Robert Saltaformaggio

The FY 2016 Budget Proposes Medicare Appeals Process Reforms

(February 27, 2015):  On February 2, 2015, President Obama released his fiscal year 2016 budget proposal. This latest proposal affects a significant number of Federal health care programs and includes over $1 trillion allocated to the U.S. Department of Health and Human Services (HHS). More than 85 percent of HHS’s budget is devoted to programs …

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Texas Physicians — Is There a Defined Physician-Patient Relationship?

(February 5th, 2015)  The Texas Medical Board recently set forth a proposed rule that would dictate what physicians must do in order to prescribe certain medications or face sanctions. Under the proposed rule, Texas physicians must establish a defined physician-patient relationship in order to prescribe any dangerous drug or controlled substance. This relationship must include, at …

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CMS Implements RAC Program Improvements

(January 9th, 2015) Health care providers increasingly complain that the Recovery Audit Program creates numerous administrative and financial burdens for those participating in the federal Medicare program. Providers continue to advocate for numerous changes to the program, especially those that will reduce their burden when dealing with Recovery Audit Contractors (RACs). In response to these …

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Dental Fraud Investigation Results in $5.05 Million Recovery

 (November 10, 2014):  Has your dental practice been the subject of a dental fraud investigation?  Medicaid dental audits are becoming increasingly prevalent throughout the United States.  An Oklahoma-based dental practice has recently agreed to pay $5.05 million in civil claims stemming from allegations that the practice committed Medicaid dental fraud, submitting false claims to Medicaid from …

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CMS Has Clarified the HHA Definition of When a Patient is Confined to Home

(August 26, 2014): On August 1, 2014, the Centers for Medicare & Medicaid Services (CMS) issued Transmittal 192, clarifying their definition of when a home health patient is considered to be Confined to Home as described in the Medicare Benefit Policy Manual. This clarification more accurately articulates the Homebound definition found in the Social Security …

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OIG Finds Nursing Homes Not Reporting Patient Abuse and Neglect

(August 21, 2014):  Nursing facilities are required and expected to report any and all allegations of patient abuse or neglect to ensure patient safety. A recent study of their records by the Department of Health and Human Services’ Office of Inspector General (OIG) has found that a number of these facilities have not been fully …

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CMS Extends HHA Enrollment Moratoria

(August 6, 2014):  The Centers for Medicare & Medicaid Services (CMS) has extended its year-long HHA enrollment moratoria on the enrollment of new home health agencies and ground ambulance suppliers in several major metropolitan areas. Furthermore, CMS has broadened its temporary enrollment moratoria so that it applies not only to Medicare, but also to enrollment in Medicaid …

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Miscoded Evaluation and Management Services Cost Medicare $6.7 Billion

(June 25, 2014)  Officials at the Department of Health and Human Services, Office of Inspector General (OIG) recently examined medical records from 2010 for claims related to evaluation and management services (E/M services). The results are astounding. OIG determined that Medicare inappropriately paid $6.7 BILLION for E/M services that year due to claims that were …

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HIPAA Encryption is the Best Way to Avoid a Violation

(May 29, 2014):  On April 22, 2014, the U.S. Department of Health and Human Services Office for Civil Rights (HHS-OCR) announced that it had entered into resolution agreements with two entities for $1,725,220 and $250,000, respectively, to resolve potential violations of the Health Insurance Portability and Accountability Act (HIPAA) Privacy and Security Rules. The main …

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Complying with an Individual’s Request to Restrict the Submission of PHI to Insurance

(October 3, 2013):  The HIPAA Omnibus Rule (Omnibus Rule) is well over 100 pages long.  When considered in the context of existing HIPAA and HITECH, health care providers are often it difficult to apply the provisions of the Omnibus Rule to privacy situations that are commonly arising in a physician’s practice.  One such situation is outlined below where a …

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