. These requests for medical records, which are used in connection with complex claims reviews, will be limited based on the size of the group/office being audited. If…
According to a Department of Health and Human Services news release issued on Thursday, February 17, 2010, the Medicare Strike Force has indicted 111 health care providers for allegedly billing false claims to Medicare. HHS called this the “largest ever federal health care fraud takedown.” 21 defendants were arrested in…
Connolly Healthcare, the region C RAC, recently posted 77 new issues eligible for review. Twenty-three of these new issues involve Medical Necessity reviews, several of which include reviews of acute inpatient admissions to validate the medical necessity of short stay admissions. These new approved issues implicate a variety of MS-DRGs,…