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 |2017-10-13T10:37:21-07:00October 10, 2017|

Understanding “Incident To” Billing

Section 1861(s)(2)(A) of the Social Security Act allows physicians to bill Medicare for patient services provided “incident to” a physician’s services. “Incident to” services are furnished incident to physician professional services in the physician’s office or in certain other locations.  These services are typically performed by non-physician practitioners (NPPs), such as a nurse practitioner or physician’s assistant.  The services, which [...]

By |2017-06-09T14:03:09-07:00June 1, 2017|

HHS and CMS Adjust Civil Monetary Penalties by More Than Double

Maximum civil monetary penalties for skilled nursing providers, home health agencies and clinical labs more than doubled under a final rule released by the Department of Health and Human Services and the Centers for Medicare & Medicaid Services. The rule, which implements the Federal Civil Penalties Inflation Adjustment Act of 2015, adjusts the penalties to reflect inflation and “maintain their [...]

By |2017-03-14T15:36:04-07:00October 28, 2016|

CMS’ Comprehensive Primary Care Plus Includes Colorado

The Centers for Medicare & Medicaid Services (CMS) announced this month that Colorado will be one of 14 regions (11 states and 3 large metropolitan areas) that will participate in a CMS initiative called Comprehensive Primary Care Plus, or CPC+. CMS originally announced CPC+ in April, describing it as the “future of primary care.” Under CPC+, CMS is offering primary [...]

By |2016-12-27T11:06:19-07:00August 16, 2016|

New Report Finds Signs of Fraud in Some Home Health Agencies

The federal Department of Health and Human Services recently issued an alert warning that it was stepping up enforcement efforts against fraud and abuse by home health agencies, a response to a new report which finds many such agencies are displaying the warning signs of fraud. The HHS’ Office of the Inspector General said in its report that approximately five-percent [...]

By |2016-12-27T11:06:20-07:00July 25, 2016|

CMS Updates Self-Referral Disclosure Protocol

The Centers for Medicare and Medicaid Services recently updated the Self-Referral Disclosure Protocol (SRDP), seeking to revise the currently approved information collection request that advises hospitals on how to disclose an actual or potential violation of the physician self-referral statute. As an additional update, CMS is also issuing a required form for SRDP submissions. CMS is seeking to revise the [...]

By |2016-12-27T11:06:24-07:00June 7, 2016|

Medicaid and CHIP Beneficiaries Gain Parity Access for Mental Health and Substance Use Services

Medicaid and Children’s Health Insurance Program (CHIP) beneficiaries will receive greater access to mental health and substance use disorder benefits in the future based upon a final rule released on March 29 by the Centers for Medicare & Medicaid Services (CMS). In the final rule, CMS requires Medicaid and CHIP programs to deliver mental health and substance use services equal [...]

By |2016-12-27T11:06:25-07:00April 20, 2016|

Physicians Beware: Care Discounts Warrant Careful Consideration

There’s a time-honored tradition in the U.S. of physicians negotiating treatment with indigent patients in creative and varied ways: discounts, payment plans, charity care, even bartering with chickens or other items and services. According to an article in Medical Economics, changes in healthcare policy, such as increased patient cost-sharing to slow rising costs, are complicating and constraining once ordinary, everyday [...]

By |2016-12-27T11:06:26-07:00April 13, 2016|

CMS Finalizes 60-Day Overpayment Rule: Providers Must Refund Overpayments Going Back Six, Not 10 Years

CMS has finalized a rule that defines the statutory obligation of providers and suppliers (“Providers”) to return Medicare overpayments (the “60-Day Rule”). The Affordable Care Act compels providers to return overpayments within 60 days of identifying them. Failing to refund overpayments can result in liability under the False Claims Act. That means a Provider could either face financial penalties or [...]

By |2016-12-27T11:06:27-07:00February 12, 2016|

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 |2016-12-27T11:06:28-07:00January 27, 2016|