On November 15, 2010, the Internal Revenue Service, the Department of Labor, and the Department of Health and Human Services jointly issued an amendment to the interim final rules relating to status as a grandfathered plan under the Patient Protection and Affordable Care Act. With the amendment, insured group health plans are now able to
November 2010
House Approves One Month “Patch” to SGR
By Michael Cassidy on
Posted in Medicare & Reimbursement
MGMA has reported that the House has approved the Senate bill delaying the 23% SGR Medicare decrease to the Medicare Physician Fee Schedule for one month. If signed by President Obama, this will apply only to the month of December, and will not address the mandatory SGR cuts for next year which, without further action, will be…
Senate Postpones 23% SGR Medicare Physician Fee Schedule Cut One Month
By Michael Cassidy on
Posted in Medicare & Reimbursement
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Senate Acts to Avert Medicare Physician Fee Cut On November 18, 2010, the Senate approved a bill that would postpone the scheduled 23% Medicare physician payment cut scheduled to take effect on December 1, 2010, for one month. If approved by the House of Representatives and signed into law |
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Actual Adverse Outcomes Irrelevant to HCQIA Investigation
By Michael Cassidy on
Posted in Credentialing and Peer Review
In Pierson v. Orlando Health, the U.S. District Court for the Middle District of Florida granted a motion for summary judgment for the hospital on the basis that the hospital was immune from any liability from damages under the immunity provisions of the Health Care Quality Improvement Act (HCQIA).
Dr. Pierson had argued that…
CMS Introduces New Center for Medicare and Medicaid Innovation
By Michael Cassidy on
Posted in Medicare & Reimbursement
On November 16, 2010, the Centers for Medicare and Medicaid Services (CMS) announced the establishment of the Center for Medicare and Medicaid Innovation (CMI), under the Patent Protection and Affordable Care Act (PPACA). The acting director of the Center is Richard Gilfillan, M.D., the former president and CEO of Geisinger Health Plan and executive vice president…
OIG Approves “Under Arrangements” Sleep Services
By Michael Cassidy on
Posted in Fraud - Stark
In OIG Advisory Opinion No. 10-24, a sleep testing entity with no physician ownership proposes to provide sleep disorder diagnostic testing and related services to a hospital as “under arrangements” contract, in which the hospital would bill for the services as a hospital outpatient service. The Requester would provide the sleep testing equipment, the sleep…
CMS Requests ACO Comments
By Michael Cassidy on
Posted in Medicare & Reimbursement
On November 10, 2010, the Centers for Medicare and Medicaid Services posted a Request For Information Regarding Accountable Care Organizations and the Medicare Shared Savings Program.
CMS is seeking comments on the multiple aspects regarding the formation and operation of an Accountable Care Organization (ACO).
Immunity Provisions Of Medical Staff Bylaws Constitute Contract
By Michael Cassidy on
Posted in Legal News
In Kandel v. The Nebraska Medical Center, Dr. Kandel sought an injunction against the Medical Center for reporting Dr. Kandel to the National Practitioner Data Bank after surrendering his medical staff privileges while being under an investigation. The Nebraska Trial Court granted a Motion for Summary Judgment by the hospital and the Nebraska Appeals…
Stark Imaging Self Disclosure Rules
By Michael Cassidy on
Posted in Fraud - Stark, Legal News
The 2011 Medicare Physician Fee Schedule adds an additional requirement to the in-office ancillary services exception of the Stark Rules. New Section 411.355(b)(7) requires that providers of MRI, CT and PET services must provide a written notice to the patient at the time of the referral, advising that the patient may receive the same services from…
CMS Releases 2011 Medicare Physician Fee Schedule
By Michael Cassidy on
Posted in Medicare & Reimbursement
The 2011 Medicare Physician Fee Schedule proposes to reduce the Medicare SGR converson factor by 6.1 % , in addition to the postponed 2010 SGR reduction of 23 % that will go into effect on Dec. 1, 2010 if that year old issue is not addressed.
Among many other items in the 2023 page document…