The CMS Medical Learning Network ("MLN") has posted an Evaluation and Management Services Guide for billing and coding. The Guide is a useful explanation of this complicated area and provides links to the 1995 and 1997 Documentation Guidelines for Evaluation and Management Services, as well as the Medicare Claims Processing Manual and the Current Procedure Terminology …

A California court has held that one hospital cannot take adverse peer review actions against a physician based solely on adverse peer review actions at another hospital; there must be an independent investigation of the medical issues.

In Smith vs. Selma Community Hospital, a copy of the opinion is attached below, the California appellate court…

An Appellate Court in Tennessee recently held that a medical practice can enforce a medical noncompete agreement with a certified orthotist who took a job with a competitor due to the protectable interest that the practice had in the training that they provided to the employee who then acquired a specialized skill.  The Court also …

The Fifth Circuit reversed the dictrict court holding in the Poliner case, and concluding that the hospital had conducted an appropriate investigation and was therefore entltled to HCQIA immunity.

As with most of these cases, the law is fairly clear and the facts are the issue. In Poliner, the physician was asked or coerced into accepting…

In follow up to a previous posting, the Wall Street Journal recently reported that the Medicare Recovery Audit Contractor Program has identified 1.03 billion dollars of improper payments over the past three years, about 992.7 million dollars of which were over-payments by Medicare. While the Recovery Audit Contractor Program is currently underway in six states, Medicare…

CMS is acknowledging the continued interest in Pay for Performance ("P4P") and gainsharing ideas, and is issuing a specific self-referral exception in Anti-Kickback Safe Harbor to permit these programs.  P4P programs are being hereinafter referred to as incentive payments, and gainsharing programs are now being referred to as shared savings programs. 

 

The …

New 2008 Medicare Physician Fee Schedule Payment Rates Effective for Dates of Service July 1, 2008 through December 30, 2008

The Medicare Improvements for Patients and Providers Act of 2008 was enacted on

July 15, 2008.  As a result, the mid-year 2008 Medicare Physician Fee Schedule (MPFS) rate of -10.6 percent has been replaced with …

Congress Overrides Medicare Veto

The House voted 383 to 41 to override the veto, while the Senate voted 70 to 26, in both cases far more than the two-thirds necessary to block the president’s action.

With organized medicine and other lobbies promoting the popular measure in an election year, Republicans broke heavily from the White

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