Coronavirus Call to Action

Corona virus call to action. Blog post by healthcare attorney David J. Davidson

Corona virus call to action. Blog post by healthcare attorney David J. Davidson By: David J. Davidson

On March 4, 2020, the Centers for Medicare & Medicaid Services (CMS) issued three Quality, Safety & Oversight Memoranda, all concerning the Coronavirus. According to these documents, effective immediately, the government will begin to focus its inspections exclusively on issues related to infection control and other serious health and safety threats. According to CMS Administrator Seema Verma, the memoranda should be seen as a “call to action across the healthcare system.” The goal of the guidance given in the memoranda is to continue to keep Americans safe and prevent the spread of the Coronavirus.

The first memorandum resets the focus of governmental surveys. The order of priority for government surveys will now be:

Continue reading

CMS Hospital Price Transparency Requirements

hospital price transparency

hospital price transparencyBy: Karina Gonzalez

On November 15, 2019 Centers for Medicare and Medicaid Services (CMS) issued a final rule requiring hospitals to publicly disclose “standard charges, including payer-specific negotiated rates for items and services. Hospitals will be required to comply by January 1, 2021. The proposed rule is subject to 60 days of comment.

The final rule requires hospitals to make public in a machine-readable file online all standard charges (including gross charges, discounted cash prices, payer-specific negotiated charges) for all hospital items and services.  It requires hospitals to de-identify minimum and maximum negotiated charges for at least 300 “shoppable” services.Continue reading

Medicare Enforcement: CMS Has Expanded Its Ability to Revoke or Deny Provider Enrollment

medicare enforcement

medicare enforcementBy: Karina Gonzalez

A Final Rule recently issued by CMS will require Medicare, Medicaid, and CHIP (Children’s Health Insurance Program) providers and suppliers to disclose current and previous affiliations (direct or indirect) with a provider or supplier that: (1)  has uncollected debt; (2) has been or is excluded by the OIG (Office of Inspector General) from Medicare, Medicaid or CHIP, or (3) has had its billing privileges with either of these three programs denied or revoked. Such provider affiliations may lead to enrollment being denied if it poses a risk to fraud, waste or abuse.Continue reading

DME Provider Alert: Medicare Competitive Bidding is Back!

commission based marketing compensation Florida

Medicare Competitive BiddingBy: Michael Silverman

Not tomorrow, but relatively soon. And with a vengeance! We knew the current Competitive Bidding Program moratorium wouldn’t last forever, and that the floodgates that opened as of the first of this year would eventually be reined in.

Indeed, on March 7, 2019 the Centers for Medicare and Medicaid Services (“CMS”) announced a new round of Competitive Bidding, which will commence on January 1, 2021 and last through December 31, 2023.

The largest changes from previous rounds of Competitive Bidding that immediately stand out are:Continue reading

CMS Releases New mHealth Codes for 2019

mHealth codes 2019 CMSBy: Amanda Bhikhari

Improving patient outcomes while maintaining physician decision making and practice efficiency is key to success in the growing health care arena. Innovation is the ability to see change as an opportunity to create new value, instead of a threat to what we find comfortable. It is clear that the Center for Medicare and Medicaid Services (CMS) is embracing the importance of innovation in the way we deliver health care.

In November 2018, the 2019 Physician Fee Schedule and Quality Payment Program was released by CMS with changes effective January 1, 2019.  This is the time for providers to definitely keep their eyes open to utilizing mHealth, and telehealth services. mHealth is also known as mobile health, and is a general term for the use of mobile phones and other wireless technology in medical care to educate consumers about preventive healthcare services as well as for disease surveillance, chronic disease management, treatment support, epidemic outbreak tracking. The release of the program is a sign that the agency is in favor of expanding the implementation of technology in providing medical care.  The updated mHealth codes are:Continue reading

Medicare Backlog Update: Judge Orders Elimination of the ALJ Backlog by 2022

medicare backlogBy: Matt Fischer

On November 1, 2018, a federal court judge in the U.S. District Court for the District of Columbia granted a motion for summary judgment in favor of the American Hospital Association (AHA) ordering the U.S. Department of Health and Human Services (HHS) to clear the Medicare appeal backlog by fiscal year (FY) 2022.  If you have not been following this litigation, the AHA initially filed suit in 2014 against the Secretary of the U.S. Department of Health and Human Services (HHS) requesting an order from the court mandating the Office of Medicare Hearings and Appeals (OMHA) within HHS to comply with its statutory deadlines (i.e. to issue a decision within 90 days).  Following brief review by the U.S. Court of Appeals and upon the case being before the district court for a third time, the case has finally reached a resolution.

In short, HHS agreed that due to recent funding, compliance is possible within four years.  Accordingly, the judge set the following deadlines for HHS and OMHA:Continue reading

A New Perspective from CMS? Medicare, Stark Law and Whistleblower Changes on Deck

cms medicare regulations

medicare stark lawBy: Dave Davidson

Over the past several months, the Centers for Medicare & Medicaid Services (CMS) has taken a number of steps that show an awareness of the regulatory burden placed upon participants in the government’s health care programs, and even some willingness to consider reducing those burdens.  While it remains to be seen whether the recent proposals will have measurable results, the following actions can still be viewed with guarded optimism.

Proposed Changes to Medicare

In July, 2018, CMS proposed significant changes to Medicare, to be included in rules that take effect in 2019.  These changes cover physician fee schedules, streamlining Evaluation & Management (E&M) billing, advancing “virtual care,” decreasing drug costs, revising the MIPS program and establishing the MAQI demonstration project.  The agency also asked for comments on price transparency issues.Continue reading

The Case Against Cloning (Medical Records)

medical records cloning

medical records cloningBy: Jacqueline Bain

The transition from paper medical records to electronic medical records has brought with it many conveniences and some unintended consequences. One example of an unintended consequence is cloning in the medical record. Cloning is copying and pasting previously recorded information from a prior patient note into a new patient note.

Providing quality medical care is only one part of the job. Appropriately documenting that care in order to be paid for your efforts is another. And while medical professionals are trained at length to provide care, hardly any are aware of the potential pitfalls associated with improper documentation.

In late 2015, CMS advised that cloning “is a problem in health care institutions that is not broadly addressed.” CMS specified that cloning records may indicate fraud, waste and abuse in inquiries and audits and that each part of a “medical record must contain documentation showing the differences and the needs of the patient for each visit or encounter.”Continue reading

Latest Developments: Medicare Appeal Backlog Litigation

cms medicare regulations

medicare appealBy: Matt Fischer

In 2012, the American Hospital Association (AHA) along with three member hospitals filed a lawsuit against the U.S. Department of Health and Human Services (HHS) for the agency’s failure to meet the 90 day decision requirement at the Administrative Law Judge (ALJ) level known as the Office of Medicare Hearings and Appeals (OMHA).  Through the years, the case has moved back and forth between a federal district court and federal appeals court in the District of Columbia.  Most recently in March, a federal district court judge ordered the AHA to expand on its suggestions it has made over the course of its litigation for how HHS can clear the ever-growing backlog and additionally, explain why the current procedures are insufficient.Continue reading

CERT Review and Top Five Medicare Documentation Errors

By: Matthew Fischer

In CMS’ latest “MLN Connects” newsletter, the agency discusses the Comprehensive Error Rate Testing (CERT) program and the top five documentation errors committed by providers.  Providers should pay close attention when CMS releases these types of notices.  If selected for CERT review, providers are subject to potential action such as post-payment denials, payment adjustments, or other actions depending on the results of the review.  Therefore, providers should ensure they fully understand Medicare’s documentation requirements and how to meet these demands. Continue reading