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Category Archives: Medicare

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Physicians Can Review and Correct Reported Data under the Sunshine Act

Posted in Health Reform, Medicare

Many physicians recently received a notice from the Centers for Medicare and Medicaid Services (CMS) notifying them of the opportunity to register with the CMS “Open Payments” system and review financial data reported about them by drug and device manufacturers under the federal Physician Payments Sunshine Act (“Sunshine Act”).  This had led to some confusion… Continue Reading

It’s Official (at least for now): ICD-10 Implementation Date is Now October 1, 2015

Posted in Medicare

According to a final rule published by the Centers for Medicare and Medicaid Services on August 4, 2014, providers will be required to use  the International Classification of Diseases, 10th Revision for diagnosis coding starting on October 1, 2015.  Until then providers are to continue using the 9th Revision (ICD-9). Given the winding path that ICD-10 has… Continue Reading

OIG Publishes Fraud Alert on Physician Lab Arrangements

Posted in Fraud and Abuse, Medicare

Physician ancillary service joint ventures continue to proliferate and not surprisingly, federal and state regulators are on the lookout for arrangements which may violate fraud and abuse laws .  In its recent “Special Fraud Alert: Laboratory Payments to Referring Physicians”, the Office of Inspector General (OIG) has (once again) expressed concern over financial arrangement between… Continue Reading

OIG Proposed Rule on New Civil Money Penalty Authorities

Posted in Fraud and Abuse, Medicare

The Office of Inspector General (OIG) today issued a proposed rule which would amend the federal civil monetary penalty (CMP) regulations addressing new CMP authorities created under the Affordable Care Act.  The revised regulations would allow for civil penalties, assessments, and exclusion from Medicare for and of the following: Failure to grant OIG timely access… Continue Reading

New Tool For HIPAA Security Assessment

Posted in Health Reform, Medicare, Practice Management

This past Friday, the Office of the National Coordinator for Health Information Technology, in collaboration with the HHS Office for Civil Rights and HHS Office of the General Counsel, developed a HIPAA “Security Risk Assessment Tool.”  The Security Risk Assessment Tool is a downloadable program that was developed to assist providers in performing HIPAA security… Continue Reading

CMS to Evaluate Release of Medicare Physician Payment Data on a Case-by-Case Basis

Posted in Medicare

CMS announced this week that it is modifying its longstanding policy regarding the release of Medicare physician payment data in response to Freedom of Information Act (FOIA) requests.  Since 1980, CMS’ policy has been that, for privacy reasons, it would not release Medicare payment data specific to individual physicians.  However, according to a pronouncement in the Federal… Continue Reading

Medicare Advantage Plans Terminating Physician Participation Without Explanation

Posted in Health Reform, Medicare

In recent months I have had a number of physician clients contact me to tell me that they have unexpectedly been dropped from one or more Medicare Advantage plans with which they have participated with no issue for, in some case, years.  These physicians are left somewhat bewildered because these terminations are being done without cause and without explanation.  A… Continue Reading

Physician-Hospital Integration Strategies

Posted in Health Reform, Medicare, Physician Compensation, Practice Management

As the implementation of the federal Affordable Care Act (ACA) continues in fits and starts, healthcare providers are scrambling to best position themselves to accommodate anticipated and developing payment models.  Unfortunately no one really knows what these new payment models will look like or how they will ultimately work.  It is apparent, however, that most… Continue Reading

Budget Sequester Brings Bad News for Physicians

Posted in Medicare

Unless you’ve been living under a rock for the last several weeks, you are likely well aware of the budget sequester that took effect on March 1.  The sequestration requires "across the board" cuts in federal spending.  That, in and of itself, may not be such a bad news.  However, what you may not be… Continue Reading

DOJ Announces Record Fraud Settlement Against Physician

Posted in Fraud and Abuse, Medicare

Yesterday the U.S. Department of Justice announced that it has entered into a $26M False Claims settlement with a dermatologist in Florida.  According to the DOJ, this is one of the largest False Claims settlements against an individual in history.  The physician was accused of allegedly accepting kickbacks from a pathology lab and billing for medically… Continue Reading

MedPAC Site-Neutral Payment Proposal Could Level Outpatient Reimbursement Playing Field

Posted in Medicare

It’s no secret that Medicare pays significantly more for certain services when they are performed in a hospital outpatient department than when they are performed in a physician office.  In fact, this is one of the reasons privately practicing physicians have been folding up shop in favor of hospital employment.  Hospitals can make more from these services than… Continue Reading

Feds Announce Largest Single Physician Medicare Fraud Bust

Posted in Fraud and Abuse, Medicare

I have been speaking with physicians for years about the importance of developing effective fraud and abuse compliance programs in their practices and I often still get the same response:  The government is only interested in the big fish like pharmaceutical manufacturers and hospitals -physicians are under the radar.  Well, contrary to popular belief, it appears that there… Continue Reading