The Patient Protection and Affordable Care Act (PPACA) Section 6404 establishes a maximum period for submission of Medicare Claims of not more than 12 months. As a result of the PPACA, Medicare has announced that claims with dates of service on or after January 1, 2010, received later than 1 calendar year beyond the date of…

CMS announced that it is sharing more than $15 million in savings with 166 Home Health Agencies (HHAs) based on their performance during the first year of the 2-year Medicare Home Health Pay For Performance (HHP4P) demonstration. The demonstration project began in January, 2008 and ended December, 2009. The results for calendar year 2008 produced $15.4 million…

The United States District in Kosenske v. Carlisle HMA Inc. has concluded that this whistleblower case must go to trial on the factual issue of whether Carlisle Hospital violated the False Claims Act by submitting claims for anesthesia services provided arising from referrals from Blue Mountain Anesthesia Associates (BMAA). Dr. Kosenske, the whistleblower in this…

The law firm of Tucker Arensberg is hosting a complimentary seminar covering the important issues impacting employers regarding the recently passed health care legislation.  The program ‘Health Care Reform: What Every Employer Needs to Know and Do’ will take place on May 5, 2010 at the Doubletree Pittsburgh/Monroeville Convention Center.  Registration and breakfast are from…

Today the Senate passed an amended version of H.R. 4851, the act to extend SGR relief ( Continuing Extension Act of 2010 ) by continuing 2009 rates. Since an earlier but different version has already passed the House, this version must be approved again. The AMA predicts action by the end of the week.

Although…

Section 6503 of the Patient Protection and Affordable Care Act (PPACA) requires that all billing agents, alternate payees, and clearinghouses that submit claims on behalf of health care providers must register with the state and the Secretary in a form specified by the Secretary. This provision will be effective January 1, 2011.

Section 6505 also prohibits…

Section 6409 of the Patient Protection and Affordable Care Act (PPACA) requires the Secretary of Health and Human Services to develop a Medicare self-referral disclosure protocol, which is intended to allow providers to disclose self-referral violations and negotiate reduced civil penalties. The protocol shall be developed no later than six months following the date of enactment…

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