Blog

CMS Issues Guidance on When a Hospital is a Hospital

Is your hospital really a hospital? Well, that depends on whether Medicare deems it so. Earlier this month, the Centers for Medicare & Medicaid Services issued clarifying guidance on what constitutes a hospital. Under these new guidelines, holding a state hospital license isn’t necessarily the end-all for receiving Medicare reimbursement. CMS says it will now […]

Joint Commission Issues Alert on Hand-off Communication

“What we have here is a failure to communicate” is a line from the 1967 film Cool Hand Luke. It’s also a problem in the world of healthcare when one provider hands over a patient’s care to another for continued care and treatment. Earlier this month, the Joint Commission issued a new Sentinel Event Alert […]

The FCA and the Use of Statistical Sampling

The U.S. Department of Justice late last month agreed to a $275,000 settlement in a False Claims Act case against a South Carolina-based company that operates elder care facilities. What’s significant about this case is that two years earlier, the DOJ rejected a significantly higher – $2.5 million – settlement. In the initial case, United […]

New vs. Established Patient Billing: Are You Doing It Properly?

It’s no secret that the Department of Health and Human Services Office of the Inspector General (HHS OIG) has been scrutinizing how Medicare pays providers for new and established patients. Such scrutiny has resulted in providers having to pay back millions for incorrectly billing for a new patient visit when the visit should have been […]

CMS Revamps Medicare Audit Strategy

Good news for some healthcare providers and not so good news for others. The Centers for Medicare & Medicaid has announced changes to its Medicare audit strategy in an effort to root out fraud and abuse. The new process is based on a pilot program that CMS introduced in 2014 in which the agency combined […]

Have Physicians Embraced the Use of End-of-Life Billing Codes?

It’s been about a year since the Centers for Medicare and Medicaid Services (CMS) approved payment for voluntary end-of-life counseling as part of its 2016 Medicare physician fee schedule. A recent article in Modern Healthcare suggests that many physicians are using the codes to have important end-of-life planning conversations with patients. The codes (99497 and […]

Proposed Opioid Bill Ensures Patient Privacy While Helping MDs Make Rx Decisions

An estimated one-in-three Americans had a prescription for opioids in 2015 and that number continues to grow. With that growth has come a startling increase in the number of overdose deaths. The National Center for Health Statistics reported that overdose deaths hit a record 19.9 per 100,000 population in the third quarter of 2016, up […]

OIG Plans to Focus on Medicare Part B Payments for Telemedicine

The Department of Health and Human Services Office of Inspector General, (HHS OIG) recently announced a new project designed to review Medicare Part B payments for telemedicine services. It’s part of the OIG’s Work Plan initiatives released last November and updated monthly. Among the June/July updates, the agency noted it will be looking to see […]

Opioid Crackdown Requires Increased Focus on Compliance

It’s not just drug dealers and traffickers selling opioids who have become the target of law enforcement. Earlier this month, the Department of Health and Human Services Office of the Inspector General, along with state and federal law enforcement partners, targeted healthcare providers. The agency announced that 412 defendants including 115 doctors, nurses and other […]

CMS Proposes Changes to 2018 Medicare Fee Schedule

The Centers for Medicare and Medicaid Services (CMS) has issued a proposed rule that will update Medicare payment and policies for doctors and other healthcare providers that the agency says “reflect a broader strategy to relieve regulatory burdens for providers; support the patient-doctor relationship in healthcare; and promote transparency, flexibility, and innovation in the delivery […]