The RAC for Region C, Connolly Healthcare, has added 20 new DRG Validation issues to the list of CMS-approved audit issues. In addition, earlier this month several issues were approved for Region C providers in Virginia and West Virginia. If you need assistance with a RAC or third party payor…
The Patient Protection and Affordable Care Act (PPACA), also referred to as the Healthcare Reform Legislation, made significant changes for Medicare providers. One change found in Section 6404 of the PPACA reduces the Medicare Parts A and B claims filing deadline to one (1) calendar year after the date of…
In the same vein as the Healthcare Reform legislation’s vendor-providing reporting requirements known as the “sunshine law,” several leading professional medical organizations have adopted the new ethics codes, including: the American College of Physicians, the American College of Cardiology, and the American Society of Clinical Oncology. The ethical codes require…
On April 15 a bipartisan bill, the Health Information Technology Extension for Behavioral Health Services Act of 2010, was introduced in the House. The bill extends the Health Information Technology for Economic and Clinical Health (HITECH) Act’s electronic health records incentives to mental health professionals. Currently the HITECH Act provides…
On April 15 President Obama signed H.R. 4851 into law, blocking the 21% reduction in Medicare physician payments through May 31. The original Senate bill delayed the cuts until April 30, but was passed with an amendment that pushed the date to May 31. Although the 21% cuts toMedicare reimbursement…
The Health Reform bill, also known as the Patient Protection and Affordable Care Act, includes amendments to the Anti-Kickback Statute (AKS), including a relaxation of the “specific intent” requirement. The Health Reform bill amended Section 1128B of the Social Security Act to add the following statement: “with respect to violations…
The Healthcare Reform legislation includes vendor-provider reporting requirements, also known as the “sunshine law.” The law requires manufacturers of drugs, medical devices, medical supplies, and biologics to report financial arrangements with certain “covered recipients.” “Covered recipients” include physicians or teaching hospitals. The manufacturer must make the report to the U.S.…
The College of American Pathologists (CAP) recently announced that it is changing its accreditation checklist for CLIA accreditation in response to an interpretation communicated by the Centers for Medicare and Medicaid Services (CMS) with regard to the qualifications for “processing” personnel. Previously CAP treated “processing” personnel different from “grossing” personnel…
A proposed bill, the Medicare Fraud Enforcement and Prevention Act, introduced in the House on Tuesday would double penalties for Medicare fraud. Sentences for Medicare fraud would be increased from 5 to 10 years and fines from $25,000 to $50,000. In addition, it would create a new crime for distributing…
Providers and suppliers that receive request letters from Recovery Audit Contractors (RACs) should ensure the following: The claims selected involve issues approved for review on their RAC region’s approved issues list. The request letters meet the timeframes and medical record limits set by CMS. The particular claims at issue have…