Does violating requirements amount to fraud under the False Claims Act (FCA) when the requirements allegedly violated are unclear? There is currently a circuit split and petitions for review pending to the Supreme Court as to...more
The Department of Justice (DOJ) recently filed suit against Anthem, Inc. (Anthem) alleging that the Medicare Advantage Organization (MAO) violated the False Claims Act (FCA) when it knowingly failed to delete inaccurate...more
Starting Oct. 1, per diem payments to skilled nursing facilities (SNFs) will be more generous on the first few days of a Medicare beneficiary’s stay, and then drop as the stay continues. That’s one of the changes under the...more
If you think you’re waiting even longer at your doctor’s office these days, you might be right. And it might be due to the overhaul of the medical billing code system that requires providers to enter an alphanumeric...more
CMS recently reminded providers that Medicare claims with a date of service on or after October 1, 2015, “will be rejected if they do not contain a valid ICD-10 code.” As CMS explained, “[t]he Medicare claims processing...more
Congress begins its summer recess this week, but last week legislators were busy holding hearings on management issues regarding HealthCare.gov, introducing legislation to increase payments to primary care doctors under...more
It’s been a while since CMS set a new “final” deadline for implementation of ICD-10—the greatly expanded medical coding system. So last Thursday CMS issued a new final rule setting October 1, 2015, as the final date for...more
According to CMS, the transition from the ICD-9 to the ICD-10 diagnosis coding system is set to occur on October 1, 2105. The ICD-10 transition was originally scheduled for October 1, 2013, but has been delayed a number of...more
The MLN Connects™ Provider eNews contains important news, announcements, and updates for health care professionals. ICD-10 Compliance Date - On April 1, 2014, the Protecting Access to Medicare Act of 2014 (PAMA)...more
The final physician fee schedule (PFS) and hospital outpatient department payment rules for FY 2014 clearly signal the continued intent by the Centers for Medicare and Medicaid Services (CMS) to transform the healthcare...more
On December 2, 2013, the Federal Register published CMS’s Final Rule regarding the prospective payment system (PPS) for End-Stage Renal Disease (ESRD). Most provisions are effective on January 1, 2014, with limited exceptions...more