On Thursday, August 23, 2012, the Final Rule regarding the Stage II Meaningful Use requirements was published. This Final Rule sets forth the requirements eligible hospitals and other eligible providers must meet in order to receive payments under the program, which provides incentive payments to Medicare and Medicaid providers that…
This summer the Centers for Medicare & Medicaid Innovation announced 81 Health Care Innovation Awards made pursuant to the Affordable Care Act. Recipients were selected based upon their innovative solutions to addressing problems facing their communities and their ability to “deliver high-quality medical care, enhance the health care workforce, and…
MEDICARE APPROVES 89 NEW ACOs WHILE NEW YORK STATE AND PRIVATE PAYERS CONTINUE TO ADOPT ACO-RELATED STRATEGIES –Federal Government On July 9th, the U.S. Department of Health and Human Services added 89 new accountable care organizations to its list of entities which have been approved to participate in the Medicare…
Recently, CMS released a related change request (CR) 7838, which informs Medicare contractors about a new addition to the “Medicare Benefit Policy Manual,” Chapter 9, Section 90, which is titled, “Caps and Limitations on Hospice Payment.” A summary of the key provisions of the new Chapter 9, Section 90 of…
The Government Accountability Office (“GAO”) recently released a Report on the National Medicaid Audit Program (“NMAP”), which found that “private contractors received $102 million to review Medicaid fraud data, yet had only found about $20 million in overpayments since 2008.” In summary, the Report found that compared with initial test…
On May 18, 2012, Medicare released their 2nd Quarter Newsletter regarding the recovery efforts of each of the region’s Recovery Audit Contractors: DCS, CGI, Connolly, and HDI. CGI Federal has the lowest level of overpayment recoupments and underpayment identification. Connolly and HDI/HMS are identifying and correcting exceedingly more improper payments…
Changes to Recovery Audit Contractor (“RAC”) tracking and reporting of RAC-associated reopenings and appeals data were recently implemented. Specifically, CMS Transmittal 1093, dated May 23, 2012, deleted Business Requirement 7604.2.4, required under Change Request (“CR”) 7469, which mandated specific data transfer protocols related to the information. The Business Requirement was…
The Centers for Medicare and Medicaid Services (“CMS”) has extended the implementation of the Physician Payments Sunshine Act Physician Payments Sunshine Act (“Sunshine Act”), which was promulgated as a result of Section 6002 of the Patient Protection and Affordable Care Act. CMS will not require manufacturers of drugs, devices, biological,…
In this rapidly-changing healthcare environment, providers need to remain cognizant of important deadlines that could affect their bottom lines. Here are several such deadlines under the Medicare program which could significantly impact cash flow. Saturday, June 30, 2012 – “E-Prescribing” – In order to qualify for an e-prescribing hardship exemption…
Medicare released new guidelines regarding the limit on the number of additional documentation requests (“ADRs”) RACs may request per 45-day period. Notably, these revisions constitute an increase for providers. (Note: the revised ADR limits outlined below do not apply to physicians and suppliers.) Effective March 15, 2012, the ADR limits…