CMS Emergency Preparedness Rule Takes Effect Nov. 15

In the wake of Hurricanes Harvey, Irma and Maria, the November 15, 2017 deadline for new Centers for Medicare and Medicaid Services regulations on emergency preparedness seems all the more critical. Hundreds of facilities were devastated by flooding and damage, leaving them without vital patient data and at risk of security breaches and Health Insurance Portability and Accountability Act violations. [...]

By |2017-10-13T10:37:21-06:00October 10, 2017|

Medicare Fraud Strike Force Sends Strong Message on Fraud and Abuse

Highlighting its continued focus on cracking down on Medicare fraud and abuse practices, the U.S. Department of Justice and the U.S. Department of Health and Human Services announced this month the largest ever health care fraud enforcement action precipitated by the Medicare Fraud Strike Force. As part of this national health care fraud takedown, the government charged 412 defendants with approximately $1.3 billion [...]

By |2017-10-10T13:03:18-06:00July 27, 2017|

Compliance and Enforcement: What to Expect in 2016

2015 was a momentous year for compliance and enforcement in the health care world and it’s only inevitable that 2016 will feel its effects. From changes in Medicare to costly false claims cases and formalized guidance like the Yates Memo, it’s clear that 2015 set the stage for an increased emphasis on accountability—a fact corporate officers, compliance oversight boards and [...]

By |2016-12-27T11:06:28-06:00January 27, 2016|

Proposed CMS Changes Expected to Cost Home Health $283 Million per Year

The Centers for Medicare and Medicaid Services proposed sweeping changes to the discharge process for hospitals, rehabilitation centers and home health agencies (HHA) on Nov. 3. Of the three sectors, HHAs are expected to be hit the hardest, absorbing annual costs of $283 million. The changes are a response to the Improving Medicare Post-Acute Care Transformation Act of 2014, which [...]

By |2015-11-16T11:25:26-06:00November 16, 2015|

Physician Compensation Under a Spotlight with Regulatory Agencies

Hospitals that pay physicians generously even though their practices are losing money may be opening themselves to fraud and abuse claims under the Stark law, which says health care organizations must value this compensation as “commercially reasonable.” The practice of overpaying physicians sometimes occurs after a physician practice has been purchased by the health care organization. While the practices might [...]

By |2016-12-27T11:06:37-06:00June 16, 2015|

Senate Approves Changes to Medicare Physician Fee Schedule

On April 14, the U.S. Senate approved broad changes to the Medicare Physician Fee Schedule (MPFS), the system by which Medicare pays physicians, and averted 21 percent across-the-board cuts in Medicare fees scheduled to take effect on April 15. The Senate vote of 92-8 will send the Medicare Access and CHIP Reauthorization Act to President Barack Obama's desk. The House of Representatives [...]

By |2016-10-31T10:12:31-06:00April 15, 2015|

Medicare Physician Fee Schedules Expired March 31, but Congress, CMS Offer Hope

Medicare providers are acutely aware that March 31, 2015 marked an important date – the date that the current Medicare Physician Fee Schedule expired.  Enacted in 1997, the Medicare Sustainable Growth Rate (SGR) was intended as a method for the Centers for Medicare and Medicaid Services (CMS) to control the Physician Fee Schedule and to begin to reduce Medicare spending.  [...]

By |2016-12-27T11:06:40-06:00April 3, 2015|

OIG Recommends Reimbursement Cuts for Swing-Beds at Critical Access Hospitals

In a new report, the Department of Health and Human Services’ Office of Inspector General is recommending that swing-bed services at critical access hospitals be reimbursed at lower skilled nursing rates for rehabilitation services. OIG estimates that the Centers for Medicare and Medicaid Services overpaid CAHs by $4.1 billion over a 6-year period. The report recommends using the skilled nursing [...]

By |2016-12-27T11:06:40-06:00March 19, 2015|

CMS Delays Final Rule on Reporting and Returning Overpayments

The Centers for Medicare and Medicaid Services recently announced a one-year delay in the publication of the final rule regarding reporting and returning overpayments to the Medicare program. A proposed rule, which was originally published on Feb. 16, 2012, requires providers and suppliers to report and return Medicare overpayments within 60 days after the date on which the overpayment was [...]

By |2016-12-27T11:06:42-06:00March 5, 2015|

CMS to Continue to Release Physician-Payment Data Annually

The Centers for Medicare and Medicaid Services (CMS) has indicated that it will release Medicare physician-payment records annually, something it did last April for the first time since 1979. After an injunction was lifted last year restricting Medicare from releasing physician-payment data, CMS released data on more than $77 billion in charges to the insurance program for the elderly and [...]

By |2016-12-27T11:06:51-06:00February 10, 2015|