Starting October 1, 2009 Providers Must Report E-codes for Surgical Never Events
Effective October 1, 2009, the Centers for Medicare & Medicaid Services (CMS) will require all providers to submit E codes for…
Reassessing Protected Classes: The Impact on Part D Formularies
This article focuses on an interim rule issued by the Centers for Medicare & Medicaid Services (CMS) on the process…
HIPAA Electronic Transaction Standards Is Your Organization Ready?
The Health Insurance Portability and Accountability Act (HIPAA) requires the Secretary of Health and Human Services (HHS) to develop standards…
Disclose or Not Disclose: That is the Question
Our firm has been engaged to review claims and arrangements for a great many of hospitals. Invariably, we find errors,…
New Legal Exposure When You Fail to Repay Overpayments
The Fraud Enforcement Recovery Act (FERA) expands the federal government’s ability to investigate and prosecute financial fraud. This article discusses…
The Relationship of Privacy Provisions in the Stimulus Bill to Health Information Technology
The American Recovery and Reinvestment Act of 2009 (ARRA) contains many provisions associated with health information technology and electronic medical…
Incident-to Supervision of Outpatient Therapeutic Services: Are You in Compliance?
IntroductionOn April 14, 2009, 12 health care organizations submitted a letter to the Centers for Medicare & Medicaid Services (CMS) requesting…
CMS’ Anti-markup Rule
The Centers for Medicare & Medicaid Services (CMS) recently issued Transmittal 445 to provide claims processing instructions for contractors when submitting…
Durable Medical Equipment (DME) Documentation Requirements for Medicare Payment
Recent Developments Highlight the Importance of Medical Necessity Documentation The U.S. Supreme Court recently denied review in a case, reaffirming the…
A Refresher: Observation Services
When tracking patients’ admissions status, identifying services rendered, calculating the number of observation hours, and ensuring accuracy and completeness of medical…
The Importance of the Conditions of Participation for Hospitals
Compliance officers and billing personnel must assist in complying with the Conditions of Participation (CoPs). This article provides a Compliance…
Scrutiny of Medical Errors Increases
The Centers for Medicare & Medicaid Services (CMS) implemented Medicare’s restriction on reimbursement for hospital-acquired conditions (HACs) that are not…