Assigning Patients to ACOs
A hotly contested area of the proposed ACO rules concerns the assignment of Medicare Fee-for-Service (“FFS”) beneficiaries to ACOs. Once a Medicare beneficiary is assigned to an ACO, the ACO will then...
View ArticleOIG ISSUES SPECIAL FRAUD ALERT ON PHYSICIAN-OWNED DISTRIBUTORSHIPS
On March 26, 2013, the Office of Inspector General (“OIG”) issued a Special Fraud Alert regarding physician-owned entities or distributorships (referred to as “PODs”) that generate revenue from the use...
View ArticleOIG Launches New Online Submission Process for the Self-Disclosure Protocol
On July 8th, the Office of Inspector General (OIG) launched a new online submission process for the Self-Disclosure Protocol (SDP). The SDP allows health care providers to voluntarily identify,...
View ArticleWant to Get Paid for Inpatient Admissions? Follow CMS Certification...
In its final regulations for the 2014 Inpatient Prospective Patient System, the Centers for Medicare and Medicaid Services emphasized the importance of physician certifications. Under the regulations,...
View ArticleIncreased OIG Focus on Kwashiorkor Claims
In its recently released 2014 Work Plan, the OIG has announced that it will investigate hospital billing for Kwashiorkor. Kwashiorkor is a form of severe protein malnutrition that generally affects...
View ArticleICD-10, Two-Midnight Rule, RAC Audits, SGR Delayed
The Senate passed this evening the “Protecting Access to Medicare Act of 2014“, which creates a 12 month delay for pending Medicare cuts pursuant to Medicare’s sustainable growth rate (SGR) payment...
View ArticleNaughty or Nice – 60 Day Overpayment Reporting Rule
According to a recent New York District Court decision, whether providers are subjected to an enforcement action under the False Claims Act for failing to report and return an overpayment within the...
View ArticleOverpayment Rule Sets 6 Year Lookback
Nearly 6 years after the passage of the Affordable Care Act, CMS published the final 60 day rule for Medicare Parts A and B overpayments. The rule requires a person who has received an overpayment to...
View ArticleMACRA Released
On Friday, CMS released the MACRA final rules, its innovative payment system for Medicare replacing the sustainable growth rate formula and the EHR Incentive Program for Medicare providers. MACRA...
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