OIG: CMS Overpaid Providers Millions in EHR Incentive Payments

The Department of Health and Human Services’ Office of Inspector General (OIG) recently released a report finding that the Centers for Medicare & Medicaid Services (CMS) overpaid some $729 million in Medicare electronic health record (EHR) incentive payments to eligible providers who did not comply with federal meaningful use requirements. In its report, the OIG […]

CMS Issues Sweeping New Rules For HHA Participation in Medicare/Medicaid

Home health agencies have six months to comply with sweeping new changes that will impact their ability to participate in the Medicare and Medicaid programs. Earlier this month, The Centers for Medicare and Medicaid, released its final rules relating to the conditions of participation (CoPs) that home health agencies must meet to participate in the […]

Why Labs Have a Lot to Lose Under CMS’ Clinical Laboratory Fee Schedule

Big changes are coming that will impact how Medicare will pay for clinical diagnostic laboratory tests (CDLTs). The changes, according to some in the industry, could result in a significant financial hit for labs across the country because they will result in substantial fee cuts. The changes, which take effect Jan. 1, 2018, were mandated […]

Judge Orders HHS to Clear Medicare Claims Appeal Backlog by 2020

Four years, that’s how long a federal judge has given the Department of Health and Human Services (HHS) to clear through a huge backlog of Medicare claims appeals. The Dec. 5 ruling, from Judge James E. Boasberg grew out of a motion for summary judgment filed in October by the American Hospital Association. At issue […]

OIG Says Free Labeling of Test Tubes, Collection Containers Could Violate Anti-Kickback Laws

The Office of Inspector General (OIG) recently issued an advisory opinion suggesting that a laboratory’s proposal to label test tubes and specimen collection containers at no cost to dialysis facilities could constitute remuneration under the anti-kickback statute and result in potential sanctions. The opinion issued this month came at the request of an unnamed laboratory […]

CMS: Ignorance not an excuse when it comes to liability

The Centers for Medicare & Medicaid Services (CMS) recently released a policy change that provides additional conditions for determining when a contractor must assume a physician, provider, or supplier should have known about a policy or rule. Currently, CMS requires its contractors to consider at least one of three conditions when assuming that a provider, […]

CMS offers plan (again) in hopes of clearing Medicare appeals backlog

Hospital executives who are tired of waiting for their Medicare appeals cases to be settled are being presented with an option. The Centers for Medicare and Medicaid is offering to pay hospitals 66 percent of the net allowable for short-term inpatient stays in exchange for dropping their pending appeals of denied claims. CMS recently announced […]

OIG report finds claims filed on behalf of the dead

With Halloween just around the corner the HHS’ Office of the Inspector General just released a report showing that during a two-year period The Centers for Medicare & Medicaid (CMS) paid out nearly half a million dollars for claims made on dead people. Federal law requires CMS to establish policies and implement claim edits to […]

The end to ICD-10 code flexibility: How are you handling it?

It may be hard to believe, but ICD-10 recently celebrated its first birthday. So we thought it only fitting that we post this blog on 10-10. The change from ICD-9 to ICD-10 meant the addition of thousands of more very specific, and in some cases, very unusual diagnostic codes. Examples include: being pecked by a […]

CMS puts HHA pre-claim review process on hold in Florida, other states

Plans by the Centers for Medicare & Medicaid Services (CMS) to begin a pre-claim review process for home health services have been put on hold for now. The demonstration program was to launch this month (October) in Florida and Texas, but CMS announced a postponement, noting that additional education efforts were needed before moving forward. […]