Recently the RAC for Region A, DCS Healthcare (DCS), added new issues for medical necessity reviews to its list of approved issues. DCS approved nine medical necessity issues, including Respiratory (limited to MS-DRG 190, 191, and 192), Gastro Intestinal Disorders (limited to MS-DRGs 391 and 393) and Diseases and Disorders…
The Centers for Medicare and Medicaid Services (CMS) published a proposed rule implementing provisions of the Patient Protection and Affordable Care Act (PPACA) that help tackle Medicare and Medicaid fraud. According to Peter Budetti, the Director of the new anti-fraud office at CMS, the proposed rules will provide federal authorities…
A manufacturer of cochlear implants (“Requestor”) inquired whether a Proposed Arrangement would violate the Anti-Kickback Statute and result in civil monetary penalties. The Office of the Inspector General for the Department of Health and Human Services (OIG) concluded that the Proposed Arrangement presents more than a minimal risk of violation…
U.S. District Judge Roger Vinson indicated last Tuesday that he will likely allow a lawsuit to proceed that challenges the Constitutionality of the Healthcare Reform law. The lawsuit, filed by 20 states, the National Federation of Independent Business and two individuals, challenges whether the Constitution permits the federal government to…
According to a study by researchers at the National Opinion Research Center at the University of Chicago and Georgetown University, the number of doctors engaged in “concierge medicine” is on the rise. The study found that almost 1,000 physicians nationwide practice concierge medicine. Physicians with these types of practices offer…
The Centers for Medicare and Medicaid Services (CMS) recently published a new rule affecting Durable Medical Equipment (DME) providers. The rule, effective September 27, 2010, strengthens Medicare’s standards for marketing and solicitations and expands enrollment requirements for DMEPOS providers. Important highlights from the rule include: – DME providers will be…
The Detroit Medical Center (DMC) recently announced that it has saved more than $5 million in costs in 2009 due to its system-wide Electronic Medical Records (EMR). This is the second consecutive year that the DMC has experienced cost-savings due to the EMR system. The system, which started to be…
The U.S. Department of Health and Human Services Office of Inspector General (OIG) recently issued two Advisory Opinions. The first Advisory Opinion, AO 10-12, found that an arrangement between a grant program operated by a nonprofit, tax exempt charitable organization that provides grants to brain tumor patients who require financial…
The Office of the National Coordinator for Health Information Technology (ONC) named the first technology review bodies that are authorized to certify electronic health record (EHR) systems. The review bodies, The Certification Commission for Health Information Technology (CCHIT) and the Drummond Group Inc. (DGI), will have the task of ensuring…
The RACs for Region D and Region C added medical necessity reviews to their lists of approved RAC audit issues. HealthDataInsights (HDI), the RAC for Region D, added ten medical necessity reviews to its list of approved issues, while Connolly Healthcare (Connolly), the RAC for Region C, posted 18 medical…