The General Accounting Office (GAO) has issued a report recommending physician profiling, which they define as identifying efficient physicians. The entire report, i.e., GAO-07-307, is available at the following link: http://www.gao.gov/new.items/d07307.pdf
Following are key findings:
GAO estimates that physician account for 20% of the total health care expenditures, but influence 90% of total expenditures through referrals…
The Internal Revenue Service issued a private letter ruling on April 20, 2007 concluding that captive professional corporations were beneficially owned by the hospital, but that the activities of the professional corporations were conducted on a larger scale then was reasonably necessary for the performance of the hospital’s exempt functions and that the professional corporations&rsquo…
The Pennsylvania Patient Safety Authority has issued its 2006 Annual Report. That report is available at the following link:
http://www.psa.state.pa.us/psa/lib/psa/annual_reports/annual_report_2006.pdf
The Highmark and Independence Blue Cross merger documents are available for viewing on the Pennsylvania Insurance Department’s website at the following link:
http://www.ins.state.pa.us/ins/cwp/view.asp?a=1347&Q=547949&PM=1
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…
