On November 10, 2010, the Centers for Medicare & Medicaid Services (“CMS”) published its much-anticipated Proposed Rule regarding the Medicaid Recovery Audit Contractor (“RAC”) program. Section 6411 of the Patient Protection and Affordable Care Act (“Affordable Care Act”) requires each State to establish a Medicaid RAC program similar to the existing Medicare RAC program. States […]
CMS’s 2011 Final Physician Fee Schedule (the “Fee Schedule”) provides for over 2000 pages of new rules and regulations pertaining to physician reimbursement under Medicare for 2011. With the passing of the Patient Protection and Affordable Care Act (“PPACA”) and the Healthcare and Education Reconciliation Act (collectively referred to as the “Affordable Care Act”), physicians […]
Following upon the heels of September’s first-ever Advisory Opinion on sleep testing, the Office of Inspector General today issued the second and third installments of what appears to be the OIG’s Sleep Opinion Trilogy. These new opinions generally follow the facts of the first opinion – a third party management company provides all of the […]
CMS published its interim final values for sleep testing yesterday, November 2, 2010, as part of Medicare’s Final Part B Physician Fee Schedule for 2011. Although the sleep code values are to be effective January 1, 2011, CMS is offering the public the opportunity to comment on these new sleep medicine values by 5:00 pm […]
The 2011 CMS Final Physician Fee Schedule has been released. Please check back with us for entries regarding specific provisions relevant to our readers! Continue Reading →
With respect to the Medicare appeals process, the OIG plans to review and examine the following: • The timeliness of the Medicare contractors’ determinations on requests for reconsideration at the first level of Medicare appeals as they have 60 days to conclude a redetermination pertaining to a denied claim. • The characteristics of cases brought […]
The OIG plans to examine a number of areas pertaining to medical equipment and supplies, including, but not limited to, the following: • The appropriateness of Part B claims in selected geographic areas with high-volume claims and reimbursement for durable medical equipment (DME) suppliers of power mobility devices, hospital beds and accessories, oxygen concentrators, and […]
Because Medicare payments for sleep testing has increased from $62 million in 2001 to $235 million in 2009, the OIG will review the appropriateness of payments for such testing and the factors contributing to such a steep increase in payments. Additionally, the OIG will examine the appropriateness of Medicare payments for sleep testing at sleep […]
The OIG will review the high-cost diagnostic tests to ensure that they were medically necessary by looking at the same diagnostic tests ordered by the primary care physician as well as the specialist. With respect to independent diagnostic testing facilities (IDTFs), federal regulations require compliance with 17 standards. The OIG will look at IDTFs to […]
Currently, Medicare Part B pays for imaging services pursuant to the physician professional cost component, the malpractice costs, and the practice expenses. Practice expenses are resources used in furnishing the services (i.e., rent, personnel costs, equipment costs, etc.). The OIG will review whether the Medicare payments for practice expenses “reflect the expenses incurred and whether […]
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