The HITECH Act (The Health Information Technology for Economic and Clinical Health Act), enacted February 17, 2009, significantly supplemented and altered the Health Insurance Portability and Accountability Act of 1996 (“HIPAA”). One such provision of the HITECH Act made both covered entities and their business associates liable for breaches of…
Centers for Medicare and Medicaid Services (CMS) noted that consignment closets (also known as stock and bill arrangements) have not complied with durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) supplier standards. As a result, CMS issued a Change Request (CR) affecting physicians and DMEPOS suppliers, which allows for consignment…
The Recovery Audit Contractor (“RAC”) for region D, HealthDataInsights, Inc. recently published its RAC website, and published its first list of approved RAC audit issues for complex coding reviews. Pursuant to the recently-published CMS RAC Review Phase In Strategy, complex reviews regarding DRG validation and coding errors were scheduled to…
OIG recommends revision of the “incident to” rule. The Office of Inspector General (OIG) released a report, “Prevalence and Qualifications of Nonphysicians Who Performed Medicare Physician Services” analyzing services that nonphysicians perform for which physicians bill Medicare. The “incident to” rule involves physicians billing for nonphysician-rendered services that are compensated…
The Recovery Audit Contractor (“RAC”) vendor for Region C, Connolly Consulting (presently acting in South Carolina and Florida), has published its initial approved audit issues. Medicare providers and suppliers in these states can expect RAC auditing to begin soon in following areas, including: • Blood Transfusions • Untimed codes •…
HHS turns HIPAA over to the Office for Civil Rights. Today, Kathleen Sebelius–Department of Health and Human Services (HHS) Secretary–transferred the Health Insurance Portability and Accountability Act of 1996 (HIPAA) Security Rule’s delegation from the Centers for Medicare and Medicaid Services (CMS) to the Office for Civil Rights (OCR). The…
OIG issued Advisory Opinion 09-10 permitting “network hospitals to discount the Medicare inpatient deductible for the Requestors’ policyholders….” Requestors are offer Medigap policies in a majority of US states. The Arrangement would allow for the Medigap policyholders to receive a 100% discount on Medicare Part A, inpatient deductibles received at…
OIG issued Advisory Opinion 09-08 allowing Requestor–“a pharmaceutical and healthcare company that develops, manufactures, and markets pharmaceutical products–to develop a Program “that will make available at no charge certain of its drug products to indigent patients without prescription drug coverage.” The OIG determined that the Program falls under the umbrella…
OIG permitted joint venture of Ambulatory Surgery Center (ASC) by a hospital and LLC. In its Advisory Opinion 09-09 released yesterday, the Office of Inspector General (OIG) analyzed a situation in which a Hospital and an LLC (Surgeon LLC), owned by seven orthopedic surgeons (Surgeon Investors), would jointly own a…
FTC postponed Red Flags. As many entities have been scrambling to get their anti-identity theft programs in place by August 1, the Federal Trade Commission (FTC) announced that it would be pushing back enforcement of the Red Flags Rule until November 1. The purpose of this is to continue to…