In Physician Hospitals of America v. Sebelius, the U.S. District Court for the Eastern District of Texas upheld § 6001 of the Patient Protection and Affordable Care Act of 2010 (PPACA), which prohibits new physician owned hospitals and the expansion of those already existing.
CMS Introduces New Center for Medicare and Medicaid Innovation
By Michael Cassidy on
Posted in Medicare & Reimbursement
On November 16, 2010, the Centers for Medicare and Medicaid Services (CMS) announced the establishment of the Center for Medicare and Medicaid Innovation (CMI), under the Patent Protection and Affordable Care Act (PPACA). The acting director of the Center is Richard Gilfillan, M.D., the former president and CEO of Geisinger Health Plan and executive vice president…
CMS Issues: Stark Voluntary Self-Referral Disclosure Protocol
By Michael Cassidy on
Posted in Fraud - Stark
Section 6409 of the Patient Protection and Affordable Care Act (PPACA) required CMS to develop a Medicare Self-Referral Disclosure Protocol (SRDP) to facilitate the resolution of potential Stark violations. The SRDP was published on September 23, 2010 with two caveats:
1. Despite the fact that potential violations or situations might violate more than just the Stark…
CMS Proposes Nursing Home Voluntary Disclosure Rules
By Michael Cassidy on
Posted in Compliance, Long Term Care
On July 12, 2010 CMS published the proposed rules to implement the 50% Civil Money Penalty (CMP) reductions for nursing homes that self-report compliance violations. The potential for the 50% reductions was enacted by Section 6111 of the Patient Protection and Affordable Care Act (PPACA), and is available under the following conditions:
1. The nursing home…
Maximum Period for Submission of Medicare Claims Reduced to Not More Than 12 Months
By Michael Cassidy on
Posted in Medicare & Reimbursement
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…
Registration of Billing Agents, Clearinghouses and Alternate Payees
By Michael Cassidy on
Posted in Medicare & Reimbursement
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…
Medicare Self-Referral Disclosure Protocol
By Michael Cassidy on
Posted in Medicare & Reimbursement
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…
PPACA STARK In Office Ancillary Service (IOAS) Disclosure Requirement
By Michael Cassidy on
Posted in Fraud - Stark
Section 6003 of the Patient Protection and Affordable Care Act (PPACA), which is the 2010 Healthcare Reform Act, imposes a new disclosure requirement for in office ancillary service referrals of imaging services. Section 6003 requires that referrals of MRI, CT, PET, and other designated health services as specified by the secretary, must be accompanied…
PPACA Reduces Medicare FFS Claim Filing Period to One Year
By Michael Cassidy on
Posted in Medicare & Reimbursement
Medicare Explains Timely Filing Requirements for Medicare Fee-For-Service Claims
On March 23, 2010, President Obama signed into law the Patient Protection and Affordable Care Act (PPACA), which amended the time period for filing Medicare fee-for-service (FFS) claims as one of many provisions aimed at curbing fraud, waste, and abuse in the Medicare program.
…