News & Analysis as of

Required Documentation Centers for Medicare & Medicaid Services

Take-Aways from CMS’ Recent Listening Session Regarding E/M Services: Documentation Guidelines and Burden Reduction

On March 21, 2018, a representative from the Hospital and Ambulatory Policy Group at the CMS, held a listening session regarding proposed updates to documentation guidelines for Evaluation and Management (“E/M”) Services. The...more

CMS issues new documentation rules for medical students

by Dentons on

On February 2, 2018, the Centers for Medicare & Medicaid Services (CMS) revised the documentation requirements associated with medical student entries in the medical record. Previously, when medical students entered notes in...more

CMS Announces Change to Student Documentation Requirement Intended to Reduce Burden on Teaching Physicians

On February 2, 2018, the Centers for Medicare & Medicaid Services (CMS) released Transmittal 3971 (Change Request 10412), which revises a section of the Medicare Claims Processing Manual (Manual), that provides guidance...more

Recent Case Highlights Risks of Paying Physicians for Routine Duties - Signed writing required, informal documentation may not be...

by Stinson Leonard Street on

Payments to physicians, even for routine, necessary duties, may cause referrals to the entity making the payments to be "prohibited referrals" under the Stark Law. This means the hospital or other entity should not have...more

Revocation of Enrollment in the Medicare Program- A Powerful Weapon in Medicare’s Arsenal

by Burr & Forman on

In 2014, CMS issued a final rule related to 42 CFR 424.535, which gave CMS expanded authority to impose penalties on providers. Although the rule is several years old, the first version published in 2006, the rule has been...more

Record-breaking FCA settlements underscore importance of Stark Law compliance

by Thompson Coburn LLP on

In September and October, the Department of Justice (DOJ) announced four record-breaking False Claims Act settlements – ranging from $25 million to $115 million – involving health care systems that allegedly made improper...more

OIG and CMS Issue Rule: Finalizing Fraud and Abuse Waivers for MSSP ACOs

by Foley & Lardner LLP on

The Centers for Medicare and Medicaid Services (CMS) and the Office of Inspector General (OIG) of the Department of Health and Human Services just issued a final rule setting forth waivers of specified fraud and abuse laws...more

Health Update - September 2015

Latest Healthcare False Claims Act Roundup and Top 3 Best Practices to Reduce Exposure - As the legal landscape in healthcare becomes increasingly complex, healthcare companies that receive federal program funds face...more

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

by King & Spalding on

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)

by Davis Wright Tremaine LLP on

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

CMS Provides Clarification Regarding HHA Face-to-Face Documentation

by Baker Donelson on

In January 2014, CMS released a Special Edition Article of MLN Matters to clarify the documentation requirements for Home Health Prospective Payment System (HH PPS) Face-to-Face Encounters. CMS found that insufficient...more

CMS Issues FAQs Regarding Self-Referral Disclosure Protocol

by Baker Donelson on

CMS has released its responses to eight frequently asked questions [PDF] regarding its Self-Referral Disclosure Protocol (SRDP). The questions fall into three categories, listed below, and respond to issues that are often...more

CMS Adopts New “2 Midnights” Presumption For Inpatient Hospital Admissions

by Perkins Coie on

On August 2, 2013, the Centers for Medicare and Medicaid Services (CMS) issued an advance copy of its final rulemaking that adopts a new approach to evaluating the medical necessity of inpatient hospital admissions. ...more

RAC Relief (Sort Of)

by Baker Donelson on

CMS announced that it would reduce the number of additional documentation requests (ADRs) available to its Recovery Audit Contractors (RACs). ...more

CMS Issues Revised Provider and Supplier ADR Limitations

by King & Spalding on

On April 3, 2013, CMS issued revised provider and supplier additional documentation request (ADR) limitations for the Recovery Audit Contractor (RAC) program. The revised provider ADR limitations are effective April 15,...more

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