Healthcare Law

CBRs for Spinal Orthoses (CBR201803): What Do You Need to Know?

Medicare, Medicaid & Private Payor Updates /

(April 12, 2018): The Centers for Medicare & Medicaid Services (CMS) utilizes a variety of private contractors to process Medicare claims and conduct both administrative and program integrity audits of claims submitted by healthcare providers and suppliers.  At the present time, CMS has contracted with eGlobalTech (eGT) to analyze data and prepare “Comparative Billing Reports” […]

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Medicare Advantage Plans May Soon Offer Personal Care Services

Medicare, Medicaid & Private Payor Updates /

(April 10, 2018): On April 2, the Centers for Medicare and Medicaid Services (CMS) announced an expansion of the benefits that private health plans may offer Medicare beneficiaries under the Medicare Advantage (MA) program in 2019.  In its Final Call Letter for bids from plans that participate in the MA program (“MA plans”) for 2019,

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Sexual Harassment: Cases Against Texas Physicians in 2017

Regulatory Issues | Privacy | Other /

(January 26, 2018): From Churches to Congress, sexual harassment and assault charges have plagued many of the institutions that our society holds dear. As revelations of sexual misconduct continue to surface, we continue to learn of the many abuses of those in powerful positions; those whom we once revered. The rise of the #MeToo Movement

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Personal Care Services Are Under the Government’s Microscope

Home Health & Hospice /

(January 22, 2018): The Department of Health and Human Services, Office of Inspector General (HHS-OIG) has conducted numerous audits, evaluations, and investigations involving the provision of “personal care services” to Medicaid beneficiaries.  In fact, from 2006 to 2012, HHS-OIG produced more than 20 audit and evaluation reports analyzing various program integrity risks presented when providing

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Revocation of Your Medicare Billing Privileges

Medicare, Medicaid & Private Payor Updates /

(December 14, 2017): The Centers for Medicare and Medicaid Services (CMS) has engaged various types of outside contracting entities to perform program integrity functions on behalf of the Medicare program. At the present time, Uniform Program Integrity Contractors (UPICs) and Zone Program Integrity Contractors (ZPICs) are very aggressive when it comes to referring evidence of

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Peer Review: How HCQIA Due Process is a Fiction

Medicare, Medicaid & Private Payor Updates /

(August 31, 2014): The Healthcare Quality Improvement Act of 1986[1] (“HCQIA”, generally pronounced “Hick Kwah”), affords peer-reviewing bodies and their members legal immunity from liability from suits by the physicians they discipline, so long as their peer-review processes include certain due process rights for the accused physician. Unfortunately, the provider peer review process is irrevocably

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The Changing Definition of Medical Necessity

Medicare, Medicaid & Private Payor Updates /

(July 16, 2014):The term “medical necessity” has varying definitions depending on who is using it. Providers, physicians, courts, private insurers, state governments, and the federal government all have their own interpretation of what constitutes medical necessity. This changing definition of medical necessity can be problematic when a provider’s claims are audited by a Zone Program

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Hospice Providers – New HIS Record Requirements!

Medicare, Medicaid & Private Payor Updates /

(July 7, 2014): As of July 1, 2014, Medicare-certified hospices must directly submit a Hospice Item Set (HIS) (for Admission and Discharge) records for each patient admission that occurs on or after July 1. These HIS records must be completed on an ongoing basis and submitted electronically the Centers for Medicare & Medicaid Services. Any

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The Cloud Storage of Medical Records Presents a Number of Risks

Medicare, Medicaid & Private Payor Updates /

(July 3, 2014): The growing trend of storing all kinds of data in the cloud comes with benefits and risks. However, when it comes to storing medical records in to the cloud, patient privacy becomes a special concern. With a properly implemented cloud storage system, hospitals can share information far more efficiently. Prescriptions and test

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