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McBrayer Blogs
Senate Finance Committee Takes an In-Depth Look at Fraud & Abuse
Earlier this week, I discussed the HHS and DOJ Annual Report for the Health Care Fraud and Abuse Program. HHS and DOJ are not the only ones who are determined to purge the health care industry of its woes. On January 31, 2013 a group of six current and former members of the Senate Finance Committee released a comprehensive report detailing recommendations on combating waste, fraud and abuse in the Medicare and Medicaid Programs. More >
Annual Report Details Record Breaking Success in Health Care Fraud Prevention
The Health Insurance Portability and Accountability Act of 1996 (“HIPAA”), required the establishment of a national Health Care Fraud and Abuse Control Program (“HCFAC”). The HCFAC Program is a joint Department of Justice (“DOJ”) and Health and Human Services (“HHS”) coordination of federal, state and local law enforcement activities to combat fraud committed against all health plans, both public and private. More >
CMS 2014 Call Letter: A Bright Future for CMS Star Rating System
On February 15, the Centers for Medicare & Medicaid Services (CMS) issued the draft calendar year (CY) 2014 Call Letter for the Medicare Advantage (MA) and Part D programs (Call Letter). It contains information that MA organizations and Part D plan sponsors (collectively, Plan Sponsors) need to prepare their 2014 bids and operations. More >
CMS Proposes to Change Physician Requirements for RHC's and FQHC's
Since the passage of the Patient Protection and Affordable Care Act of 2010 (“PPACA”), many providers, suppliers and physicians that were enrolled in Medicare and Medicaid were mandated to create compliance programs for their healthcare facilities. Since that time, small and rural providers have been scrambling to adopt and implement programs that can adequately withstand regulatory and law enforcement scrutiny. Larger providers, such as multi-state hospitals, were already equipped with a compliance program. It is the small and rural providers, limited by staff and financial resources, which have had their hands full complying with the new regulatory requirements. More >
State Legislation, the ACA, and Autism: New Laws Bring in Waves of Change
In recent years, state legislators across the country have closely focused on a specific health problem that can affect mental capacity: autism. Autism and autism spectrum disorders (ASD’s) cause developmental disabilities and numerous social, behavioral, and physical challenges. The tragedy at Sandy Hook Elementary School renewed intense public debate about this particular diagnosis and treatment of other mental health issues. More >
HHS Issues Final HIPAA/HITECH Rule
The United States Department of Health and Human Services (“HHS”) issued its Final Rule modifying the requirements of the Health Insurance Portability and Accountability Act (“HIPAA”) privacy and security regulations pursuant to the Health Information Technology for Economic and Clinical Health Act (“HITECH”) on January 17, 2013. The Final Rule strengthens the privacy and security requirement of HIPAA governing protected health information (“PHI”) and gives HHS greater enforcement authority to police violations of the privacy and security requirements. The Final Rule will require health care providers and their business associates to re-evaluate their HIPAA compliance policies and procedures to avoid potential liability for violations of HIPAA requirements. More >
The Wrap-Around Slap-Around for Primary Care Centers
For Kentucky Primary Care Centers (“PCCs”), Rural Health Centers (“RHCs”), and Federally Qualified Health Centers (“FQHCs”), getting the run-around from Medicaid on wrap-around payments is not so unusual. Frequently, these providers complain that supplemental payments distributed by the Kentucky Department for Medicaid Services’ (“Medicaid”) are too low, too late or both. More >
The Kentucky Health Benefit Exchange: How Obamacare is Changing the Health Insurance Marketplace
Now that the President has been re-elected and the Supreme Court has upheld most of the Accountable Care Act (“ACA”), Obamacare will not be repealed. So, what does that mean for Kentuckians? Several things including an individual mandate to buy health insurance and a health benefit exchange where Kentuckians can buy insurance. More >
AN EFFECTIVE COMPLIANCE PROGRAM: PREVENTIVE MEDICINE FOR THE INDIVIDUAL AND SMALL PHYSICIAN GROUP PRACTICE
With federal and state fraud and abuse enforcement efforts on the rise, all health care providers must be vigilant in identifying areas of risk and putting in place mechanisms to ensure regulatory compliance. This holds true not just for larger institutional providers, but individual and small physician group practices, as well. With the proliferation of federal and state contractors tasked with performing audits of coding and billing practices, physician practices must be prepared to demonstrate proper coding and billing practices and proper documentation to support those practices. The best preventive medicine for the individual and small physician group practice is a carefully drafted compliance program to identify and address areas of risk and to promote a culture of compliance within the practice. More >
Reforming Medicare Audits
On October 16, 2012, the Medicare Audit Improvement Act of 2012[1] was introduced in the U.S. House of Representatives by Representative Sam Graves. The purpose of this legislation is to reform the Medicare auditing program. This legislation aims to improve the accuracy and transparency of Medicare audits of hospitals as well as increase the accountability of Recovery Audit Contractors (“RAC”).[2] More >
