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Showing 62 posts in Medicare.

Tips for New Enrollment & Revalidation for Participation in Medicare & Medicaid

June 3, 2014
Posted In Centers for Medicare & Medicaid Services (“CMS”), Chain and Organization System (“PECOS”), Medicaid, Medicare

The new enrollment and revalidation requirements for providers and suppliers for Medicare/Medicaid participation was previously  detailed on this blog. As promised as a follow-up, this blog post will describe enrollment best practices and tips for ensuring that enrollment or revalidation is properly accomplished. Not only is initial enrollment now more onerous, but revalidation is required for all physicians and other providers/suppliers who were enrolled before March 25, 2011, which generally means that all physicians and physician groups must complete the re-enrollment process. A failure to re-enroll means that CMS will de-activate payment until a successful re-enrollment process is completed. In some cases, CMS may even revoke participation. Thus, it is crucial that physicians, providers, and suppliers get it right the first time. More >

Physicians: Have You Checked Your Numbers?

April 24, 2014
Posted In Health Care Law, Health Reform, Medicare, Physician Payments

As promised, the Centers for Medicare and Medicaid Services released information about Medicare payment to physicians and certain health care professionals on April 9th. The release is in conjunction with the policy change instituted by the U.S. Department of Health and Human Services, which allows CMS to respond on a case-by-case basis to Freedom of Information Act requests for Medicare payment information related to individual physicians (see more on the topic here). More >

New Enrollment and Re-Validation Requirements for Providers/Suppliers for Participation in Medicare and Medicaid: Watch Your Mail! Part I

April 3, 2014
Posted In Abuse and Waste, Affordable Care Act, Centers for Medicare & Medicaid Services (“CMS”), Compliance Officer, Compliance Programs, Enrollment, Health Care Law, Medicare, Re-validation

Even though the Centers for Medicare and Medicaid Services (“CMS”) published final regulations to implement provisions to the Affordable Care Act (“ACA”) on February 2, 2011, it is likely that many Kentucky health care providers, including physicians, are not aware of the importance of the new requirements for revalidation of Medicare and Medicaid enrollment or the new and more burdensome requirements for initial enrollment. The requirements are aimed at strengthening provider and supplier screening procedures to reduce fraud, waste, and abuse in federal health care programs. Because CMS contractors and KY Medicaid have been slow to comply with these new requirements, it is likely that many providers have not noticed the enrollment/screening changes unless they have been asked to revalidate or have applied for new or additional provider/supplier numbers. More >

Changes Halted on Medicare Prescription Drug Program

March 27, 2014
Posted In Centers for Medicare & Medicaid Services (“CMS”), Health Care Law, Healthcare Regulation, Medicare, Medicare Part D

After receiving bipartisan opposition and heavy concern from patient groups and insurers, the Centers for Medicare and Medicaid Services (“CMS”) has declared that it will not be moving forward with draft regulations released in January which proposed several changes to the Medicare Part D program. More >

2014 Work Plan Highlights for Physicians

February 25, 2014
Posted In Chiropractic services, Medicare, Office of Inspector General of the United States Department of Health and Human Services (OIG), Ophthalmological services, Physician Compare website, Physician Payments

On January 31, 2014, the Office of Inspector General (“OIG”) finally released its Work Plan for fiscal year 2014. The Work Plan is a dense summary of the OIG’s various enforcement priorities for the year. This overview is specifically for physicians, hospitals, and other health care providers. Some of this year’s plan’s significant focus areas are discussed below. More >

New Rule Brings Sweeping Changes to Physician Privacy, Part II

February 13, 2014
Posted In Compliance Programs, False Billings, Health Care Law, Medicaid, Medicare, Physician Payments

Earlier this week, we discussed the new U.S. Department of Health and Human Services (HHS) policy on disclosure of Medicare reimbursement to individual physicians.  The policy, set to take effect on March 18, 2014, enables the Centers for Medicare & Medicaid Services (CMS) to evaluate requests for physician pay information under the Freedom of Information Act (FOIA) and, in some cases, release the data. This new policy marks a fundamental shift in HHS’ commitment to protect physician privacy. More >

New Rule Brings Sweeping Changes to Physician Privacy

February 11, 2014
Posted In Centers for Medicare & Medicaid Services (“CMS”), Health Care Law, Health Reform, Medicare, Payors, Physician Payments

On January 17, the U.S. Department of Health and Human Services (HHS) announced that the Centers for Medicare & Medicaid Services (CMS) would begin granting Freedom of Information Act (FOIA) requests for Medicare reimbursement to individual physicians on a “case-by-case basis.”  The new policy, effective March 18, 2014, is a departure from CMS’ long-standing practice of withholding information on physician reimbursement under the Medicare program. More >

Medicare Physician Fee Schedule Final Rule Issued for CY 2014

December 17, 2013
Posted In 2014 Medicare Physician Fee Schedule (“PFS”), Chronic Care Management, Critical Access Hospitals (“CAHs”), Health Care Law, Medicaid, Medicare, Primary Care Physicians ("PCPs"), Sustainable Growth Rate (“SGR”), Telehealth

The CY 2014 Medicare Physician Fee Schedule (“PFS”) final rule has been issued. The rule, over 1,000 pages in length, determines physician reimbursement for services provided to Medicare beneficiaries. Let’s take a look at just a few of the changes contained therein. More >

Top Ten Health Law Issues for Physicians, Health Systems and Providers in 2014

December 17, 2013
Posted In Audit, Health Care Law, Health Information Technology for Economic and Clinical Health Act (HITECH Act), Health Insurance Portability and Accountability Act of 1996 (HIPAA), House Bill 1, Meaningful use incentives, Medicaid, Medicare, Stark Laws

Change is the one constant that physicians, health systems and other providers face in 2014 as the ACA and its myriad regulations become effective along with increasing review and scrutiny from not just state and federal regulators, but also private companies with state and federal contracts to review and audit claims, cost reports, and billing practices.  So, listed below are the top ten areas that physicians and other providers should watch in 2014. More >

An Unlikely Consequence, cont.

October 24, 2013
Posted In Affordable Care Act, Affordable Insurance Exchanges, Health Care Law, Health Reform, Medicaid, Medicare

On Tuesday, I discussed the recent trend of hospital layoffs of staff, administrative and professional alike, in order to reduce costs despite expectations of an unprecedented number of individuals seeking health care services under the ACA. More >

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