Medicare, Medicaid & Private Payor Updates

A HIPAA Risk Assessment is Essential to Avoid Liability

Medicare, Medicaid & Private Payor Updates /

(August 23, 2014): Almost all health care providers and suppliers qualify as a “covered entity” under the Health Insurance Portability and Accountability Act of 1996 (HIPAA). Together with the “business associates” with whom they work, these entities are responsible for ensuring that any protected health information (PHI) under their control has been properly secured and […]

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OIG Finds Nursing Homes Not Reporting Patient Abuse and Neglect

Medicare, Medicaid & Private Payor Updates /

(August 21, 2014): Nursing facilities are required and expected to report any and all allegations of patient abuse or neglect to ensure patient safety. A recent study of their records by the Department of Health and Human Services’ Office of Inspector General (OIG) has found that a number of these facilities have not been fully

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CMS Extends HHA Enrollment Moratoria

Medicare, Medicaid & Private Payor Updates /

(August 6, 2014): The Centers for Medicare & Medicaid Services (CMS) has extended its year-long HHA enrollment moratoria on the enrollment of new home health agencies and ground ambulance suppliers in several major metropolitan areas. Furthermore, CMS has broadened its temporary enrollment moratoria so that it applies not only to Medicare, but also to enrollment

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Mandatory Compliance Programs for Medicaid & Medicaid Providers?

Medicare, Medicaid & Private Payor Updates /

(July 30, 2014): In recent years, both the type and the frequency of Medicare and Medicaid audits of health provider and supplier claims have greatly increased. Not surprisingly, these administrative enforcement actions have led to a wide variety of adverse collateral effects, ranging from Medical Board investigations to the initiation of private payor audits. Notably,

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OIG Report on the Nationwide Background Check Program

Medicare, Medicaid & Private Payor Updates /

(July 23, 2014): Rightly or wrongly, critics of our nation’s long-term care system have long cited incidents of patient abuse, neglect, and the alleged misappropriation of funds among the identified widespread problems many seniors face when receiving long-term care and treatment services. In an effort to address these problems, legislators were sure to include provisions

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CMS Guidance on the Role of a Medical Director

Medicare, Medicaid & Private Payor Updates /

(July 16, 2014): In 2005, the Centers for Medicare and Medicaid Services (CMS) revised and implemented surveyor guidance pertaining to the role of medical directors in long-term facilities. This guidance gives surveyors and providers more information about the role of a medical director, which is outlined in regulation 42 C.F.R. §483.75 (i). It also helps

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The Changing Definition of Medical Necessity

Medicare, Medicaid & Private Payor Updates /

(July 16, 2014):The term “medical necessity” has varying definitions depending on who is using it. Providers, physicians, courts, private insurers, state governments, and the federal government all have their own interpretation of what constitutes medical necessity. This changing definition of medical necessity can be problematic when a provider’s claims are audited by a Zone Program

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Hospice Providers – New HIS Record Requirements!

Medicare, Medicaid & Private Payor Updates /

(July 7, 2014): As of July 1, 2014, Medicare-certified hospices must directly submit a Hospice Item Set (HIS) (for Admission and Discharge) records for each patient admission that occurs on or after July 1. These HIS records must be completed on an ongoing basis and submitted electronically the Centers for Medicare & Medicaid Services. Any

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Responding to a Texas Medical Board Complaint

Medicare, Medicaid & Private Payor Updates /

(July 7, 2014): The Texas Medical Board (Board) investigates complaints against physicians, physician assistants, acupuncturists and surgical assistants. A Texas Medical Board complaint can be filed by a patient, a patient’s family or a health care provider. On the average, the Board receives and evaluates over 7,000 complaints each year. The kinds of violations the

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The Cloud Storage of Medical Records Presents a Number of Risks

Medicare, Medicaid & Private Payor Updates /

(July 3, 2014): The growing trend of storing all kinds of data in the cloud comes with benefits and risks. However, when it comes to storing medical records in to the cloud, patient privacy becomes a special concern. With a properly implemented cloud storage system, hospitals can share information far more efficiently. Prescriptions and test

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