It is often instructive to review the thinking of health care decision-makers as a tool to acquire insight on the direction of health care policy. In this regard, Dr. Donald Berwick, the administrator of the Centers for Medicare & Medicaid Services (“CMS”), recently authored an Op-Ed in the Wall Street Journal outlining his view of […]
Healthcare providers are more frequently utilizing social media to market their practices and to dispense health information. In order to protect the patient-physician relationship and ensure a continued positive internet presence for healthcare providers, the American Medical Association (“AMA”) adopted recommendations for physician use of social media. The guidelines recommend that physicians utilize privacy settings […]
Based on a recent report from the Office of Inspector General (“OIG”), Medicare permitted $38 million of improper claims for interpretation and reports of radiology services based on insufficient documentation in hospital emergency departments in 2008. This includes a 19 percent erroneous allowance of claims for interpretation and reports for magnetic resonance imaging (“MRI”) and […]
The Centers for Medicare and Medicaid Services (“CMS”) overpayment recovery through its Recovery Audit Contractor (“RAC”) program is on the rise. CMS recovered in excess of $313 million in Medicare overpayments since October 2009, and almost half of that amount ($162 million) was collected during the first three months of 2011. In comparison, only $75.8 […]
The Centers for Medicare & Medicaid Services (“CMS”) recently proposed a rule regarding the hospice wage index for the fiscal year (“FY”) 2012 (“Proposed Rule”). The rule would result in a 2.3 percent increase in Medicare payments to hospices for FY 2012 and implement a new quality reporting system as required by the Affordable Care […]
On May 5, the Centers for Medicare and Medicaid Services (CMS) published in the Federal Register its final rule for telemedicine credentialing and privileging for hospitals and critical access hospitals (CAHs). Beginning July 5, 2011, hospitals and CAHs, will have the option of proxy credentialing distant-site physicians and practitioners pursuant to a written agreement. Currently, […]
The Office of Inspector General (OIG) released a report in April entitled Review of Medicaid High-Dollar Payments for Inpatient Services in Michigan from January 1, 2007 Through March 31, 2009 that reviewed whether certain high-dollar Medicaid payments (defined as payments of $200,000 or more) “made to hospitals for inpatient services were based on accurate charges […]
Our attorneys are seeing an increase in Medicare claim denials resulting from the lack of valid practitioner signatures. A new publication from the Medicare Learning Network® titled “Comprehensive Error Rate Testing (CERT) Signature Requirements” provides the guidance necessary to avoid such denials. The fact sheet aims to educate health care providers on signature and supporting […]
On February 16, we wrote about a $200 million healthcare fraud scheme in southern Florida in connection with improper billing for Medicare mental health services. In an April 14 Department of Justice press release, the two orchestrators of the fraud scheme–Lawrence Duran and Marianella Valera–pleaded guilty at an arraignment hearing to all counts charged in […]
Dr. Joel Kahn has been named Detroit Medical Center’s (DMC) Medical Director of Wellness and Medical Director of Preventive Cardiology and Cardiac Rehabilitation. Dr. Kahn plans to develop a clinic for preventive cardiology as well as reopening a cardiac rehabilitation program for DMC. Continue Reading →
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