President Signs Bill Clarifying the Scope of the Red Flags Rule

On December 18, 2010, President Obama signed the Red Flag Program Clarification Act of 2010. The bill more narrowly defines the term “creditor” so that, in effect, far fewer organizations, including hospitals, must comply with the rule simply because they advance the cost of services. Under the Red Flags Rule, organizations that extend credit to […]

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Federal Judge Rules Parts of Healthcare Reform are Unconstitutional

On December 13, 2010, a federal judge in Virginia declared a portion of the Patient Protection and Affordable Care Act (PPACA) unconstitutional by ruling that the government can not require Americans to purchase insurance. In his order, U.S. District Judge Henry E. Hudson said he will allow the law to remain in effect while appeals […]

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Face Validity Assessment of ABNs Required on All Complex Medical Reviews

On December 10, 2010, CMS issued transmittal R361PI requiring that a mandatory Advanced Beneficiary Notice (ABN) be requested as part of the additional document requests (ADR) on all claims undergoing complex medical record review.  This transmittal applies to Medicare administrative contractors (MACs), affiliated contractors (ACs), fiscal intermediaries (FIs) and carriers, Comprehensive Error Rate Testing Program […]

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Final Rule Issued Requiring Full and Equal Privileges for all Visitors Requested by Patient

In November, the Centers for Medicare & Medicaid Services (CMS) issued a final rule that allows patients to decide whom they want by their bedside in the hospital.  The rule includes protections when the visitor is a same-sex domestic partner. This rule changes the Medicare Conditions of Participation for hospitals effective January 18, 2011 and […]

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President Signs “Doc Fix” Into Law

Today (12/16), President Obama signed a bill that would prevent a 25% cut in Medicare payments to physicians. The bill will freeze reimbursement rates at current levels until the end of 2011. This freeze will cost an estimated $19 billion and will primarily be paid for by “tightening the rules on tax credits in the […]

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Recovery Audit Contractors Begin Medical Necessity Audits

The Recovery Audit Contractor (RAC) program is an effort by the Centers for Medicare and Medicaid Services (CMS) to reduce improper payments within Medicare programs as well as identify process for improvements to reduce or eliminate future improper payments. Connolly Healthcare, the contractor selected by CMS to provide recovery audit services in this region, has […]

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Janitor Sells Boxes Containing Protected Health Information

Media Health Leaders reports that the janitor at the Martin Luther King, Jr. Multi-service Ambulatory Care Center in Willowbrook, California sold 14 boxes containing 33,000 patient records to a recycling center for paper value equaling $40.  The ambulatory care center told officials that the records contained no Social Security numbers or any medical record numbers, but […]

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President Signs into Law the Improper Payments Elimination and Recovery Act

On July 22, 2010, President Obama signed the Improper Payments Elimination and Recovery Act (Act) into law to combat overpayments due to fraud, waste, and abuse.  The Act creates a number of changes to the Improper Payments Information Act of 2002. Essentially the Act mandates that every agency review all of its programs and identify […]

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Healthcare Reform Provides New Requirements for Compliance Programs

Prior to 2005, hospitals were not required to have a compliance program to address issues of fraud, waste, and abuse.  After the passage of the Deficit Reduction Act of 2005, any entity that receives at least $5 million annually from Medicaid is now required to have a compliance program in place. The Deficit Reduction Act […]

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DHHS releases final rule clarifying incentive payment requirements for EHRs under HITECH

On Tuesday, July 13, 2010, the U.S. Department of Health and Human Services released final rules to clarify how eligible healthcare professionals and hospitals may qualify for the Medicare and Medicaid incentive payments provided under the Health Information Technology for Economic and Clinical Health (HITECH) Act of 2009. Under the HITECH Act, providers qualify for […]

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