Three of my colleagues just published the piece below summarizing the recent ESRD PPS Final Rule. This is the second piece of rulemaking to directly affect dialysis/ESRD providers in the last month. Taken together, they make some significant changes to the way ESRD is reimbursed and provide additional details on previously announced changes. Please feel [...]

On July 13, 2010, the Centers for Medicare & Medicaid Services (CMS) published a proposed rule that would make several changes to the current composite rate system of reimbursement for end-stage renal disease (ESRD) facilities. Some changes were also made to the Monthly Capitation Payment for physician services to ESRD patients. The changes were contained [...]

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 [...]

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 [...]

The April 8, 2009 issue of the North Carolina Healthcare Report is now available. Please click here to download. document.getElementById(“post-655-blankimage”).onload();

RAC Audit Preparation – 7 Key Steps By: Elissa Moore and Lainey Gilmer   After a short delay, the Department of Health and Human Services’ (DHHS) roll-out of the Recovery Audit Contractor (“RAC”) program will be implemented in all states by the year 2010.  As of March 1, 2009, the four national RACs[1] have commenced [...]

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 [...]

On February 6, 2008, the Centers for Medicare and Medicaid Services (CMS) announced that the bid protests to the recovery audit contractor program (RAC) program had been settled and the RAC implementation could proceed. The RAC program, authorized by Congress in the Medicare Modernization Act of 2003 and made permanent in the Tax Relief and [...]

The January 2009 edition of the North Carolina Healthcare Report is now available. Please click here. document.getElementById(“post-428-blankimage”).onload();

  On January 30, 2009 the United States Court of Appeals for the District of Columbia overturned a district court decision and held that Medicare claims are exempt from disclosure under the Freedom of Information Act (“FOIA”).[1]  Consumers’ Checkbook, Center for the Study of Services (“CSS”) had sought disclosure of Medicare claims by physicians in [...]

On January 12, the Ninth Circuit Court of Appeals affirmed a California physician’s 180-month prison sentence for defrauding the Federal Medicare and California State Medi-Cal programs.  The physician, Aziz F. Awad, was found guilty of illegally billing Medicare and Medi-Cal for certain respiratory services that were in many cases not medically necessary, not properly coded, [...]

   On January 16, 2009 the American Hospital Association (“AHA”) sent a letter to the U.S. Office of Management and Budget (“OMB”) criticizing the proposed mandatory Disclosure of Financial Relationships Report (“DFRR”), which would require approximately 400 hospitals in the United States to report all financial relationships they have with physicians. CMS has not specified [...]

One of our colleagues at McGuireWoods has authored a white paper on Medicare Recovery Audit Contractors. For a copy of the white paper, please visit  Medicare Recovery Audit Contractors (RACs): What Providers Need to Know and How to Prepare. document.getElementById(“post-307-blankimage”).onload();

On February 23rd, Haywood Regional Medical Center in Clyde, NC, which is just west of Asheville, lost its Medicare certification.  Medicare and Medicaid funding accounted for about 68% of the Hospital’s revenue and as a result, this is obviously a move which jeopardizes the financial health of the Hospital.  In the wake of loss of [...]

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 [...]

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 [...]