Health Law

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 …..

2024-12-04T13:28:18-06:00August 8th, 2014|Categories: Health Law|Tags: , |

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 …..

2024-12-04T13:29:04-06:00March 6th, 2014|Categories: Health Law|Tags: , |

Sixth Circuit Dismisses Racial Discrimination Claim by Surgeon Following Suspension of Privileges

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 …..

2024-12-04T13:29:30-06:00February 13th, 2014|Categories: Health Law|Tags: |

Physician Owned Hospitals Must File Annual Report by December 1, 2013 to Comply with Stark II

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 …..

2024-12-04T13:29:58-06:00November 26th, 2013|Categories: Fraud & Abuse Compliance, Health Law, Stark II|Tags: |

The Affordable Care Act and Closing the Prescription Benefit Coverage Gap

(“Doughnut Hole”) Medicare Part D Coverage Gap 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 …..

2024-12-04T13:30:23-06:00October 8th, 2013|Categories: Health Law, Medicare & Medicaid Enrollment, Provider Operations|Tags: |
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