Articles
CMS to Enforce 20 Hours per Week Therapeutic Services
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 …..
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 …..
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 …..
OIG Issues Additional Compliance Guidance Emphasizing Responsibility of Governing Boards
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”) …..
Avoiding and Managing CMS Audit Procedures
RACs, ZPICs and other appeals: Timelines, Recoupment, and Accrual of Interest. Byline: J. Stuart Showalter Routine internal and external auditing of Medicare claims is a critical step in avoiding denials and managing audits effectively when …..
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 …..