CMS Releases Final “60-Day Rule” on Overpayments Quantification Required as Part of “Identifying” and Overpayment Six years after issuing its Proposed Rule, CMS released its final 60-Day Rule for reporting and returning overpayments. The Final 60-Day Rule is more industry-friendly, but still creates an obligation for providers to exercise reasonable diligence to identify and [...]
OCR Begins Phase 2 of its HIPAA Audit Program The U.S. Department of Health and Human Services’ Office for Civil Rights (OCR) has begun its second phase of audits (Phase 2 Audits) of compliance with Health Insurance Portability and Accountability Act of 1996 (HIPAA) privacy, security and breach notification standards (HIPAA Standards) as required [...]
Final 60-Day Rule for Reporting and Returning Overpayments CMS Releases Final “60-Day Rule” on Overpayments Quantification Required as Part of “Identifying” and Overpayment Six years after issuing its Proposed Rule, CMS released its final 60-Day Rule for reporting and returning overpayments. The Final 60-Day Rule is more industry-friendly, but still creates an obligation for [...]
CMS to Enforce 20 hrs. per Week Therapeutic Services with Weekly Billing Requirement Patients admitted to a partial hospitalization program (PHP) must be under the care of a physician who certifies the need for partial hospitalization and that the patient requires a minimum of 20 hours per week of therapeutic services, evidenced by their [...]
Business Associates the Target of HIPAA Audits For the first time since HIPAA was enacted in 1996, vendors and other business partners such as law firms and billing companies who handle health information on behalf of healthcare providers can be held directly liable for violations of the HIPAA laws. The U.S. Department of Health [...]
Medicare Appeals – Limiting the Scope of Review on Redeterminations and Reconsiderations of Certain Claims CMS recently provided direction to A/B MACs and QICs regarding the scope of appellate review for redetermination (1st Level) and reconsideration (2nd Level) appeals of certain claims. Historically, MACs and QICs had discretion while conducting appeals to develop new [...]
OIG Issues Additional Compliance Guidance Emphasizing Responsibility of Governing Boards. by Michael Schulze A Hospital’s commitment to effective statutory and regulatory compliance starts at the top with the Hospital’s Governing Board. On April 20, 2015, the Office of Inspector General, U.S. Department of Health and Human Services (“OIG”) issued Practical Guidance for Health Care [...]
Avoiding and Managing CMS Audits Byline: J. Stuart Showalter Routine internal and external auditing of Medicare claims is a critical step in avoiding denials and managing audits effectively when they do occur. Hospital and health system finance leaders can take important steps—such as self-audits and accurate documentation—to limit denials and avoid CMS audits. This [...]
LHA IMPACT Law Brief Volume 29, No. 10 December 2014 Louisiana Department of Health and Hospitals Issues RAC Emergency Rule By: Michelle Buford, JD, RHIA On November 20, 2014, the Louisiana Department of Health and Hospitals (DHH) issued an Emergency Rule implementing a Recovery Audit Contractor (RAC) program. This adds yet another layer to [...]
CMS Provides MACs, CERT, RACs, and ZPICs with Automatic Denial Authority for “Related claims” – REDUX You may recall earlier this year, CMS issued a Transmittal giving MACs, RACs, CERT contractors, and ZPICs discretion to automatically deny other “related” claims submitted before or after the primary claim in question. For instance, if documentation associated [...]
