Michael Cassidy

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CMS has issued interpretive guidelines regarding informed consent relating to the conditions of participation requirements for patient rights, informed consent for surgical services, and the appropriate contents of medical records. The guidelines were released on April 13, 2007 and can be found at the following link:

http://www.cms.hhs.gov/SurveyCertificationGenInfo/downloads/SCLetter07-17.pdf

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…

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