In its report, “The Medicare RAC Program: Update to the evaluation of the three-year demonstration,” the Centers for Medicare and Medicaid Services (CMS) reveals that providers have been winning more appeals since its last report in January 2009. The report first noted that the number of reported claims for appeal…
The U.S. Department of Health and Human Services Office of Inspector General (OIG) issued Advisory Opinion 10-08 to address the provision of dietitian and social worker services at a freestanding radiation oncology center (Center) at no extra charge to the beneficiaries. The OIG determined that the proposed arrangement would not…
On June 18 the U.S. Senate passed a six-month plan to prevent the Medicare physician 21 percent payment cut. The measure, which will cost $6.4 billion, was pushed through with the concern that the steep payment cut would raise the possibility that medical providers would turn away patients covered by…
Michigan’s budget may be threatened by U.S. Congressional action. Crain’s Detroit Business reported that Congress’ concern over the nation’s deficit may affect its willingness to pay for an estimated $24 billion in Medicaid assistance to states and other financial assistance, leading to the removal of the enhanced Federal Medical Assistance…
The Michigan Office of Financial and Insurance Regulation released details about a new high-risk pool that will offer insurance to the uninsured. To qualify the individuals must have been uninsured for at least six months, have been rejected by an insurer, and first spend $1,000 in out-of-pocket costs. The purpose…
As noted in our June 11 blog entry, the American Board of Internal Medicine (ABIM) recently took unprecedented action in immediately suspending the board certifications of 139 physicians. We have been in communication with the ABIM urging them to characterize the action as non-final recommended action pending appeal rather than…
The Director of Health Care for the Government Accountability Office (GAO), Kathleen M. King, recently testified before the Subcommittees on Health and Oversight, Committee on Ways and Means, House of Representatives. An important component of her testimony included a recommendation that Recovery Audit Contractors (RACs) should focus their post-payment review…
Accountable Care Organizations (ACOs) are beginning to populate Michigan’s healthcare sector. ACOs are integrated groups of hospitals, physicians, long-term care facilities and home health agencies. A provision in the Patient Protection and Affordable Care Act (PPACA) authorized provider organizations to create ACOs so long as they agree to manage care…
The American Board of Internal Medicine (ABIM) has filed suits against 5 physicians for alleged copyright infringement, the misappropriation of trade secrets, and breach of contract. In addition, ABIM immediately suspended or revoked a total of 139 physicians’ board certification. The ABIM is an organization that certifies internal-medicine specialists and…
The RAC for Region D, HealthDataInsights, added two new RAC issues for Part B claims review to its CMS-approved list. The new issues are co-surgery not billed with modifier 62 and global days. The issues apply to providers in all Region D states. For more information on RAC approved issues…