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Physician Signature on Lab Requisition Requirement Finalized
CMS released the final rule for the 2011 Medicare Physician Fee Schedule November 2, 2010. A new policy will significantly impact order requirements for services paid under the Clinical Laboratory Fee Schedule (“CLFS”). Currently, physician signature is not required on orders/requisitions for clinical diagnostic tests paid on the basis of the CLFS; rather the physician documentation may be evident solely in the patient’s medical record. The 2011 final rule reverses this policy. Effective January 1, 2011, physician signature will be required on requisitions for all clinical diagnostic laboratory tests paid on the basis of CLFS. It should be noted that orders generated and transmitted electronically from the physician to the laboratory do not appear to be impacted at this time. >Read more>
Place of Service Coding for Physician Medicare Part B Services
On July 28, 2010, the Office of Inspector General issued audit results for place of service coding for physician services processed by Medicare Part B carrieres during calendar year 2007. Based upon the sample results, the OIG estimates that Medicare contractors overpaid physicians $13.8 million for incorrectly coded services during calendar year 2007. Medicare pays physicians a higher rate for services performed in non-facility locations, such as physicians' offices, to account for the increased overhead expenses incurred by physicians. A lower rate is paid for services performed by physicians in facilty settings, such as hospital outpatient departments or ambulatory surgical centers. In 90 of the 100 services in teh sample, the billing physicians used non-facility place of service codes on tehir claim forms when such services were actually performed in hospital outpatient departments or ambulatory surgical centers.
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OIG Cites Overpayments to Inpatient Rehabilitation Facilities
Fiscal intermediaries overpaid inpatient rehabilitation facilities more than $34 million during fiscal years 2004 and 2007, estimates the U.S. Office of Inspector General (OIG) in a recent report. The overpayments pertained to transfers that were improperly coded as discharges. The rehabilitation facilities generally attributed the miscoded claims to clerical errors and a lack of knowledge of where beneficiaries went after leaving their facilities.
Under Medicare’s transfer regulation, Medicare pays the full prospective payment to inpatient rehabilitation facilities that discharge beneficiaries to their homes. In contrast, Medicare pays a lesser amount for a transfer case, based on a per diem rate and the number of days that the beneficiary stayed in the rehabilitation facility.
According to the OIG final report, the Centers for Medicare & Medicaid Services plans to identify and recover overpayments to inpatient rehabilitation facilities. >read more>
Medicare to Eliminate Reimbursement of Consultation Codes in 2010
Effective January 1, 2010, CMS will eliminate reimbursement for all consultation CPT/HCPCS codes. This will include inpatient hospital consultation codes (99251-99255) and office/outpatient consultation codes (99241-99245). Billing providers are to report initial hospital care (99221-99223), initial nursing facility care (99304-99306), initial office/outpatient visits (99201-99205) or established patient office/outpatient visits as appropriate based on the place of service and patient type/situation. (Telehealth consultation G-codes (G0406-G0408) will remain).
>read more>
Medicare Advantage Health Plans Face Increased Scrutiny
As of Jan. 12, 2009, CMS forced suspension of WellPoint, Inc. Medicare Advantage (MA)plans and Part D marketing and enrollment until problems with member's access to prescription drugs and other identified issues are resolved. This suspension is the first of many to hit MA insurance plans. MA Plans must increase their compliance activities and awareness.
>read more>
CMS Approves RAC Audit Process Implementation- Providers Must Get Ready
Although there had been a temporary delay due to the protest of the award of the Recovery Audit Contractor (RAC) contracts, the protests were settled on February 4, 2009. The settlement means that the delay has been stopped and CMS will continue with the implementation of the RAC program. Get ready today!
>read more>
HIPAA Security Enforcement Becoming Much More of a Reality
It is difficult to remember a time without HIPAA Rules, yet, only a few years have passed since implementation of the HIPAA Security Rule. Not surprising are the number of health industry reports indicating many covered entities are not yet, years later, compliant with all of the specifications of the Security Rule. Get ready to respond to greater HIPAA scrutiny.
>read more>
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Sharon Blackwood discusses the benefits of a proactive approach to compliance in Compliance Today. View article.
Jeff Sinaiko discusses the Returning Physician Integration Trend in BNA's Health Insurance Report. View article.
Derek Woo discusses Health Care IT in Managed Care Outlook. View article.
Curtis Bernstein discusses ASC Transactions and Valuation issues in this month's Becker's ASC Review. View article.
Kelly C. Loya, CPht, CPC-I, CHC is Pharmacy Technician Certification Board's July Spotlight of the Month.
Melissa Scott, CHC, CPC discusses CMS' delayed enforcement of the laboratory recquisition signature requirement.
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Sinaiko Healthcare Consulting, Inc. is pleased to announce the hiring of Curtis Bernstein.
Mr. Bernstein joins the firm as a Director.
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Davina Lane and Derek Woo are quoted in the May 2010 issue of Managed Healthcare Executive.
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Michael Sullivan discusses the benefits of electronic health records and interoperable systems.
Playing Catch-up in Health Care Technology
By Michael Sullivan
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Sinaiko Healthcare Consulting is pleased to announce the published work of Dinh Nguyen and Jeffrey Sinaiko in The Health Care Compliance Professional's Manual.
Delivery of Behavioral and Mental Health Services in the US: Funding, Legal and Regulatory Challenges.
By Dinh Nguyen, Kathy Drummy & Jeffrey Sinaiko
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Sinaiko Healthcare Consulting, Inc. partners with Compliance 360 to provide comprehensive compliance, risk managment and claims audit solutions for the healthcare industry.
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Sinaiko Healthcare Consulting, Inc. advises Rockwood Clinic in transaction with subsidiary of Community Health Systems
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Sinaiko Healthcare Consulting, Inc. is pleased to announce the hiring of Kelly Nueske. Ms. Nueske joins the firm as Director of Risk Management Services.
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Sinaiko Healthcare Consulting, Inc. was named to Nightingale's Healthcare News' 2009 list of Full Service Healthcare Consulting Firms.
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Jeff Sinaiko interviewed on AMA's American Medical News on XM Radio.
June 15, 2009.
www.ama-assn.org/amednews/site/radio.htm
Sinaiko Healthcare Consulting is pleased to announce the published work of Jeff Sinaiko and Greg Endicott in this year's 2009 Health Law and Compliance Update.
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Please view Chapter 4: Fair Market Valuations in Health Care: A Better Understanding Breeds Better Compliance.
By Jeff Sinaiko & Greg Endicott. |
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