In accordance with New York State’s recently enacted accountable care organization (“ACO”) law (Article 29-E of the New York Public Health Law), the New York State Department of Health (“DOH”) will begin to process applications for Medicare-only ACOs to obtain certification under the new statute. The so-called “fast-track certification” under…
On November 14, the Office of Inspector General (“OIG”) of the Department of Health and Human Services (“HHS”) issued a report stemming from a review of the Administrative Law Judge (“ALJ”) level of the Medicare appeals system. The study analyzed all ALJ appeals decided in fiscal year 2010 from a…
Last week, AARP, along with five other consumer and professional organizations, sent a letter to leaders in Congress, urging them to protect access to health care for people with Medicare by addressing the flawed Medicare physician payment formula. Without congressional action, a 27.5 percent cut in payments to physicians treating…
Abby Pendleton, Esq. of The HLP was quoted in “Hospitals Brace for Audits of Short-Stay Admissions”, published November 5, 2012 in Crain’s Detroit Business on-line regarding RAC audit activity. In particular, the story discussed the new Medicare RAC pre-payment program and its impact on short-stay hospital admissions. Pendleton was interviewed…
The American Hospital Association (“AHA”) and four hospitals (collectively, the “Plaintiffs”) have filed a lawsuit against the Department of Health and Human Services (“HHS”), alleging that the Centers for Medicare and Medicaid Services (“CMS”, a sub-agency of HHS), through its Medicare RAC Program, has inappropriately refused to pay for Medicare…
On October 5, the Office of Inspector General (“OIG”) issued Advisory Opinion 12-13, approving a proposed arrangement allowing a hearing aid supplier to bill Medicare for certain audiometric testing services, while also offering a free hearing exam to potential patients (“Proposed Arrangement”). The requestor owned a chain of hearing aid…
On September 28, CMS issued Transmittal 2156 revising and clarifying Place of Service Coding (POS) instructions. The Transmittal rescinds previous Transmittal 2435, extends the implementation date to April 1, 2013 and provides a few clarifications for physicians and other supplier entities when determining the appropriate Point of Service (POS) designation…
On October 3, 2012, the OIG released its Work Plan for the FY of 2013. Throughout the week, we will be posting on various aspects of the Work Plan pertinent to our clients and our readers in the following areas: • Hospitals • Home Health Agencies • Hospices • Evaluation…
We are pleased to announce that Abby Pendleton, Esq. and Claudia Hinrichsen, Esq. will be speaking at the upcoming Healthcare Financial Management Association (HFMA) of Western New York education session entitled “Compliance Update: RAC, HIPAA/HITECH, Hospital and Physician Compliance” scheduled for Friday, September 28, from 8:30am-12:00pm EDT. Ms. Pendleton and…
Adrienne Dresevic and Jessica Gustafson, founding partners of Southfield, Mich.-based The Health Law Partners, recently presented at The Association for Medical Imaging Management’s (AHRA) 40th Annual Meeting and Expo in Orlando, Fla. Founding partner, Abby Pendleton made the announcement. Dresevic and Gustafson spoke on key legal issues impacting radiology providers…