The Compliance INSIDER

Anyone who enters anything into a patient encounter must make sure the documentation is detailed, accurate and thorough. Now more than ever before "if you didn't document it, it's the same as if you didn't do it." Below are...

For information on Medicare or Medicaid cards, please call 1-800-MEDICARE (663-4227). The Centers for Medicare & Medicaid Services (CMS) announced that under the Medicare Access and CHIPS Reauthorization Act (MACRA) of 2015, they are required to...

The Centers for Medicare & Medicaid (CMS) issued a reminder about correct coding of Evaluation and Management (E/M) services. As part of their reminder, they mentioned a study report the Office of the Inspector General (OIG) that noted 42 percent...

Each year in August, National Immunization Awareness Month (NIAM) provides an opportunity to highlight the value of immunization across the lifespan. National Immunization Awareness Month presents a great opportunity to educate seniors and other...

Just last week, the Houston Chronicle reported that a doctor was "sentenced to three and a half years in federal prison for fraudulently billing Medicare for hundreds of thousands of dollars in treatment and tests that patients didn't...

Today is the first day of fall.  In the northern hemisphere autumn (fall) is the season between the September equinox and the December solstice.  For many of us, fall is a time for change and a time for preparation.  This year, one...

Anyone who is involved with the delivery of patient care for a provider who participates in the Medicare or Medicaid incentive programs plays an important role in the Meaningful Use process.  Some employees may only need an overview of...

You may recall one of our recent articles discussed 5 Meaningful Use Facts and Tips for you and your organization.  We received positive feedback from the article and we were asked about our Meaningful Use services. Because of this feedback...

This past week it was announced that there was a nationwide sweep led by the Medicare Fraud Strike Force resulting in charges against 243 individuals, including 46 doctors, nurses and other professionals, for their alleged participation in...

You may recall several of our articles have discussed important Meaningful Use steps your organization should be taking to ensure compliance with CMS requirements.  The following list will discuss 5 of the most important Meaningful Use facts...

  It was recently reported by the U.S. Department of Justice that two durable medical equipment (DME) providers will pay $7.5 million to resolve allegations that false claims were submitted to federal health care programs for power...

Did you know the submission deadline for Eligible Professionals (EPs) to submit an application for a 2016 Medicare EHR Incentive Program hardship extension is 11:59 PM EDT July 1, 2015? The hardship exception will be granted under specific...

In both Stage 1 and Stage 2 Meaningful Use, regardless of what stage of meaningful use the provider is attesting to, medical assistants are required to be credentialed.  What is important, as we discussed in previous articles, is that the...

To help your organization prepare for a Medicare Audit – RAC, MAC, ZPIC, CERT and/or Meaningful Use, we have created a new Form that has been uploaded to our Forms section. Highlights from the Prepare for an Audit Form Recovery Audit...

There are just over 6 months to go until the October 1, 2015 deadline for ICD-10 implementation.  While this deadline is getting closer, the rumblings about ICD-10 readiness issues and yet another possible ICD-10 delay are starting to...

In our Cover Your Attestation article series, we discussed how FDRs (first-tier, downstream, and related entities) must check the List of Excluded Individuals and Entities (LEIE) before credentialing, hiring, or contracting with any individual or...

The U.S. Labor Department announced a rule change to the Family and Medical Leave Act (FMLA) in keeping with the U.S. Supreme Court ruling in United States v. Windsor. That ruling struck down the federal Defense of Marriage Act provision that...

In our Exclusion Lists: Part 2 article, we mentioned Medicare Advantage plan sponsors are required to ensure that all FDRs are screening all  employees/vendors/subcontractors against the DHHS OIG List of Excluded Individuals and Entities...

In this concluding part of our Cover Your Attestation article series, we will discuss Medicare's requirements for plan sponsors to monitor its first tier, downstream and related entities; report detected noncompliance or potential fraud,...

Conducting and reviewing a security risk analysis (SRA) is perhaps one of the most important HIPAA and Meaningful Use requirements your organization will undertake. A SRA is an ongoing process of continual improvements your organization should...

In addition to Meaningful Use Attestation requirements, many insurance companies are asking for Annual Compliance Attestation for organizations to validate compliance with applicable requirements. In the first part of our Cover Your Attestation...

The Department of Health and Human Services' Office of the National Coordinator for Health Information Technology (ONC) released Connecting Health and Care for the Nation: A Shared Nationwide Interoperability Roadmap Version 1.0. The draft...

We have been asked some questions about Medical Assistant Credentialing lately and rightfully so. With Meaningful Use, audits, attestation, and the constant changes in healthcare; questions about Medical Assistant Credentialing are expected. Is...

Health and Human Services Secretary Sylvia M. Burwell announced measurable goals and a timeline to move the Medicare program towards paring providers based on the quality of care they give patients, instead of the quantity of patients they see....

Last Friday, it was announced that Marilyn Tavenner, the administrator of Centers for Medicare and Medicaid Services (CMS) will be stepping down in February.  In her role as CMS administrator, she oversaw government health insurance programs...

The Centers for Medicare & Medicaid Services (CMS) announced yet another delay for ICD-10. This time, the delay will benefit providers. CMS has pushed out the ICD-10 testing deadline to January 21, 2015. CMS will use takeaways from end-to-end...

A Two-Part Series on Attestation Requirements and Training. In addition to Meaningful Use Attestation requirements, many insurance companies are asking for Annual Compliance Attestation for organizations to validate compliance with applicable...

The Centers for Medicare & Medicaid Services (CMS) announced the bidding timeline for Round 2 Recompete and the national mail-order recompete of the Medicare Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) Competitive...

After last week's post regarding the Credentialed Medical Assistant requirement under Meaningful Use, we were asked the following question: If we are not attesting to Stage 2 until next year, when should credentialing for our medical...

The Centers for Medicare and Medicaid Services (CMS) Administrator Marilyn Tavennar recently announced new rules that strengthen oversight of Medicare providers. The new safeguards are designed to prevent physicians and other providers with...

In October, we announced our new Medical Assistant Credentialing module. This module is available for the purpose of helping medical assistants and other health care professionals who are not credentialed, to meet the requirements of Centers of...

On October 31, 2014 the United Stated Department of Health and Human Services (HHS) Office of Inspector General (OIG) released its Fiscal Year 2015 Work Plan. The Work Plan is released annually to identify new and ongoing investigative,...

Last week, the Health and Human Services (HHS) Secretary announced the Transforming Clinical Practice Initiative. The initiative encourages doctors, peers and other to move from volume-driven systems to value-based, patient centered, and...

Did you know as of January 2013, to demonstrate Meaningful Use requirements under the Centers for Medicare & Medicaid Services EHR incentive program, only credentialed medical assistants are permitted to enter medication, radiology and laboratory...

Last week, the Office of Inspector General (OIG) of the United States Department of Health and Human Services (HHS) proposed a rule that would amend the safe harbors to the anti-kickback statute and the civil monetary penalty (CMP) rules....

Recently the Medical Group Management Association (MGMA) sent a letter to the Centers for Medicare and Medicaid Services (CMS) asking to extend the October 1, 2014 date for new eligible professionals (EPs) to attest to meeting the 2014 meaningful...

A State agency made incorrect EHR incentive payments in accordance with Federal and State Requirements. The incorrect Medicaid electronic health record (EHR) incentive payments were made to 20 hospitals totaling $4.4 million.  In addition,...

Occasionally, questions arise about annual compliance training requirements, specifically whether Fraud, Waste and Abuse training needs to occur annually if at all. For those organizations billing Medicare, the following applies. Under 42 C.F.R....

Friday, August 29, 2014 the Department of Health and Human Services (HHS) published a final rule that allows health care providers more flexibility in how they use certified electronic health record technology (CEHRT) to meet meaningful use for...

Monday, a Louisiana psychiatrist was sentenced to serve 86 months in prison for his role in a $258.5 million Medicare fraud scheme involving partial hospitalization psychiatric services. In addition, he was ordered to pay $43.5 million in...

The Centers for Medicare and Medicaid Services informed congressional health staff members on August 4, 2014, that the Recovery Audit Contractor (RAC) Program is restarting in August. According to the CMS Communication, "Today, the Centers...

For many of us, Health Information Exchange (HIE) has been a hot topic. HIE has been mentioned in articles, podcasts, trainings, and for some us, as a topic of everyday conversation. In this article we will provide answers to some common...

Last week CMS announced in the second year of operations, CMS' Fraud Prevention System identified or prevented $210 million in improper fee-for-service Medicare payments, which more than doubled the previous year's findings of improper...

It was reported last week that the Medicare Fraud Strike Force charged 90 individuals for approximately $260 million in false billing. The defendants who were charged are accused of various health care fraud-related crimes, including conspiracy...

On May 1st, 2014 the Centers for Medicare and Medicaid Services (CMS) announced the new ICD-10 implementation date. The ICD-10 implementation date will be October 1st, 2015. According to the announcement, CMS will officially release an interim...

Several of the ICD-10 publications and resources on the CMS.gov website are still referencing the October 1, 2014 ICD-10 deadline. On April 14, 2014 CMS did release a statement acknowledging the delay. The statement from CMS reads "with...

In addition to freeing up time for compliance, the provision to delay ICD-10 for an additional year will free up additional time to focus on meaningful use and security risk analysis.  As part of both Stage 1 and Stage 2 meaningful use...

On Monday CMS issues the 2015 rate announcement and final call letter for Medicare Advantage and prescription drug benefit programs. Key changes and updates that are included in the finalized Rate Announcement and final call letter include: ...

On August 23,2012, the Centers for Medicare & Medicaid Services (CMS) ruled that only "credentialed medical assistants" – including CMA's (AAMA) – would be allowed to enter medication, laboratory, and radiology orders...

At the end of February 2014, Marilyn Tavenner the administrator of the Centers for Medicare and Medicaid Services said "there are no more delays (for ICD-10 implementation), and the system will go live on Oct.1," 2014. Fast forward one...

If you meet the Medicare Eligible Professional criteria as defined by law, the last day you can register and attest to demonstrating meaningful use for the 2013 Medicare EHR Incentive Program is March 31, 2014. In order to receive incentive...

The Office of the National Coordinator for Health IT issued proposals for voluntary electronic health record technology certification criteria.  The 2015 Edition of certification criteria proposals are separate from CMS "meaningful...

CMS recently announced that it has extended its Medicare EHR Incentive Program meaningful use attestation deadline for eligible professionals (EP) and will offer retroactive attestation for some eligible hospitals for the 2013 reporting year. The...

In this coding tip, we will review a few modifiers that specify which portion of the surgical package the provider is billing for.  The global surgical package includes payment for services that are a necessary part of a...

Eligible professionals (EPs) participating in the Medicare EHR Incentive Program may be subject to payment adjustments beginning on January 1, 2015. CMS will determine the payment adjustment based on meaningful use data submitted prior to the...

If you are an eligible professional (EP), the last day you can register and attest to demonstrating meaningful use for the 2013 Medicare EHR Incentive Program is February 28, 2014. You must successfully attest by 11:59 p.m. Eastern Standard Time...

According to a report released this month by the Department of Health and Human Services' Office of Inspector General, The Centers for Medicare and Medicaid Services and many of its contractors need to adopt better practices to...

Federal regulators plan to extend Stage 2 of the HITECH Act electronic health record incentive program one year, giving healthcare providers and EHR software vendors more time to comply with requirements that include a variety of privacy and...

The Center for Medicare and Medicaid Services (CMS) recently published updated beneficiary cost-sharing and premium requirements for those enrolled in original Medicare during calendar year (CY) 2014. Under original Medicare Parts A and B,...

ICD-10 will be here in 2014. What are you doing to prepare for this massive change? ICD-10 will be here on October 1, 2014 and we will be going from 17,000 ICD-9 codes to 68,000 ICD-10CM codes. These new ICD-10CM codes will bring with them new...

Eligible professionals (EPs) participating in the Medicare EHR Incentive Program may be subject to payment adjustments beginning on January 1, 2015. CMS will determine the payment adjustment based on meaningful use data submitted prior to the...

The following is a brief overview of the Sunshine Act and how it affects covered entities: As part of the Affordable Care Act of 2010, the Sunshine Act was implemented in order to provide important ownership transparency by requiring applicable...

A major Electronic Prescribing (eRx) Incentive Program deadline is approaching for both individual eligible professionals (EPs) and group practices participating in the Group Practice Reporting Option (GPRO).  If you are an EP or an eRx GPRO...

Eligible professionals (EPs), eligible hospitals, and critical access hospitals (CAHs) that cannot demonstrate meaningful use of electronic health records (EHRs) could soon face Medicare payment adjustments. But CMS has an important message for...

A major Electronic Prescribing (eRx) Incentive Program deadline is approaching for both individual eligible professionals (EPs) and group practices participating in the Group Practice Reporting Option (GPRO).  If you are an EP or an eRx GPRO...

HHS Secretary Kathleen Sebelius recently announced that more than half of all eligible providers have been paid under the Medicare and Medicaid Electronic Health Record (EHR) Incentive Programs. More than 50 percent of all eligible professionals...

Incentive payments made through the Medicare Electronic Health Record (EHR) Incentive Program are subject to the mandatory reductions in federal spending known as sequestration, required by the Budget Control Act of 2011. Incentive Payment...

CMS recently posted a new web resource for eligible professionals (EPs), My EHR Participation Timeline, to the EHR Incentive Programs website. This interactive tool allows EPs to determine what year you will meet Stage 1, Stage 2, and Stage 3 of...

The Stage 2 rule for the Electronic Health Record (EHR) Incentive Programs included changes to the Stage 1 meaningful use objectives, measures, and exclusions for eligible professionals (EPs), eligible hospitals, and critical access hospitals...

The EHR Incentive program for achieving "Meaningful Use" can cause a lot of questions and confusion. Here is another question regarding that program: Q: To meet the third measure of the objective of providing "a summary of care...

Although the implementation date for ICD-10-CM and ICD-10-PCS (jointly referred to as "ICD-10" throughout the rest of this document) has been postponed to October 21, 2014, it is not too early to begin planning for the transition, and...

Q: Can EPs (Eligible Professionals) who are not anesthesiologists, pathologists and radiologists apply for the exception for lack of face to face patient interaction and lack of need for follow-up? A: Yes this exception is open to any EP who...

Medicare will soon start fining hospitals that have too many patients readmitted within 30 days of discharge due to complications. The penalties are part of a broader push under President Barack Obama's health law to improve quality while...

Criminals who plot to defraud the Government and steal money from the American people have a new target: people with diabetes. Please pass along the following information to your Medicare patients with diabetes. Although the precise method may...

HHS will delay implementation of ICD-10 by one year, from October 1, 2013 to October 1, 2014. HHS announced the delay August 24th. HHS originally proposed a one-year delay (from October 1, 2013, to October 1, 2014) for ICD-10 implementation April...

CMS and the Office of the National Coordinator for Health IT (ONCHIT) released August 23 the final requirements that hospitals and healthcare providers must meet in order to qualify for incentives during the second stage of the meaningful use...

Although your practice is not as large as a state Medicaid agency, you can use this incident as good negative example because the same principles apply to a smaller practice. Alaska's Medicaid program has agreed to pay OCR $1.7 million over...

We pick up where we left off in Part 1 of our article on RAC Self-audits which was posted back on June 6, 2012. Here are 14 simple questions that will give you peace of mind regarding your RAC self-audits. Randomly select 10 Medicare patient...

Self-auditing is an important preparation tool as internal audit results can show where additional education and training are needed. Self-auditing should also be used when determining whether your staff is appropriately coding, billing and...

The Notice of Proposed Rule Making (NPRM) for Stage 2 requirements for meaningful use of electronic health records (EHRs) was recently released by the Centers for Medicare and Medicaid Services (CMS). The final rule is expected this summer. In...

Professional courtesy, when extended to a physician or entity who refers "designated health services" can implicate the Stark Law. The Stark Law is a strict liability statute and the penalties for violating the statute can include...

CMS recently reminded providers of their responsibilities under the Medicare Secondary Payer (MSP) Rules. Under the MSP Rules, Medicare is secondary to certain other payers in the following circumstances: * Workers' compensation (WC) plans,...

HHS Secretary Kathleen Sebelius Announced Today the Delay of ICD-10 until October 1, 2014 Secretary Kathleen Sebelius announced in a new press release a proposed rule that would delay the compliance date for ICD-10 from October 1, 2013 to October...

It's begun; a sudden, nationwide revalidation effort that's hitting you off the normal cycle. CMS is kicking into high gear. The initial waves of revalidation notices have hit a total of 126,184 providers nationwide as of February 1,...

Criminals who plot to defraud the federal government and steal money from the American people have a new target: people with diabetes. Please pass along the following information to your Medicare patients with diabetes. Although the precise...

Q. If a beneficiary received a seasonal influenza virus vaccination more than once in a 12-month period, will Medicare still pay for it? A. Yes. Medicare pays for one seasonal influenza virus vaccination per influenza season; however, a...

It's no longer a mere possibility; HHS has confirmed its intent to delay the ICD-10 compliance deadline, according to its latest press release. "We have heard from many in the provider community who have concerns about the administrative...

The "Updated LEIE" database file reflects all OIG exclusion and reinstatement actions up to, and including, those taken in January 2012. This new, "Updated LEIE" (List of Excluded Individuals and Entities) is a complete...

Do you have your Risk/Gap Analysis completed for your practice, which is required to achieve "Meaningful Use" for the CMS EHR Incentive Program? The Risk Analysis provided by Healthcare Compliance Pros is the same as is required for...

Hospitals and physicians that qualify for Stage 1 of the HITECH Act electronic health record incentive program this year will have extra time to comply with Stage 2 requirements, which are expected to include tougher privacy and security...

If you haven't started working on it, there is no time to waste! Your revenue will be at great risk! The compliance date for implementation of the International Classification of Diseases, 10th Edition, Clinical Modification/Procedure Coding...

The Centers for Medicare & Medicaid Services (CMS) recently issued a final rule with comment period that updates payment policies and rates for physicians and non-physician practitioners (NPPs) for services paid under the Medicare Physician Fee...

The Centers for Medicare and Medicaid Services has sent a Shared Savings/Accountable Care Organizations final rule to the Office of Management and Budget (OMB) for review. OMB review is one of the last steps before publication of a rule in the...

CMS wants to remind eligible professionals (EPs), eligible hospitals, and critical access hospitals (CAHs) of the key registration dates for the Electronic Health Record (EHR) Incentive Programs, and provide information to help them successfully...

The Medicare EHR Incentive Program will provide incentive payments to eligible professionals, eligible hospitals, and CAHs that demonstrate meaningful use of certified EHR technology. Participation can begin as early as 2011. Eligible...

The HIPAA 5010 compliance date is fast approaching. There are only 100 days left until full implementation on Jan. 1, 2012. As of this date, version 5010 will be required for all HIPAA standard transactions. This means: * HIPAA version 4010A1...

Provider groups have slammed the Centers for Medicare & Medicaid Services after the agency issued a final rule that would reduce Medicare payments to skilled nursing facilities by $3.87 billion for fiscal year 2012. "We are appalled that the...

CMS issues the Advance Beneficiary Notice of Non-coverage (ABN) for you to use to notify your Medicare patients when you believe an item or service may not be covered. This form has been updated and changed several times, with the most recent...

Under the in-office ancillary exception to the Stark Law, if you refer a patient for MRI, CT, or PET scans offered by your practice, you provide notice to the patient of alternative area suppliers for the imaging services. The notices are...

Doctors who failed to do a minimum amount of electronic prescribing in the first half of 2011 will lose 1 percent of their Medicare reimbursement in 2012 if they do not qualify for an exemption. Under new proposed regulations on physician...

Professional courtesy or other practices that involve waiving co-payments or other cost-sharing amounts raise concerns. Where the recipients of such waivers are Medicare beneficiaries, the waiver of co-payments and deductibles can be viewed as a...

Professional courtesy, when extended to a physician or entity who refers "designated health services" can implicate the Stark Law. The Stark Law is a strict liability statute and the penalties for violating the statute can include...

CMS recently announced that the first payments of the Medicare EHR Incentive Program were distributed on May 19. As part of the American Recovery and Reinvestment Act, the Medicare EHR Incentive Program provides payments to eligible professionals...

CMS released a short but useful Recovery Audit Contractor (RAC) update on its website last week reporting the total amount of improper payments identified since the RAC demonstration period. From October 2009 through the end of March 2011, RACs...

Eligible professionals (EPs) can now attest through the CMS web based attestation system and be on their way to receiving Medicare EHR incentive payments. Several new CMS resources can help you successfully navigate the Medicare EHR Incentive...

Self-auditing is an important preparation tool as internal audit results can show where additional education and training are needed. Self-auditing should also be used when determining whether your staff is appropriately coding, billing and...

The Department of Health and Human Services (HHS) has released proposed regulations on accountable care organizations (ACOs). The rules will guide provider organizations in setting up exchanges of healthcare data to improve care and reduce costs,...

Several of you have asked recently if eligible professionals can participate in the 2011 Physician Quality Reporting System ("PQRS"), 2011 eRx Incentive Program, and the EHR Incentive Program all at the same time and earn incentives for...

Medicare once again reminded physicians and their billing agents to ensure that they are reporting the correct place of service on physician claims, particularly on claims for outpatient physician services payable under Part B. Such services...

OIG recently posted the latest updated exclusion and reinstatement files. The "Updated LEIE" (List of Excluded Individuals and Entities) database file reflects all OIG exclusion and reinstatement actions up to, and including, those...

The Departments of Justice and Health and Human Services (HHS) announced that a Las Vegas woman recently plead guilty to falsely representing to Medicare that she owned a Los Angeles-area durable medical equipment (DME) company that was actually...

Each year the Medicare program makes billions of dollars in estimated improper payments. CMS employs several types of Review Contractors to measure, prevent, identify, and correct these improper payments. Review Contractors find the improper...

The Chicago-based Certification Commission for Health Information Technology (CCHIT), and the Drummond Group Inc. (DGI) of Austin, TX, were recently named as the first official certifiers of EHR technology. Healthcare professionals and their...

Recently the Centers for Medicare & Medicaid Services (CMS) and the Office of the National Coordinator for Health Information Technology (ONC) announced the availability of registration for the Medicare and Medicaid electronic health record (EHR)...