Date archive: April 2013

The Why, How and Benefits of Compliance Programs for the Small Physician Practice

Let’s Look at the WHY’s First? The Patient Protection and Affordable Care Act (PPACA) requires providers or suppliers of medical or other items or services—as a condition of enrollment in Medicare, Medicaid, or the Children’s Health Insurance Program (CHIP)—to establish a compliance program that contains certain core elements. PPACA requires the Secretary of the Department…

Physician Payments Sunshine Act Upheld – Are you ready?

The decision by the U.S. Supreme Court to uphold the Patient Protection and Affordable Care Act (PPACA) leaves in place the Physician Payment Sunshine Act (Sunshine Act), which will require pharmaceutical and medical device companies to disclose payments to physicians. These disclosures will eventually be posted on publicly available web sites. After the Centers for…

A Few Seconds is All it Takes to Save Your Practice from Being Penalized for Hiring or Contracting with Medicare Excluded Individuals?

The Social Security Act gives the Office of the Inspector General, OIG, of the U.S. Department of Health and Human Services the authority to exclude individuals and entities from all federally funded health care programs and maintains a list of all currently excluded individuals and entities on its List of Excluded Individuals and Entities (LEIE)….

HHS and DOJ Combine Forces with Private Groups for Increased Fraud Enforcement

On July 26, 2012, the U.S. Department of Health and Human Services (HHS) and the U.S. Department of Justice (DOJ) announced a wide scale group effort among the federal and state governments, private health insurers, and other health care anti-fraud groups to join together to prevent health care fraud.  This is a logical next step…

Are you Behind the Curve on EHR?

According to a newly released 2011 survey the U.S. Centers for Disease Control and Prevention (CDC), fifty-five percent of office-based physicians have adopted electronic health records (EHR) systems.  CDC surveyed over 3,000 physicians across specialty and practice size and found that: Stand-alone systems offer faster response times than web-based systems, have a higher initial cost,…

Keep a Vigilant Lookout for Your Medicare Enrollment Revalidation Notice

Under the Patient Protection and Affordable Care Act (PPACA), providers who have been enrolled in Medicare since before March 25, 2011, will be required to submit complete enrollment revalidation information within 60 days of request from Centers for Medicare and Medicaid Services (CMS). Failure to respond to the request will place providers at risk of…

Delay in Medicare Payment and Extension of Physician Participation Enrollment Period

On January 3, 2012 the Centers for Medicare and Medicaid Services (CMS) released an announcement regarding implementation of the American Taxpayer Relief Act of 2012. The law prevents the scheduled 26.5% sustainable growth rate (SGR) formula cut for 2013 Medicare Physician Fee Schedule (MPFS).  CMS also clarified the 2013 conversion factor will be $34.0230.  As…

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