In a potentially striking blow to the Pennsylvania Medicaid (Medical Assistance)Third Party Liability (“TPL”) collection practices, the Honorable Joy Flowers Conti, Judge for the United States District Court for the Western District of Pennsylvania, issued a Memorandum Opinion dated March 25, 2009 in the Tristani v. Richman et al. proposed class action. PAWD Civil Action
Medicare & Reimbursement
Highmark Issues Local Coverage Determinations (LCDs)
By Michael Cassidy on
Posted in Medicare & Reimbursement
Highmark has issued four new local coverage determinations, as follows:
- Intraoperative Neurophysiological Testing
- Sleep Disorders Testing
- Posterior Tibial Nerve Stimulation (PTN)
- Electromyography (EMG) and Nerve Conduction Studies
The following is the link of the full text of those LCDs: http://www.highmarkmedicareservices.com/policy/draft-status.html
2009 Physician Enrollment Changes for Medicare Eliminates Retroactive Billing
By Michael Cassidy on
Posted in Medicare & Reimbursement
The 2009 Medicare Physician Fee Schedule made some changes regarding physician enrollment. The most significant change is the elimination of retroactive billing. Prior to the 2009 changes, Medicare permitted retroactive billing for up to 27 months following the effective date of a physician’s Medicare enrollment, to allow physicians to bill for services that they provided while the…
Medicare Approves Sleep Testing for Obstructive Sleep Apnea (OSA)
By Michael Cassidy on
Posted in Medicare & Reimbursement
On March 3, 2009, CMS published the "Decision Memo for Sleep Testing for Obstructive Sleep Apnea." A summary of the decision follows:
"CMS finds that the evidence is sufficient to determine that the results of the sleep tests identified below can be used by a beneficiary’s treating physician to diagnose OSA, that the use of such…
Medicare Fraud and Abuse Resource Reference
By Michael Cassidy on
Posted in Medicare & Reimbursement
CMS recently published a resource reference listing the internet resources available for fraud and abuse research and reference. Below is a link to the Medicare Learning Network publication and direct links to the fraud and abuse web resources cited therein.
Medicare Learning Network
http://www.cms.hhs.gov/MLNProducts/downloads/Fraud_and_Abuse.pdf
OIG Listserv
http://www.oig.hhs.gov/mailinglist.asp
CMS Website
CMS Websites for Medicare Fee-for-Service Providers
By Michael Cassidy on
Posted in Medicare & Reimbursement
CMS has aggregated the various web pages pertaining to Medicare fee-for-service providers. The link to that website is included below and is also included separately in the links section on the title page of the Blog.
http://www.cms.hhs.gov/MLNProducts/Downloads/FFS_Provider_Web_Pages.pdf
Medicare January 2009 Update for Ambulatory Surgical Center (ASC) Payment System
By Michael Cassidy on
Posted in Medicare & Reimbursement
Medicare has announced the January 2009 ASC payment updates. It covers new surgical procedures, new and updated codes for drugs and biologicals, and additional services. The link is attached.
http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM6323.pdf
HIGHMARK WINS MEDICARE ADMINISTRATIVE CONTRACTORS STATUS FOR JURISDICTIONS 12 AND 15
By Michael Cassidy on
Posted in Medicare & Reimbursement
As required by Section 911 of the Medicare Prescription Drug, Improvement and Modernization Act of 2003 (MMA), CMS is replacing its current claims payment contractors, previously known as Fiscal Intermediaries or Carriers, with new contract entities called Medicare Administrative Contractors (MACs).
The responsibility for paying Medicare Part A and Part B claims is divided into …
CMS SURETY BOND REQUIREMENTS FOR DMEPOS
By Michael Cassidy on
Posted in Medicare & Reimbursement
Thanks to Claire Miley of Bass, Berry & Sims in Nashville, Tennessee for posting an alert regarding the final DMEPOS Surety Bond requirements. Below is the text of the American Health Lawyers Association e-mail alert.
CMS Issues Final Rule Requiring Surety Bonds for DMEPOS
On December 29, 2008, the Centers for Medicare & …
HEALTHCARE REFORM: ISSUES AND COSTS
By Michael Cassidy on
Posted in Medicare & Reimbursement
The Congressional Budget Office has prepared two remarkably thorough analyses regarding the fundamental issues confronting healthcare policy and the projected costs of more than 100 different reform proposals. Great summer vacation reading — if you start now, you might finish by summer vacation. Check the links below: