On April 21, 2008 the Centers for Medicare and Medicaid Services ("CMS") released a proposed rule regarding the Fiscal Year 2009 Inpatient Rehabilitation Facility Prospective Payment System. The proposed rule discusses changes to the 75% rule and requires a freeze on inpatient rehabilitation facility rates from April 1, 2008 through September 30, 2009. The proposed rule also…

Form 990 Redesign for Tax Year 2008

The IRS currently requires every charitable organization, and every similar tax-exempt organization, with gross receipts of at least $100,000 or assets of at least $250,000 to file an annual return on Form 990. On December 20, 2007, the IRS published major changes to its Form 990. Certain of the changes…

Gainsharing is generally defined as an arrangement between physicians and hospitals to share cost reductions, which can be narrowly targeted projects such as standardization of hospital equipment and supplies or broadly targeted projects such as average cost per case. Gainsharing is an attempt to align financial incentives in an environment where the existing incentives are actually…

Malpractice Plaintiff Obtains Peer Review Records

A United States District Court has decided that malpractice plaintiffs seeking recovery pursuant to the Federal Tort Claims Act are entitled to obtain hospital peer review records, regardless of state immunity laws. In Vezina vs. United States of America, the Plaintiff brought suit for personal injuries, allegedly suffered while…

STARK: "STAND IN SHOES" REGULATIONS

The original proposed physician "Stand in Shoes" regulations provide that any physician would stand in the shoes of any other doctor in the following circumstances:

1.      Another physician who employs the referring physician;

2.      His or her wholly owned professional corporation;

3.      A physician’s medical practice that employs or contracts with…

CMS has proposed new Stark regulations as part of the hospital in-patient perspective payment system rules for Fiscal Year 2009. 

On April 14, 2008, CMS proposed new IPPS rules which contain proposed Stark regulations with respect to alternative solutions for the "stand in the shoes" provisions which were first proposed in the Stark Phase III…

Pittsburgh MSA Included in DMEPOS Medicare Competitive Bidding Program

Medicare will begin implementation of a Competitive Bidding Program for DMEPOS effective July 1, 2008. This program will affect patients in ten competitive bidding areas (CBAs) that align with the ten metropolitan statistical areas (MSAs) selected for the first phase of this program and includes ten product…

Highmark Medicare Local Coverage Determinations (LCDs)

Highmark Medicare Services has published the initial draft set of LCDs as part of its plans to fulfill CMS requirements to consolidate ICEs by July 1, 2008. Highmark’s instructions for submitting comments for the proposed Local Coverage Determinations (LCDs) and the proposed LCDs are included in the attached link. The following…

Georgia Peer Review Decision Exhibits Rare Common Sense

Finally, there seems to be a peer review decision that exhibits common sense. In Madonna v. Satilla Health Services, Inc., and LeFever vs. Satilla Health Services, Inc., the Georgia Court of Appeals handed a peer review decision in a case pitting exclusive contract rights against individual…

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