As the regulatory compliance landscape becomes increasingly laden with landmines, government agencies have been busy drawing maps for the unprepared.
The newest navigational guideline is the work of the Office of Inspector General for the Department of Health and Human Services (OIG). In November, OIG released its booklet entitled "A Roadmap for New Physicians: Avoiding Medicare and Medicaid Fraud and Abuse." Though the booklet is a basic primer targeted to newly practicing physicians, it is well worth a read for any practitioner. The booklet provides a concise review of key fraud and abuse laws and sheds some light on issues the OIG is prioritizing. Five pages of the booklet are dedicated to physician relationships with other providers, including hospitals. This section specifically offers physicians and other providers a list of questions they should ask when contemplating new integration strategies such as developing an accountable care organization. Although it is anti cipated that the yet-to-be-issued regulations for accountable care organizations may carve out new exceptions to the Stark law for certain arrangements, for now this booklet is a relevant and straightforward resource for physicians and hospitals considering integration.
In October 2010, the Centers for Medicare and Medicare Services (CMS) released the first edition of its new Medicare Quarterly Provider Compliance Newsletter as part of its Medicare Learning Network. These newsletters are intended to cover the key Medicare general errors and billing issues that CMS has identified for the quarter.
The information included in the newsletter not only suggests ways providers can avoid common billing errors, it also provides suggestions for which guidance to look to for each issue. Some of the first report's tips were general reminders, such as the importance of including sufficient documentation within the medical record. More specific topics covered included: (i) direction to guidance on which injectable drugs may be covered as drugs furnished "incident to" a physician's service; (ii) a notification that inpatient care settings are not medically necessary for particular cardiac pacemaker implantations, and a recommendation to use of Condition Code 44 to change the status of a patient from inpatient to outpatient; (iii) how to handle issues of inpatient services provided in the wrong setting; and (iv) which sections of the P rogram Integrity Manual have been recently amended.
Both of these compliance resources provide helpful hints on what issues are gaining scrutiny and offer tips for avoiding penalties from non-compliance, whether due to fraud and abuse claims or billing errors.
To access A Roadmap for New Physicians click here. For more information about the Medicare Quarterly Provider Compliance Newsletter visit the CMS website here or click here to download the first issue of the Quarterly Provider Compliance Newsletter.