The Centers for Medicare & Medicaid Services (CMS) has updated the Appeals of Claims Decisions chapter of the Medicare Claims Processing Manual. The changes will be effective beginning July 23, 2013. The updates were enacted to ensure consistency with provisions of the Final Rule issued December 9, 2009, to improve and clarify operating instructions and […]
On June 13, 2013, the Department of Health and Human Services (“HHS”) Office of Inspector General (“OIG”) released Advisory opinion 13-03 regarding a proposed arrangement for clinical laboratory services. The OIG’s ruling on the arrangement was unfavorable, concluding there was potential to generate remuneration prohibited under the anti-kickback statute. THE ARRANGEMENT The Proposed Arrangement contemplated […]
Effective September 1, 2013, Blue Cross Blue Shield of Michigan (BCBSM) will implement a new Prescriber Prescription Block Policy. The policy focuses on protecting patient and public safety. Under the new policy, prescriptions will no longer be payable if: • A provider prescribes drugs that are not medically necessary, may cause significant patient harm, or […]
On May 9th, the Centers for Medicare and Medicaid Services (CMS) announced the start of a procurement process for new Medicare Fee for Service Recovery Audit Program contracts. The General Services Administration issued a Request for Quotes (RFQ) seeking four A/B Recovery Auditors, one national Durable Medical Equipment auditor and one Home Health/Hospice Recovery Auditor. […]
On May 18, 2013, the Office of the Inspector General (OIG) of the Department of Health & Human Services issued a Special Advisory Bulletin on the Effect of Exclusion from Participation in Federal Health Care Programs. This Bulletin replaces the previous version issued in 1999. The Bulletin performs several functions: • Lists prohibited payments. • […]
On May 13, 2013, the American Orthotic and Prosthetic Association (“AOPA”) filed suit in the federal district court for the District of Columbia against the Centers for Medicare and Medicaid (“CMS”), alleging that payment denials by CMS and its Recovery Audit Contractors (“RAC”) are invalid. The lawsuit states that CMS rules call for denial of […]
On April 30, 2013, the Department of Health and Human Services (“HHS”) Office for Civil Rights (“OCR”) announced the availability of new tools to educate health care providers and consumers about the Health Insurance Portability and Accountability Act (“HIPAA”) Privacy and Security Rules. Specifically for health care providers, three HIPAA education modules (offering free CME […]
The state of Michigan joined more than two dozen states in passing legislation to permit reporting of unsafe drivers by healthcare providers. Pursuant to Michigan Public Acts 354 and 355 of 2012, signed into law in late December of 2012, physicians and optometrists may now report information regarding a patient’s mental or physical qualifications to […]
The Department of Health and Human Services Office of Inspector General (“OIG”) issued an Updated Provider Self-Disclosure Protocol (“SDP”) on April 17, 2013 which supersedes the original SDP published in 1998 and three later-released open letters that provided additional guidance. The SDP clarifies that it is only available for “all health care providers, suppliers, or […]
On April 25, 2013, the Centers for Medicare and Medicaid (“CMS”) announced the release of additional information for states on implementation of the Affordable Care Act (“ACA”), part of a series of FAQs addressing the subject. The new FAQ provides information on three topics: 1. The availability of the federal match (75%) for maintenance and […]
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