Contact Us
Subscribe to this blog via RSS
Join us on LinkedInCategories
- Data Privacy
- Department of Health and Human Services' Office of Civil Rights
- Medical Malpractice
- Medical Cannabis
- Workplace health
- Workplace Violence
- Assisted Living Facilities
- EMTALA
- FDA
- Reproductive Rights
- Roe v. Wade
- SCOTUS
- COVID-19
- Prescription Drugs
- Telemedicine
- Medical Spas
- Code Enforcement
- Corporate
- United States Department of Justice ("DOJ")
- Employee Contracts
- Non-Compete Agreement
- Compliance
- HIPAA
- Kentucky Board of Nursing
- Managed Care Organizations (“MCOs”)
- Primary Care Physicians ("PCPs")
- Accountable Care Organizations (“ACO”)
- Anti-Kickback Statute
- Data Breach
- Electronic Protected Health Information (ePHI)
- False Claims Act
- Health Information Technology for Economic and Clinical Health Act (HITECH Act)
- Health Insurance Portability and Accountability Act of 1996 (HIPAA)
- HPSA
- KASPER
- Kentucky Board of Medical Licensure
- Kentucky’s Department for Medicaid Services
- Medicaid
- Mental Health Care
- Office for Civil Rights ("OCR")
- Office of Inspector General of the United States Department of Health and Human Services (OIG)
- Patient Protection and Affordable Care Act (“ACA”)
- Pharmacists
- Physician Assistants
- Qui Tam
- Stark Laws
- Affordable Care Act
- APRNs
- Centers for Medicare & Medicaid Services (“CMS”)
- Charitable Hospitals
- Federally Qualified Health Centers (“FQHCs”)
- Health Professional Shortage Area ("HPSA")
- Hospitals
- HRSA
- Medicare
- Mid-Level Practitioners
- Rural Health Centers (“RHCs”)
- Rural Health Clinic
- Telehealth
- Business Associate Agreements
- Compliance Programs
- ERISA
- Fraud
- Hospice
- Overpayments
- Part D
- Appeal
- Electronic Health Records (“EHR")
- Advanced Practice Registered Nurses
- Business Associates
- Denied Claims
- Division of Regulated Child Care
- Employee Agreement
- Fair Labor Standards Act (FLSA)
- Licensed practical nurses (LPN)
- Licensure Requirements
- Nurse practitioners (NP)
- Part A
- Part B
- Patient Autonomy
- Personal Health Information
- Personal Service Entities
- Physician Payments
- Qualified Health Plan ("QHP")
- Registered nurses (RN)
- Abuse and Waste
- Occupational Safety and Health Administration (“OSHA”)
- Department of Health and Human Services (HHS)
- Health Insurance
- Healthcare Regulation
- Health Care Law
McBrayer Blogs
Showing 3 posts tagged Centers for Medicare & Medicaid Services.
Malnutrition Diagnosis Codes: The Compliance Danger You’re Not Taking Seriously Enough
It may seem like hair-splitting, but including the wrong diagnostic codes for malnutrition on hospital inpatient claims – using codes for severe malnutrition in place of other forms of malnutrition – is a costly mistake. The estimated overpayment as a result of these coding errors is a reported $1 billion. Because the payment error rate was so high at a colossal 31%, Medicare-Severity Diagnosis Related Group ("MS-DRG") applicable entities must take note and prepare for a marked increase in Department of Health and Human Services Office of Inspector General ("OIG") audits for these coding practices. The Centers for Medicare & Medicaid Services ("CMS") also plans to implement review practices for malnutrition coding on a sample of inpatient claims. The increased payer audits will result in severe financial damage for hospitals and other MS-DRG applicable entities if they do not mitigate coding and documentation risks. More >
A New Opportunity: Centers for Medicare and Medicaid Services Recognizes the Full Potential of Ambulance Crews and Services
In mid-February 2019, the Centers for Medicare and Medicaid Services (“CMS”), Innovation Center and the Department for Health and Human Services (“HHS”) announced a ground-breaking payment and medical services initiative for ambulance providers called “Emergency Triage, Treat and Transport” (the “ET3”). This new model is the first step in allowing providers of Emergency Medical Services to finally “take off the gloves” to fully utilize both their medical skills and unique patient knowledge to implement a more efficient and effective care model. More >
"Incident to" Billing - Easy to Get Wrong
Billing for medical services is never easy. Despite attempts by the Centers for Medicare & Medicaid Services (“CMS”) to simplify the rule regarding “incident to” billing for Medicare services, it remains misunderstood by a large swath of providers. This proves problematic, as incorrect billing practices may lead to overpayments and False Claims Act violations. Billing for “incident to” services is an important mechanism to reflect the actual value of mid-level services provided under the specific plan of a physician. When properly followed, the “incident to” rules allow physicians to bill for services provided by non-physician practitioners as if they were performed by the physician at physician reimbursement rates. Additionally, the non-physician provider can be an employee, an independent contractor or even a leased employee, provided that they are supervised by a physician and the requirements are met. Because of the confusing nature of allowing a physician to bill for services he or she did not directly provide to the patient, serious landmines exist that can create problems if the rules are not scrupulously followed and documented. More >
