Mike Cassidy was published in the July 2014 edition of the Allegheny County Medical Society Legal Bulletin regarding Highmark and UPMC Consent Decree. You can read the article, here.
July 2014
CMS Seeking Comments Regarding Expanding Coverage for Secondary Interpretation of Images
By Michael Cassidy on
Posted in Medicare & Reimbursement
In the proposed 2015 Medicare Physician Fee Schedule, CMS is seeking comments regarding expanding coverage for secondary interpretation of diagnostic imaging.
I’m enclosing pages 40370 and 40371 of the proposed Medicare Physician Fee Schedule. The enclosed material sites the Medicare Claims Processing Manual provisions which make is clear that a professional component interpretation service should…
CMS Designates Global Surgery as “Potentially Misvalued Services”
By Michael Cassidy on
Posted in Medicare & Reimbursement
In the recently proposed 2015 Physician Fee Schedule, CMS devoted significant resources to discussing potentially misvalued services, which I believe is code for places where CMS would like to reduce reimbursement. One of the areas is global surgery fees.
CMS has concerns with the 10 and 90 day global surgery fees because these global packages…
CMS Releases Proposed 2015 Physician Fee Schedule and Projects 20.9% SGR Reduction
By Michael Cassidy on
Posted in Medicare & Reimbursement
CMS has issued the Proposed 2015 Physician Fee Schedule and Fact Sheets for specific issues (ASC, ESRD, Home Health, Physician Quality Programs).
SGR Reduction
Although the Protecting Access to Medicare Act Prohibits any SGR reduction for the first 60 days of 2015, i.e., until March 1, 2015, CMS predicts a 20.9% decrease without legislative action.…
OIG Report: Questionable Billing for Medicare Part B Clinical Laboratory Services
By Michael Cassidy on
Posted in Compliance
Perhaps not coincidentally, immediately following the release of the Questionable Laboratory Payments Special Fraud Alert by the OIG, posted yesterday on the Med Law Blog, the OIG has followed up with Audit Report OIG – 03-11-00730: Questionable Billing for Medicare Part B Clinical Laboratory Services. Below are two quoted paragraphs from the executive…
Anti-Kickback Laboratory Enforcement Actions – Special Fraud Alert
By Michael Cassidy on
Posted in Compliance
There has been significantly enhanced scrutiny of financial relationships between referring physicians by both the Office of Inspector General (OIG) and Pennsylvania authorities.
Pennsylvania
Pennsylvania enacted amendments to the Pennsylvania Clinical Laboratory Act on December 18, 2013 (the amendments are referred to as Act 122) and the Department of Health and Bureau of Laboratories just…