MACs

News & Analysis as of

CMS Announces Provider Relations Coordinator for RAC and MAC Issues

CMS recently announced that it has established a CMS Provider Relations Coordinator, Latesha Walker, to assist providers in resolution of issues with Recovery Auditor Contractors (RACs) and Medicare Administrative Contractors...more

RAC Program Update: CMS Appoints Provider Relations Coordinator

On June 2, 2014, CMS posted a brief update on its Recovery Audit Contractor (RAC) program website announcing the creation of a “Provider Relations Coordinator” position within CMS. The announcement states that the role of...more

Compounded Drugs and Medicare Part B: OIG Report Recommends Payment and Oversight Changes

The Office of the Inspector General (OIG) for HHS recently published a report titled “Compounded Drugs Under Medicare Part B: Payment and Oversight” (OIG Report) in which it recommended that CMS implement changes to the way...more

Fingerprinting Policy Implementation - Risk to Enrollment Status?

In March 2011, when CMS published regulations to implement the Medicare enrollment screening provisions of the Affordable Care Act, the requirement for background fingerprint screening was put on hold. In a recent Special...more

CMS Cancels ICD-10 Testing

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

Complaint Filed Against HHS Alleges Medicare LCDs Deprive Beneficiaries of Necessary Clinical Laboratory Services

On April 18, 2014, California Clinical Laboratory Association (“CCLA”) and “Jane Doe” (collectively, “Plaintiffs”) filed a lawsuit against HHS for equitable relief in the United States District Court for the District of...more

CMS Implements Fingerprinting Background Checks for New DME and Home Health Providers

In a recently released MLN Matters (Number: SE1417), CMS announced that it is implementing the enhanced enrollment screening provisions of the Affordable Care Act (ACA) by requiring finger print based background checks for...more

OIG Reports Limited Compliance with Face-to-Face Certification Requirement for Home Health

The OIG recently released a report summarizing the details of its study regarding compliance with the requirement that physicians (or certain practitioners working with them) who certify beneficiaries as eligible for Medicare...more

Emerging EHR Risks: When Documentation May Not Be Enough (or Too Much)

Today’s Electronic Health Record (EHR) technologies feature many tools that help providers practice more efficiently and allow them to spend more time caring for patients. However, the federal government recently has posted...more

Making “Material Adverse Change” Mean What You Choose It to Mean — Neither More nor Less

A recent decision by the Court of Chancery of Delaware provides a reason to pause before agreeing to standard, boilerplate “material adverse change” clauses in purchase agreements. In Osram Sylvania, Inc. v. Townsend...more

Enforcement of the Two-Midnight Rule Delayed Again

Last week President Obama signed into law a measure to extend Medicare physician pay rates for one year and to extend the enforcement delay of the “Two-Midnight” rule through March 2015. Medicare Recovery Audit Contractors...more

Health Law Insights Newsletter

The Centers for Medicare & Medicaid Services (CMS) has extended the deadline for compliance with the two-midnight rule through September 30, 2014. The rule provides that if an inpatient stay crosses two midnights, the...more

CMS Posts Guidance on Two-Midnight Rule and Related Audits

On February 24, 2014, CMS posted a list of updates to its guidance on the new Two-Midnight Rule and the Probe and Educate Audits. Several of the more major updates are discussed below....more

A Calm Before the Storm: Updates on CMS Audit Activity

In February 2014, CMS made two announcements that affect future Medicare audits. First, CMS instructed RACs to stop issuing post-payment additional documentation requests (ADRs) after February 21 and instructed MACs to stop...more

CMS authorizes contractors to deny ‘related’ claims of physicians who are not undergoing review

The Centers for Medicare and Medicaid Services (CMS) of the Department of Health and Human Services recently issued Transmittal 505 modifying Section 3.2.3 of the Medicare Program Integrity Manual. CMS employs a variety of...more

CMS Requests Re-Review of Two-Midnight Probe & Educate Denials and Releases Additional Guidance

On February 24, 2014, CMS released additional guidance addressing implementation of the revised inpatient hospital admission standards adopted in the 2014 IPPS Final Rule and new instructions to the Medicare Administrative...more

OMHA's Medicare Appellant Forum Offers Few Meaningful Answers for Frustrated Medicare Providers and Suppliers

On February 12, 2014, the Office of Medicare Hearings and Appeals ("OMHA") hosted a Medicare Appellant Forum ("Forum") to address its current backlog of appeals. OMHA is responsible for hearings before Administrative Law...more

CMS Provides MACs, RACs, and ZPICs With Automatic Denial Authority for “Related” Claims

Effective March 6, 2014, Medicare contractors may automatically deny claims that are “related” to other claims that have been denied as a result of pre- or postpayment review. Contractors need not issue Additional...more

CMS Announces Transition Process for RAC Contracts

On February 18, 2014, CMS announced that it is in the procurement process for the next round of Recovery Audit Contractor (RAC) program contracts and that the transition to new contracts will include a pause in RAC audits in...more

Recovery Audits Cease as CMS Introduces New Provider-Friendly Contract Terms

February is the last date Recovery Audit Contractors (RACs) and Medicare Administrative Contractors (MACs) can issue additional documentation requests (ADRs) as the current Recovery Audit Program contracts are coming to a...more

CMS Extends Time for Probe Audits of Inpatient Admissions, and Clarifies Inpatient Order and Certification Requirements

Probe and Educate Audits of Inpatient Admissions Extended - CMS announced on its Inpatient Hospital Review website on Friday that it was extending the probe and education audits of inpatient admissions for an...more

Two-Midnight Rule Delayed

Facing severe opposition, the Centers for Medicare & Medicaid Services (CMS) has delayed the “two-midnight” rule through September 30, 2014. The two-midnight rule is a new regulation included in the 2014 Medicare inpatient...more

"Asia M&A: Understanding the Differences Between English and US Approaches to Negotiated Acquisition Agreements"

As the M&A markets in Asia continue to mature, U.S. and European multinationals involved in such markets are more frequently experiencing the clash in approaches to M&A risk allocation that Asia-based lawyers and financial...more

OIG Releases Study on MAC Performance

On January 8, 2014, OIG released a study of Medicare Administrative Contractors’ (MAC) performance between September 2008 and August 2011. The OIG found that while MACs met the majority of quality assurance standards...more

OIG Recommends that CMS Scrutinize Clinicians with High Cumulative Payments

Focusing on clinicians who receive high cumulative payments under Medicare Part B could be a useful means of identifying possible improper payments, according to a recent report issued by the Office of Inspector General of...more

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