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…
The healthcare reform legislation included changes for home health and DME providers. First of all, DME or home health services may only be ordered for Medicare beneficiaries by Medicare enrolled physicians or eligible professionals. In addition, Medicare enrolled physicians are required to have a face-to-face encounter with a patient prior…
The Health Reform bill, or the Patient Protection and Affordable Care Act, amended the definition of remuneration in the Civil Monetary Penalties Law. The amendment clarifies that certain charitable activities are not prohibited under the law. The amended law excludes the following from qualifying as remuneration: Any remuneration which promotes…
On Monday, April 6, 2010, Andrew Wachler was a guest speaker at the RAC Monitor webinar, where he discussed Medicare inpatient/outpatient reimbursement issues and the financial impact they have on hospitals and health systems.
Andrew Wachler, principal of Wachler & Associates, P.C., presented “The New Audit Landscape: MICs, MACs, and RACs” in an American Bar Association (ABA) teleconference with James Sheehan, New York Medicaid Inspector General.