Last month, I had the opportunity to attend the outstanding Power Breakfast program presented by the Wilmington Business Journal on healthcare. Rob Kaiser, Publisher of WBJ did a tremendous job in planning and promoting this event. It was a packed house and one of the better panel discussions I’ve seen recently on healthcare. The panelists [...]

The Wall Street Journal today published a report that home health companies  Amedisys Inc. and Almost Family Inc. are now under investigation by the SEC following a month and a half of Congressional inquiries. You can read the full article here. Although not typically on this scale, these types of investigations and inquiries into billing [...]

The American College of Radiation Oncology has a brief write-up on their site regarding the recent elimination of consultation fees for radiation oncology effective January 1, 2010. You can find their full summary here. Instead of billing for a yearly consultation, the radiation oncologist can now only bill for a new patient visit every three [...]

From time to time, The Centers for Medicare & Medicaid Services (CMS) holds “Open Door Forums” to provide an opportunity for live dialogue between CMS and the provider community at large. The goal is to learn from other providers’ discussions and to get clarification on various rules and instructions associated with coverage, coding, and payment. The [...]

Effective January 1, 2010, the outlier payments made to each home health agency (“HHA”) in 2010 will be subject to an annual limit of 10% of the HHA’s total Medicare PPS payments for the year. Generally, payments for Home Health PPS claims are based on a certain number of “episodes of care.” Each episode of [...]

Bloomberg is reporting that effective January 1, the Mayo Clinic will no longer see primary care Medicare patients at its Glendale, AZ facility. Mayo cited inadequate reimbursement rates as one of the primary drivers of this decision. They claim that their hospital and four clinics in Arizona collectively lost a total of $120 million on [...]

American Medical News reported yesterday that Blue Cross Blue Shield of North Carolina has agreed to give up its demand that its participating physician providers accept an amendment to their existing provider agreements that would have potentially allowed BCBS to unilaterally change reimbursement rates. The North Carolina Medical Society along with the NC Medical Group [...]

Becker’s Hospital Review is reporting that six hospitals in North Carolina are being asked to repay approximately $2.5 million in overpayments made by the state health plan, which is administered by Blue Cross Blue Shield of North Carolina. The full report can be found here. The News and Observer also has an article, which can [...]

Today, CMS released the Final Rule for the 2010 Home Health Prospective Payment System Rate Update.  The complete text of the Final Rule can be found here. According to CMS, the final rule makes three key changes: – continues with the previously promulgated 2.75 percent reduction to the HH PPS rates in CY 2010 (to [...]

The new ASC Condtions of Coverage became effective on May 18, 2009. One of the more significant changes is the addition of certain requirements that ASCs inform all patients about advance directives. Below is a short summary authored by several of my colleagues. Health Care 5/18/2009 Revised ASC Conditions of Coverage & Advance Directives Effective [...]

     McGuireWoods is proud to sponsor the Charlotte Chamber Health Care Summit  Your…employee’s, region’s, state’s health: it affects us all.  Wednesday, May 20, 2009 Hilton Charlotte University Place 8629 J M Keynes Drive Charlotte, NC 28262 REGISTRATION: $25/advance & $30/door for members and nonmembers (Includes breakfast) For addition information and to register, please click [...]

On April 9, Blue Cross Blue Shield of Texas (“BCBS”) entered into an “Assurance of Voluntary Compliance” (i.e., a settlement agreement) with the State of Texas stemming from allegations that that it (1) had improperly threatened retaliation against physicians who referred patients for out-of-network procedures and (2) produced inaccurate and misleading information about the affordability, [...]

RAC Appeals By Elissa Moore and Jessica Smith The RAC program, authorized by Congress in the Medicare Modernization Act of 2003 and made permanent in the Tax Relief and Health Care Act of 2006, is intended to detect and correct improper payments in the Medicare program.  More than 1 billion Medicare claims are submitted every [...]

           McGuireWoods Consulting and The Insider North Carolina State Government News Service Partner to Provide Critical Legislative Information RALEIGH, NC – January 26, 2008 – Today marks the launch of a newsletter providing North Carolinians with timely, comprehensive and reliable reporting on health care policy and the future of health care in North Carolina direct [...]

  Sending an early blow to the physician-owned hospital industry, the Democratic-controlled House of Representatives authorized legislation this week halting the growth of physician-owned hospitals.  Democrats have called the whole hospital exception to the Stark Act a loophole that needs to be closed. Tacked on to the reauthorization of the State Children’s Health Insurance Program [...]

    On January 14, 2009, UnitedHealth Group, Inc., one of the nation’s largest health insurers, agreed to pay a $50 million settlement in connection with the overcharging of millions of individuals.  The New York attorney general’s office commenced its investigation against Oxford Insurance and its parent company, UnitedHealth Group, focusing on the method in [...]

  If you would like a copy of any of the articles below, please contact Bart Walker at 704-373-8923 or bwalker@mcguirewoods.com. Provider-Based Status “Hospitals and Health Systems: Provider-Based Status: The Rules and Common Issues” (co-authored with Elissa Moore), Health Care Law Monthly, April 2008 Establishing an ASC “Establishing an Ambulatory Surgery Center – A Primer [...]

This month, Medicare is launching a pilot program in South Carolina where it will offer personal health records to about 100,000 Medicare recipients. The goal of the project is to provide patients with their own comprehensive personal health records which include information gathered over a number of years from a variety of sources. The program [...]

Following the lead of the Medicare program, several major private insurers are moving to exclude payments for clear medical errors that occur while a patient is hospitalized. Aetna is adding to its new and renewal contracts that it will not pay for 28 different events included on a list of “mistakes that should never happen,” [...]

We have been made aware of a Memorandum recently issued by CMS to the various state departments of health in which CMS set forth a number of guidelines for Initial Surveys for New Medicare Providers. In short, the guidelines say that due to federal resource limitations, the states must prioritize initial surveys for providers and [...]