The Centers for Medicare & Medicaid Services (CMS) is pleased to announce that the 2007 Physician Quality Reporting Initiative (PQRI) webpage is now available.
On December 20, 2006 the President signed the Tax Relief and Health Care Act of 2006 (TRHCA). Section 101 under Title I authorizes the establishment of a physician quality reporting system …
The Internal Revenue Service has issued guidance regarding rollovers from Flexible Spending Arrangements (FSAs) and Health Reimbursement Arrangements (RHAs) to Health Savings Accounts (HSAs). The guidance is necessary because Health Savings Accounts are typically not available to individuals who are covered by standard FSAs and HRAs. The Tax Relief and Health Care Act of 2006…
The Centers for Medicare and Medicaid Services (CMS) announced significant changes to the regulatory requirements for operating independent diagnostic testing facilities (IDTFs) on January 26, 2007, which new rules will become affective February 26, 2007. These new requirements affect the:
§ Performance standards for operation.
§ The requirements for both interpreting and supervising physicians.…
For an amusing satire about managed care, check out www.calhealthplan.org, which was created by California consumer activists ( who else?) to highlight perceived managed care abuses. The Nurse Avenger video game is mildly amusing, but the theme song & video, the "Pirates of the Health Care-ibbean" is biting and hysterical, unless you’re a managed…
A California court recently concluded that exhaustion of administrative remedies was not required as a condition precedent to reinstatement of a physician. The summary description of this holding is somewhat misleading, because it is commonly accepted that physicians must exhaust their administrative remedies, i.e., the medical staff peer review hearing process, before pursuing either civil or…
Medicare will cover intracranial percutaneous angioplasty (PTA) with stenting effective February 5, 2007. MLN Matters #MM5432 released on January 5, 2007 explains the changes in Medicare policy regarding reimbursement for PTA. Coverage will be effective as of November 6, 2006 for a PTA and stenting of intracranial arteries for the treatment of cerebral artery stenosis greater than…
Coincidentally, just a few days after the Office of Inspector General announced the $3 million settlement of the credit balance case with the Tennessee cardiology practice, Highmark Medicare Services issued a bulletin reminding providers of their obligation to file the Medicare Credit Balance Detail Report 838. Let me remind you that part of the basis…
A comment by Al Tobias www.medicalaw.net indicates the problem with the new proposed standars for disruptive physicians. There are no standards. This is an open invitation for hospitals to impose new peer review issues on physicians with the support of the Joint Commission.
JOINT COMMISSION PROPOSES STANDARDS FOR DISRUPTIVE PHYSICIANS
The Joint Commission (which has always been the informal name for the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) and which will now be its formal name) has proposed disruptive behavior standards for Joint Commission accreditation, which it intends to apply in early 2007.
The new standard…
Two former employees of East Tennessee Heart Consultants, a forty physician cardiology practice in Tennessee, tipped off federal prosecutors, who then filed a qui tam claim alleging the cardiology practice had a policy of retaining overpayments for services provided unless refunds were specifically requested, and that the practice maintained its billing records to conceal the…
