HHS Launches New Web site on HIPAA Privacy Compliance and Enforcement
To coincide with the fourth anniversary of the enforcement of the HIPAA Privacy Rule, the Department of Health and Human Services (HHS) announced today the launch of an enhanced Web site that will make it easier for consumers, health care providers and others to…
TEN TOP PHYSICIAN BILLING ERRORS
Highmark Medicare Services recently presented a teleconference on the ten top reasons for rejections and most common billing errors. The list is as follows:
1. No performing PIN
2. No verification HIC/entitlement
3. Invalid procedure code
4. Incomplete physical exam information for chiropractic services
5. Missing or incomplete modifiers
6. Missing…
My last MedLaw Blog post described four rules for making the peer review process fair. Here are four rules physicians should follow to protect themselves regardless of the peer review process.
1. Recognize peer review when it is happening to you. There is no doubt that peer review is occurring when you get a letter proposing…
Sham peer review is created and perpetuated by secrecy. Charles Mackay wrote in “Eternal Justice”:
“But the sunshine aye shall light the sky,
As round and round we run;
And the truth shall ever come uppermost,
And justice shall be done.”
Physicians do not need voluminous due process protections in medical staff bylaws in order to…
The first criminal HIPAA verdict was entered in January of 2007, and HIPAA privacy rule enforcement statistics were reported at the 14th National HIPPA Summit.
In U.S. v. Ferrer, in the Cleveland Clinic case, a Florida jury found the Defendant, Mr. Fernando Ferrer, Jr. guilty of one count of wrongful disclosure of individually…
The United States District Court for the District of Iowa held that Mercy Medical Center-Sioux City was not immune from liability under the Federal Health Care Quality Improvement Act. The Court entered summary judgment to the estate of Dr. Horst G. Blume on the basis of Mercy’s breach of contract and awarded damages to Dr. Blume…
Highmark Blue Shield has expanded its list of procedures requiring pre-authorization. The full list of procedures is available on the Highmark Resource Center website:
https://www.highmarkblueshield.com/pdf_file/rc-hbs-auth-code-update-april-2007.pdf
It includes a significant number of home health and DME services, prosthetic devices and other services.
Highmark has also removed two procedures from the list, i.e., pharmacologic management (90862) and the…
There has been an explosion in the Qui Tam litigation in the healthcare industry, as well as other industries dependent upon government payment. Qui Tam litigation allows private parties, frequently disgruntled employees (and more frequently disgruntled ex-employees) or competitors to file suit to recover damages on behalf of the government. The complaints are filed under seal and…
2007 Physician Quality Reporting Initiative (PQRI)
National Provider Conference Call with Question & Answer Session
The Centers for Medicare & Medicaid Services’ (CMS) Provider Communications Group will host the first in a series of national provider conference calls on the 2007 Physician Quality Reporting Initiative (PQRI). This toll-free call will take place from 3:00 p.m. …
RESTRICTIVE COVENANT UNENFORCEABLE
BY SURVIVING SPOUSE
The Virginia Supreme Court ruled that a medical practice corporation, ownership of which had transferred from the deceased sole physician shareholder to his spouse and which was converted to a business corporation by state law, could not enforce a restrictive covenant because it could not practice medicine and had…
