The Internal Revenue Code was amended in April 2015 as part of the Medicare Access and CHIP Reauthorization Act of 2015 to increase allowable IRS levies against federal payments, such as Medicare receivables, from 30% to 100% effective October 16, 2015.
CMS has issued MLM Matters – MLM number MM9285, to explain these changes.
CMS issued a special edition MLN Matters meant to be effective August 1, 2015. The guidance reflects CMS instructions to Medicare Administrative Contractors (MACs) and Qualified Independent Contractors (QICs) regarding the scope of review for redeterminations and reconsiderations of certain claims.
CMS acknowledges its concern that MACs and QICs were using their discretion to conduct…
By now, everyone knows ICD-10 coding starts October 1, 2015.
Starting October 1, 2015, Medicare claims with dates of service after October 1, 2015 will only be accepted if they contain a valid ICD-10 code. The Medicare claims system will be programmed not to accept ICT-9 codes after September 30, 2015.
However, Medicare announced in…
There are two interesting items in telehealth news.
Iowa Supreme Court Rejects Ban on Telemedicine Abortions
An Iowa Board of Medicine rule requires the presence of a physician when abortion inducing drugs are provided. Planned Parenthood sued claiming the requirement of physician presence was unconstitutional on the basis that it discriminated against women, due to…
Medicare Regulations allows CRNA’s to administer anesthesia without physician supervision if the state governor opts out of the regular physician supervision requirement.
Governor Ritter of Colorado opted out in 2010, and his action was challenged by the Colorado Medical Society and the Colorado Society of Anesthesiologists. That challenge was dismissed by Colorado trial courts, which…
The Centers for Medicare and Medicaid Services (CMS) released a proposed rule intended to make ACOs and Medicare Shared Savings Plans more practical and attractive to potential providers. The proposed rule was released on December 1, 2014, along with a CMS Fact Sheet.
Longer Lead Time to Develop
In order to provide more development…
On July 21, 2014, I posted the proposed Medicare Physician Fee Schedule, and described the intent by CMS to eliminate global surgery.
On November 13, 2014, CMS issued the final 2015 Medicare Physician Fee Schedule, and CMS incorporated the changes regarding global surgery.
Global Surgery
There are three primary categories of global surgery…
CMS has announced its concern regarding the level of compliance for documenting the face-to-face elements necessary for home health care certification.
Attached is an educational piece published by Novitas Solutions on its Part B website.
It lists the qualification criteria for home health benefits:
…
Perhaps not coincidentally, immediately following the release of the Questionable Laboratory Payments Special Fraud Alert by the OIG, posted yesterday on the Med Law Blog, the OIG has followed up with Audit Report OIG – 03-11-00730: Questionable Billing for Medicare Part B Clinical Laboratory Services. Below are two quoted paragraphs from the executive…
Practical considerations to protect against being ‘out of network’
The disengagement of Highmark and UPMC is looming on the horizon; most of the hospital participation agreements between these two competing healthcare systems end on December 31, 2014. There are some hospital agreements that continue, such as those at Children’s and Magee, but the focus of…
