About Alicia Alcina

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So far Alicia Alcina has created 28 blog entries.

Automatic Denial Authority for “Related claims” – REDUX

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 [...]

By |2017-04-20T15:47:40-05:00August 8th, 2014|News|Comments Off on Automatic Denial Authority for “Related claims” – REDUX

OCR Begins Phase 2 of its HIPAA Audit Program

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 [...]

By |2017-04-20T15:48:27-05:00July 29th, 2014|News|Comments Off on OCR Begins Phase 2 of its HIPAA Audit Program

LHA IMPACT Law Brief – Volume 29, No. 5 June 2014

LHA IMPACT Law Brief Volume 29, No. 5 June 2014 Hospitals and American Hospital Association Sue HHS Over ALJ Appeals Delays By: Michelle K. Buford, J.D., RHIA Angry and frustrated over long delays in the Medicare appeals process, several hospitals filed suit on May 22, 2014, seeking to compel the Secretary of Health and [...]

By |2017-04-20T15:49:50-05:00June 5th, 2014|News|Comments Off on LHA IMPACT Law Brief – Volume 29, No. 5 June 2014

Automatic Denial Authority for “Related claims”

CMS Provides MACs, CERT, RACs, and ZPICs with Automatic Denial Authority for “Related claims” Effective March 6, 2014, CMS amended the Medicare Program Integrity Manual 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 with [...]

By |2017-04-20T15:51:04-05:00March 6th, 2014|News|Comments Off on Automatic Denial Authority for “Related claims”

Sixth Circuit Dismisses Racial Discrimination Claim

Sixth Circuit Dismisses Racial Discrimination Claim by Surgeon Following Suspension of Privileges By Michael Schulze and Harry Shulman* For Brintley to prevail on her state-law racial discrimination claim, the appeals court observed that the lack of any direct evidence that St. Mary's discriminated against her on the basis of her race required Brintley to present [...]

By |2017-04-20T15:51:45-05:00February 13th, 2014|News|Comments Off on Sixth Circuit Dismisses Racial Discrimination Claim

Physician Owned Hospitals

Physician Owned Hospitals Must File Annual Report by December 1, 2013 to Comply with Stark II by Michael Schulze The Centers for Medicare & Medicaid Services (“CMS”) defines hospitals with physician owners or investors as Physician Owned Hospitals. Physician Owned Hospitals utilizing the Stark II whole hospital and rural provider exceptions must now file an [...]

By |2017-04-20T15:52:32-05:00December 1st, 2013|News|Comments Off on Physician Owned Hospitals

The Affordable Care Act and Closing the Prescription Benefit Coverage Gap

The Affordable Care Act and Closing the Prescription Benefit Coverage Gap (“Doughnut Hole”) by: Michael R. Schulze, Under the Medicare Part D Prescription Drug Benefit, many Medicare beneficiaries have annually encountered a large gap in their prescription drug coverage that is commonly referred to as the “Doughnut Hole.” This gap in coverage occurred when [...]

By |2017-04-20T15:53:04-05:00October 8th, 2013|News|Comments Off on The Affordable Care Act and Closing the Prescription Benefit Coverage Gap

LHA IMPACT Law Brief

LHA IMPACT Law Brief Volume 28, No. 6 July 2013 Landmark Settlement Agreement for Rehabilitation Providers By Michelle K. Buford A recent American Medical Rehabilitation Providers Assn. (AMRPA) Seminar in New Orleans discussed a very significant proposed Settlement Agreement that was filed in federal district court on October 16, 2012 – the Jimmo v. [...]

By |2017-04-20T15:53:33-05:00July 6th, 2013|News|Comments Off on LHA IMPACT Law Brief