CMS Guidance

The Centers for Medicare & Medicaid Services ("CMS") have announced that Latesha Walker will serve as a Provider Relations Coordinator to improve the Recovery Auditor Contractor ("RAC") and Medicare Administrative Contractor ("MAC") programs. While CMS stated that providers are still encouraged to go to their RAC or MAC for specific claims, the provider may go to Ms. Walker for more global processing issues. Ms. Walker may be contacted via email. For RAC concerns, please contact Ms. Walker at RAC@cms.hhs.gov. For MAC concerns, please contact Ms. Walker at MedicareMedicalReview@cms.hhs.gov.

CMS recently issued Transmittal 118 providing independent informal dispute resolution (“IIDR”) to nursing facilities. Transmittal 118 replaces previous Transmittal 113 and gives skilled nursing facilities and nursing facilities facing civil monetary penalties the additional option to seek IIDR in addition to traditional informal dispute resolution. For more information regarding Transmittal 118, please click here.

CMS Final Rule

A new CMS rule will provide flexibility for electronic health record (“EHR”) users. The final rule, published August 29, 2014, gives providers more flexibility to use EHR to meet meaningful use objectives. For more information regarding this new rule click here.

OIG Update

The Office of the Inspector General (“OIG”) recently issued a Special Fraud Alert (the "Alert") addressing payment from laboratories to physician practices. The Alert identifies two specific trends regarding these payments that may be suspect under the Anti-Kickback Statute. One arrangement discussed in the Alert involves the laboratory paying physicians for the collection, processing and packaging of blood specimens. The other arrangement discussed in the Alert involves payment regarding Registries. The Alert outlines several suspect characteristics of Registry payments that can give rise to a violation of the Anti-Kickback Statute. The Alert may be accessed here.

RAC Update

CMS recently announced that it will make partial payment for Part A claims on appeal. In efforts to lessen the backlog of appeal cases pending before Administrative Law Judges (“ALJs”), CMS announced that effective August 29, 2014, it began paying 68 percent of the net payable amount of the denied inpatient claim. Most of the cases involve determinations that the inpatient status was not reasonable or necessary. In exchange for the payment, the hospital must agree to dismiss any associated appeal and agree that the payment will be “final.” Hospitals have until October 31, 2014, to participate. CMS's full announcement, along with instructions on how to participate, may be accessed here.

HIPAA Update

At a recent privacy and security forum in Boston, a senior advisor stated that the Office of Civil Rights ("OCR") is planning a number of audits regarding HIPAA compliance. One thing the advisor said the OCR looks for is a pattern of similar types of breaches which could indicate that the provider is not doing anything about the breaches or does not have proper procedures in place to prevent them. To read the full article regarding this issue, click here.

American Medical Association Guidance

The American Medical Association ("AMA") recently adopted guiding principles for telemedicine. The AMA stated in a press release that the principles, based on a policy report, provide guidance for improving access, quality of care and patient safety. The principles also address coverage and payment issues for telemedicine. To view the AMA press release in its entirety please click here.

Blue Cross Blue Shield of Alabama (“BCBS”) Guidance

BCBS of Alabama has recently announced guidance for providers faced with members wishing to pay for their services out of pocket rather than have their claims submitted to BCBS. Before accepting payment, providers need the member to sign a Notification of Non-filed Claims form. This form may be accessed here.

Alabama Medicaid Update

The Alabama Medicaid Agency issued a Medicaid Alert (the "Alert") clarifying the disbursement of a Medicaid-eligible resident's funds after the resident's death. The Alert states that beginning September 15, 2014, nursing homes must maintain documentation of the disbursement of these funds. Additionally, the Alert provides a new Administrator of Estate Designation Form (the "Form") that allows a resident to select who may receive any remaining funds. The Alert and the Form may be accessed here.