Contact Us
Subscribe to this blog via RSS
Join us on LinkedInCategories
- Department of Labor ("DOL")
- Employment Law
- FFCRA
- CARES Act
- Nursing Home Reform Act
- SB 150
- COVID-19
- Families First Coronavirus Response Act
- Family and Medical Leave Act (“FMLA”)
- KBML
- medication assisted therapy
- Acute Care Beds
- Clinical Support
- Coronavirus
- Emergency Medical Services
- Emergency Preparedness
- Department of Health and Human Services
- Legislative Developments
- Corporate
- United States Department of Justice ("DOJ")
- Employee Contracts
- Non-Compete Agreement
- Opioid Epidemic
- Sexual Harassment
- Health Resource and Services Administration
- Litigation
- Medical Malpractice
- House Bill 333
- Senate Bill 79
- locum tenens
- Senate Bill 4
- Physician Prescribing Authority
- HIPAA
- Chronic Pain Management
- Prescription Drugs
- "Two Midnights Rule"
- 340B Program
- EHR Systems
- Hospice
- Kentucky minimum wage
- Minimum wage
- Skilled Nursing Facilities (“SNFs”)
- Uncategorized
- ICD-10
- Primary Care Physicians ("PCPs")
- Drug Screening
- Electronic Health Records (“EHR")
- Urinalysis
- KASPER
- Mental Health Care
- Affordable Insurance Exchanges
- Fraud
- Health Care Fraud
- HIPAA Risk Assessment
- Kentucky’s Department for Medicaid Services
- Office for Civil Rights ("OCR")
- Qui Tam
- Stark Laws
- Compliance
- Department of Health and Human Services (HHS)
- HPSA
- Kentucky Board of Medical Licensure
- Office of Inspector General of the United States Department of Health and Human Services (OIG)
- Pharmacists
- Physician Assistants
- Accountable Care Organizations (“ACO”)
- Anti-Kickback Statute
- Centers for Medicare & Medicaid Services (“CMS”)
- Certificate of Need ("CON")
- Data Breach
- Electronic Protected Health Information (ePHI)
- False Claims Act
- Federally Qualified Health Centers (“FQHCs”)
- Fee for Service
- Health Information Technology for Economic and Clinical Health Act (HITECH Act)
- Health Insurance Portability and Accountability Act of 1996 (HIPAA)
- Part D
- Rural Health Centers (“RHCs”)
- Telehealth
- Affordable Care Act
- Alternative Payment Models
- Charitable Hospitals
- Health Professional Shortage Area ("HPSA")
- Hospitals
- HRSA
- Limited Services Clinics
- Medicaid
- Medical Staff By-Laws
- Medically Underserved Area ("MUA")
- Medicare
- Mid-Level Practitioners
- Patient Protection and Affordable Care Act (“ACA”)
- Rural Health Clinic
- American Telemedicine Association (“ATA”)
- Criminal Division of the Department of Justice (“DOJ”)
- Health Care Fraud Prevention and Enforcement Action Team (“HEAT”)
- Kentucky Board of Nursing
- Qualified Health Care Centers (“FQHC”)
- Telemedicine
- Hydrocodone
- Kentucky Pharmacists Association
- United States ex. Rel. Kane v. Continuum Health Partners
- Webinar
- APRNs
- Chain and Organization System (“PECOS”)
- Jimmo v. Sebelius
- Maintenance Standard
- Agreed Order
- Douglas v. Independent Living Center of Southern California
- Drug Enforcement Agency ("DEA")
- Emergency Rooms
- Enrollment
- Hinchy v. Walgreen Co.
- Overpayments
- Re-validation
- Vitas Innovative Hospice Care
- All-Payer Claims Database ("APCD")
- Chiropractic services
- Clinical Laboratory Improvement Amendments of 1988 (“CLIA”)
- Kentucky Senate Bill 7
- Medicare Part D
- Minors
- Ophthalmological services
- Physician Compare website
- Texting
- 2014 Medicare Physician Fee Schedule (“PFS”)
- 501(c)(3)
- Chronic Care Management
- Compliance Officer
- Compounding
- CPR
- Drug Quality and Security Act (“DQSA”)
- Essential Health Benefits
- House Bill 3204
- ICD-9
- New England Compounding Center ("NECC")
- Outsourcing facility
- Sustainable Growth Rate (“SGR”)
- Appeal
- Cadillac tax
- Centers for Disease Control and Prevention
- Dispenser
- Federation of State Medical Boards (“FSMB”)
- Food and Drug Administratio
- HealthCare.gov
- Individual mandate
- Kentucky Medical Practice Act
- Kindred v. Cherolis
- Kynect
- Long-term care communities
- Mobile medical applications ("apps")
- Model Policy for the Appropriate Use of Social Media and Social Networking in Medical Practice (“Model Policy”)
- National Drug Code ("NDC")
- National Institutes of Health
- Ping v. Beverly Enterprises
- Power of Attorney ("POA")
- Prescriber
- Social Media
- Spousal coverage
- State Health Plan
- UPS
- Affinity Health Plan
- Arbitration
- Community health needs assessment (“CHNA”)
- Condition of Participation ("CoP")
- Denied Claims
- Department of Medicaid Services’ (“DMS”)
- Form 4720
- Grace Period
- Home Health Prospective Payment System
- Home Medical Equipment Providers
- Hospitalists
- Inpatient Care
- Licensure Requirements
- LLC v. Sutter
- Long-Term Care Providers ("LTC")
- Low-utilization payment adjustment ("LUPA")
- Medicare Shared Saving Program (MSSP)
- Network provider agreement
- Nonprofit hospitals
- Nonroutine medical supplies conversion factor (“NRS”)
- Payors
- Personal Service Entities
- Physician Payments
- Qualified Health Plan ("QHP")
- Quality reporting
- Upcoding
- “Superuser”
- "Plan of Correction"
- Audit
- Daycare centers
- Decertification
- Division of Regulated Child Care
- Doe v. Guthrie Clinic
- EHR vendor
- Employer Group Health Plans
- Employer Mandate
- ERISA
- Fair Labor Standards Act (FLSA)
- False Billings
- Health Professional Shortage Areas (“HPSA”)
- Health Reform
- Intermediate Sanctions Agreement
- Kentucky Health Benefit Exchange
- Licensed practical nurses (LPN)
- List of Excluded Individuals and Entities
- Meaningful use incentives
- Medicare Administrative Coordinators
- Medicare Benefit Policy Manual
- Nurse practitioners (NP)
- Office of the National Coordinator for Health Information Technology (“ONC”)
- Part A
- Part B
- Physician Recruitment
- Physician shortages
- Provider Self Disclosure Protocol
- Registered nurses (RN)
- Residency Programs
- Self-Disclosure Protocol
- Statement of Deficiency ("SOD")
- Trade Association Group Coverage
- Advanced Practice Registered Nurses
- Business Associate Agreements
- Business Associates
- Call Coverage
- Group Purchasing Organizations ("GPO")
- House Bill 104
- Kentucky House Bill 217
- Patient Autonomy
- Patient Privacy
- Personal Health Information
- Senate Bill 39
- Senate Finance Committee Report
- State Medicaid Expansion
- Autism/ASD
- Genetic Information Nondiscrimination Act ("GINA")
- Kentucky House Bill 159
- Kentucky Primary Care Centers (“PCCs”)
- Managed Care Organizations (“MCOs”)
- Center for Disease Control
- Compliance Programs
- Critical Access Hospitals (“CAHs”)
- Essential Health Benefits (“EHBs”)
- Healthcare Information and Management Systems Society (HIMSS)
- Medicare Audit Improvement Act of 2012
- Occupational Safety and Health Administration (“OSHA”)
- Recovery Audit Contractors (“RAC”)
- Small Business Health Options Program (“SHOP”)
- Sunshine Act
- Abuse and Waste
- Consumer Operated and Oriented Plan programs (“CO-OPS”)
- Kentucky Cabinet for Health and Family Services
- Kentucky Health Care Co-Op
- Kentucky Health Cooperative (“KYHC”)
- Free Conference Committee Report
- Health Care Fraud and Abuse Control Program
- House Bill 1
- House Bill 4
- Kentucky “Pill Mill Bill”
- Pain Management Facilities
- Employee Agreement
- Health Insurance
- Healthcare Regulation
- Health Care Law
McBrayer Blogs
Showing 2 posts in Recovery Audit Contractors (“RAC”).
CMS Ruling on Part B Rebilling
Posted In Centers for Medicare & Medicaid Services (“CMS”), Health Care Law, Medicare Administrative Coordinators, Medicare Benefit Policy Manual, Part A, Part B, Recovery Audit Contractors (“RAC”)
Increasingly, Administrative Law Judges (“ALJs”) and the Medicare Appeals Council were upholding Part A denials on RAC audit appeals based on determinations that inpatient admissions were not reasonable and necessary, and then ordering payment under Part B as if services were rendered at an outpatient or “observation level” of care. The problem with this practice is that Medicare Benefit Policy Manual (“MBPM”) allows hospitals to bill a Part B inpatient claim for only a limited set of medical and other health services. Additionally, the providing for payment of all reasonable and necessary Part B services under these circumstances are contrary to CMS policy that the services be billed within the usual timely filing restrictions. The Centers for Medicare & Medicaid Services (“CMS”), concerned about this practice, recently released both a Ruling and a Proposed Rule to seemingly help the hospital community. How much relief it will actually provide is yet to be seen. More >
Reforming Medicare Audits
Posted In Health Care Law, Medicaid, Medicare, Medicare Audit Improvement Act of 2012, Recovery Audit Contractors (“RAC”)
On October 16, 2012, the Medicare Audit Improvement Act of 2012[1] was introduced in the U.S. House of Representatives by Representative Sam Graves. The purpose of this legislation is to reform the Medicare auditing program. This legislation aims to improve the accuracy and transparency of Medicare audits of hospitals as well as increase the accountability of Recovery Audit Contractors (“RAC”).[2] More >
