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CMS issues final rule limiting overpayment recoupment

Baker & Hostetler LLP
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USA
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October 1 2009

On September 16, 2009, the Centers for Medicare & Medicaid Services (CMS) issued a final rule implementing section 935 of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA), which provides for payment of interest to a provider whose overpayment is reversed on appeal and limits CMS’s ability to recoup certain overpayments during earlier stages of the appeals process

Privacysweeping expansion of HIPAA requirements to significantly impact business associates

Baker & Hostetler LLP
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USA
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March 5 2009

February 17, 2009, broadens the scope of the Health Insurance Portability and Accountability Act (HIPAA) to impact not only covered entitiesincluding physicians, hospitals and health plansbut also those entities that support the healthcare industry as "business associates," which include third-party administrators, consultants, service providers and attorneys

Part B drugs removed from payment formula under proposed physician fee schedule rule

Baker & Hostetler LLP
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USA
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July 9 2009

The 2008 elimination of the four-month "track record" for initial accreditation surveys has created some questions regarding the best way to approach the initial accreditation process for hospitals

Little recourse in intermediary's refusal to reopen

Baker & Hostetler LLP
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USA
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December 10 2009

On November 24, 2009, the Seventh Circuit issued a decision narrowing its own prior ruling in Edgewater Hospital v. Bowen, 857 F.2d 1123 (7th Cir. 1989), in which it held that an intermediary's decision not to reopen an issue can constitute an appealable determination

Medicare FFS claims - new filing timeframe for submissions

Baker & Hostetler LLP
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USA
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May 27 2010

The Centers for Medicare and Medicaid Services (CMS) recently advised providers that, pursuant to the Patient Protection and Affordable Care Act (PPACA), Medicare fee-for-service (FFS) claims with dates of service on or after January 1, 2010 that are received later than one calendar year beyond the date of service will be denied by Medicare

Certified electronic health records: the meaning of meaningful use

Baker & Hostetler LLP
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USA
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January 21 2010

On the cusp of the new year, CMS and the Office of the National Coordinator for Health Information Technology (ONC) released copies of closely related rules to implement provisions of the HITECH Act which provide for incentive payments for the adoption and meaningful use of certified electronic health record (EHR) technology

CMS publishes inaugural edition of Medicare Quarterly Provider Compliance Newsletter

Baker & Hostetler LLP
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USA
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October 14 2010

CMS released the inaugural edition of a new educational tool, the Medicare Quarterly Provider Compliance Newsletter (Newsletter) on October 5, 2010

RAC medical necessity reviews at hand

Baker & Hostetler LLP
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USA
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August 19 2010

The Centers for Medicare & Medicaid Services (CMS) has approved an initial set of issues for the first medical necessity reviews under the permanent recovery audit contractor (RAC) program

First arrest everybody -- notes on the National Summit on Health Care Fraud

Baker & Hostetler LLP
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USA
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February 4 2010

"In some districts they don’t like to arrest white collar defendants. . . . We arrest everybody."

HIPAA won't shield providers' improper disclosures under more stringent state laws

Baker & Hostetler LLP
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USA
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February 18 2010

The Cleveland Clinic received a subpoena that ordered it to appear as a witness before a grand jury and produce certain books, papers, documents and other objects relating to the medical treatment of a patient

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