January 2007

Medicare will cover intracranial percutaneous angioplasty (PTA) with stenting effective February 5, 2007. MLN Matters #MM5432 released on January 5, 2007 explains the changes in Medicare policy regarding reimbursement for PTA. Coverage will be effective as of November 6, 2006 for a PTA and stenting of intracranial arteries for the treatment of cerebral artery stenosis greater than…

 

Coincidentally, just a few days after the Office of Inspector General announced the $3 million settlement of the credit balance case with the Tennessee cardiology practice, Highmark Medicare Services issued a bulletin reminding providers of their obligation to file the Medicare Credit Balance Detail Report 838. Let me remind you that part of the basis…

JOINT COMMISSION PROPOSES STANDARDS FOR DISRUPTIVE PHYSICIANS

The Joint Commission (which has always been the informal name for the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) and which will now be its formal name) has proposed disruptive behavior standards for Joint Commission accreditation, which it intends to apply in early 2007.

The new standard…

Two former employees of East Tennessee Heart Consultants, a forty physician cardiology practice in Tennessee, tipped off federal prosecutors, who then filed a qui tam claim alleging the cardiology practice had a policy of retaining overpayments for services provided unless refunds were specifically requested, and that the practice maintained its billing records to conceal the…

Highmark Blue Cross Blue Shield plans to follow the Medicare reductions for the technical component of multiple diagnostic imaging services beginning in the spring of 2007. Following is a quote from the announcement in the December 2006 PRN:

“Highmark Blue Cross Blue Shield plans to reduce payment for certain diagnostic imaging services when more than one…

It seems that electronic health records (EHRs) are constantly being touted as the next best way to improve both healthcare quality and medical practice profitability, but adoption of EHRs by physician practices continues to languish. The range for provider adoptions in small and solo practitioners’ offices, as determined by the Robert Wood Johnson Foundation, is somewhere…

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Tucker Arensberg’s Healthcare Practice Group includes some of the most experienced health law attorneys in the region. We handle the legal problems so our clients can handle the important work of caring for patients. We work with physicians, physical therapists, dentists, optometrists, and all other professional care givers to help them avoid the many legal traps of running a practice. Tucker Arensberg lawyers have experience in all major health law issues.