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Wisconsin Physician Services (an existing Medicare Carrier and Medicare Administrative Contractor) issued a reminder today on its website for providers concerning the new deadlines for Medicare claims submission. The CMS Medlearn matters article dated May 7, 2010 and effective January 1, 2010 on the subject provides specific details relative to the topic. For example, Section […]

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According to a press release of the Department of Justice dated June 14, 2010, a Texas management physician, Dr Anthony Francis Valdez, was arrested and stands charged with carrying out an estimated $41 million fraudulent health care benefit program billing scheme. Valdez is the owner of the Institute of Pain Management with clinics in El […]

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On June 7, 2010, the U.S. District Court for the Western District of Oklahoma held that a Department of Health and Human Services (HHS) regulation, 42 C.F.R. § 418.309(b), implementing a statutory cap on Medicare payments for hospice care was invalid and must be set aside (Compassionate Care Hospice v. Sebelius, No. CIV-09-28-C (W.D. Okla. […]

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Detroit and Wayne County leaders are attempting to convince federal authorities to provide $20 million over the next five years to build at least 10 more community health centers. Although Detroit and Wayne County rank among of the nation’s highest poverty and unemployment rates, the area has only 24 federally funded health centers or federally […]

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On June 19, 2010, the Senate unanimously passed legislation, known as the “doc fix”, sparing doctors a 21% cut in Medicare payments until November 30, 2010. However, moments after the Senate acted, Medicare announced it would begin processing claims it has already received for June at the lower rate, which will force medical providers who […]

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A final rule establishing the temporary certification program for electronic health record (“EHR”) technology was released today by the Office of the National Coordinator for Health Information Technology (“ONC”). As explained by the HHS press release and in a previous HLP blog about the proposed rule, the HITECH Act of 2009 established incentives for providers […]

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OIG has posted an advisory opinion No. 10-08 concerning two affiliated corporate entities that both operate a freestanding radiation oncology center and intend to provide to their Medicare cancer patients the services of a dietitian and social worker at no additional charge as part of their patient’s treatment. The proposed arrangement would not generate prohibited […]

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By letter dated June 16, 2010, the American Society of Anesthesiologists (“ASA”) continued its efforts to request that the OIG intervene to issue a Special Advisory Bulletin prohibiting what is called the anesthesia “company model.” The ASA originally made the request to the OIG in March of 2009; however, to date, the OIG has not […]

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Attention physicians, according to the WPS website, they are conducting a widespread Service-Specific Prepayment Probe on CPT code 99213, using samples obtained from Wisconsin, Illinois, Michigan and Minnesota for all specialties. This probe arises after a Medical Review analysis of claims in the May 2009 sample period revealed 217 CERT errors. This specific probe will […]

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The New York State Legislature has approved about $775 million in spending cuts for healthcare as part of a budget “extender” package on June 7, 2010. The legislation, in addition to requiring the State to save $300 million in Medicaid fraud costs, also presents considerable financial challenges for healthcare providers in the state. Facilities across […]

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