CMS’ Proposed Rule Would Update 2015 Home Health Prospective Payment System, Includes Important Updates and Additional Proposals
In the July 7, 2014 Federal Register, The Centers for Medicare & Medicaid Services (CMS) published proposed updates to the calendar year (CY) 2015 Medicare Home Health Prospective Payment System (HH PPS) rates. Notable proposed changes include simplifying the face-to-face encounter regulatory requirements, adjusting the home health quality reporting program and payment reductions, streamlining therapy reassessment timeframes, and limiting the reviewability of civil monetary penalties. I. Background on the HH PPS In order to qualify for home health services, a Medicare beneficiary must meet certain requirements. The beneficiary must be under the care of a physician, be receiving services under a plan ...
Federal Government Made $100 Billion in Improper Payments in 2013
According to a new report released by the Government Accountability Office (GAO), the Federal Government made over $100 billion in improper payments in Fiscal Year (FY) 2013. What is troubling, however, is that this figure could be even higher. And the largest sources for improper payments? That would be government health care programs, such as Medicare’s Fee-for-Service program. I. Background The Improper Payments Information Act of 2002 (IPIA) – as amended by the Improper Payments Elimination and Recovery Act of 2010 (IPERA) and the Improper Payments Elimination and Recovery Improvement Act of 2012 (IPERIA) – requires all federal executive branch agencies to: Review all ...
Hospice Providers – Don’t Forget About Your New Hospice Item Set Requirements!
As of July 1, 2014, Medicare-certified hospices must directly submit a Hospice Item Set-Admission and -Discharge record for each patient admission that occurs on or after July 1. These records must be completed on an ongoing basis and submitted electronically the Centers for Medicare & Medicaid Services. Any hospice that fails to collect and report its HIS records for July 1 through December 31, 2014 will incur a 2% reduction in hospice payments for fiscal year 2016. I. Hospice Quality Reporting Requirements On August 7, 2013, CMS published its final rule setting forth changes to the requirements for the hospice quality reporting ...
Medicare Lifts Ban on Medicare Coverage for Sex Change Surgery
On Monday, June 2, the Obama administration lifted its 33 year ban on Medicare coverage for Sex Reassignment Surgery (SRS). The decision is being hailed as a major victory for transgender rights. However, the decision does not necessarily mean that Medicare will pay for these operations – only that it could do so. I. HHS Issues NCD Stating that SRS is “Experimental” and Therefore Not Covered In 1989, the Department of Health and Human Services (HHS) issued a blanket Medicare ban when it determined that SRS was an “experimental” surgery. This guidance was outlined under HHS’s National Coverage Determination (NCD) titled “140.3, ...
Health Law ArticlesState Requirements for Conducting Background Checks on Home Health Agency Employees CMS’ Proposed Rule Would Update 2015 Home Health Prospective Payment System, Includes Important Updates and Additional Proposals Hospital Physician’s Role in Certifying Patient’s Eligibility for Home Health Benefit Physician Accommodations in CMS’s Face-to-Face Encounter Rules CMS Proposes Changes to Medicare Home Health Benefit Face-to-Face Encounter Requirement Read More Posts From This Category
Dental Law ArticlesInvestigations of Medicaid Dental Fraud in Texas Medicaid Dental Fraud: New Hampshire Dentist Indicted on Nearly 200 Counts of Medicaid Fraud. Medicaid Dental Fraud: Dentist Alleged to Have “Systematically Bilked” the State in Dental Fraud Scheme. Medicare Dental Services: Take Care to Ensure that Your Hospital Outpatient Dental Services Meet Medicare’s VERY Limited Coverage Requirements Before Billing the Program. Medicaid Dental Audits: Medicaid Dentists are Under the Microscope. Are Your Dental Records Complete and Accurate? Read More Posts From This Category
Municipal Law ArticlesCMS Announces RAC Audit “Pause” and Additional RAC Program Reforms
The Centers for Medicare & Medicaid Services (CMS) recently announced that... [Read more of this review]Peddling and Soliciting, Municipal Regulations These Issues Can be Complex. Is Your City Clear on these Points?
(January 8, 2013): As a general rule cities can regulate hawking, canvassing,... [Read more of this review]City Contracts and Arbitration
It is recommended that cities do not agree to arbitration, either voluntarily or... [Read more of this review]Read More Posts From This Category
Business & Transaction ArticlesThe Dangers of Keeping Medical Records in the “Cloud”
(July 3, 2014): The growing trend of storing all kinds of data in the cloud comes... [Read more of this review]Liles Parker Attorney has Article Titled “Individual Liability in Medicare Overpayment Cases” Published in Law Journal.
Will the government seek to “pierce the corporate veil”? (October 16,... [Read more of this review]A Recent False Claims Act Case Being Brought Against an Individual Physician has Resulted in a Record Recovery for the Government.
(February 12, 2013): The civil False Claims Act is the primary civil enforcement... [Read more of this review]Read More Posts From This Category