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Study: Medicare Appeals Process Reforms Not Enough to Eliminate Backlog

The Centers for Medicare & Medicaid Services’ (CMS) current and proposed reforms may not be enough to eliminate the appeals backlog and restore a timely and fair appeals process. That was the finding of a study published recently in the Journal of Hospital Medicine. Researchers investigated all appeals reaching level three at three facilities: Johns […]

Is Your Telemedicine Company HIPAA Compliant?

UPDATE: According to a news release, the lawsuit filed against MDLive, Inc. was voluntarily dropped by the law firm that originally filed it. MDLive has since published a fact sheet responding to the allegations. A lawsuit seeking class action status recently filed against Telehealth provider MDLive, Inc. underscores the need for all healthcare companies using […]

CMS Launches New Online MIPS Tool

The Centers for Medicare and Medicaid Services (CMS) wants to help healthcare providers to determine whether they must take part in the Merit-Based Incentive Payment Program – better known as MIPS. The new Medicare reimbursement program is central to the Quality Payment Program, which intends to shift reimbursement away from the volume of services provided […]

Feds File False Claims Act Lawsuit Against UnitedHealth Group

Is it the government’s “murky policies,” as suggested by a UnitedHealth spokesman, or was it outright fraud that led to allegations the healthcare insurance giant engaged in fraud? That’s a question that will have to be answered following the U.S. Department of Justice’s recent decision to intervene and file a complaint against UnitedHealth Group (UHG). […]

Why You Need a HIPAA-Compliant Business Associate Agreement

The recent announcement by The Department of Health and Human Services’ Office for Civil Rights (OCR) that it agreed to settle potential violations of the Health Insurance Portability and Accountability Act (HIPAA) with The Center for Children’s Digestive Health (CCDH) should serve as a lesson to other healthcare organizations about the need to obtain signed, […]

CMS Looks to Streamline Self-Disclosure Process

In an attempt to streamline the self-disclosure process, The Centers for Medicare and Medicaid Services (CMS) recently posted revisions to the Voluntary Self-Disclosure Protocol (SRDP), which allows providers of healthcare services and suppliers to self-disclose actual or potential violations of the federal physician self-referral law. Beginning June 1, providers of services and suppliers must use […]

Lawmakers Seek to Expand Medicare Coverage of Telemedicine Again

Congress is taking another crack at expanding Medicare coverage for services delivered via telemedicine. U.S. Senators Cory Gardner (R-CO) and Gary Peters (D-MI) recently introduced bipartisan legislation that would require the Center for Medicare and Medicaid Innovation (CMMI) to “test the effect of including telehealth services in Medicare health care delivery reform models.” CMMI’s role […]

CMS Easing DME MAC Requirements

The Centers for Medicare and Medicaid (CMS) is modifying requirements for DME Medicare Administrative Contractors (MACs) by allowing them to accept timely orders and medical documentation, regardless of whether the supplier received the documentation directly from the beneficiary’s eligible practitioner or from a transferring supplier, as long as they meet Medicare requirements. In a Change […]

When Ignorance is Not a Defense

A 79-year-old New Jersey physician who was charged in connection with a healthcare kickback scheme now faces sentencing in June after being convicted of accepting bribes in exchange for blood test referrals. As we previously wrote about, Dr. Bernard Greenspan, 79, was among more than 40 people, many of them physicians, who allegedly accepted payments […]

OIG Opinion Applies Access to Care Exception

Can a hospital system provide free or reduced-cost lodging and meals to certain financially needy patients, or would such an arrangement (a) constitute either a violation of the federal anti-kickback statute or (b) constitute grounds for the imposition of civil monetary penalties because it would violate a provision of the Social Security Act that prohibits […]