Medicare Compliance & Reimbursement
PER-PATIENT FEE STRUCTURES RAISE COMPLIANCE RED FLAGS
If you're about to ink a business deal with another health care provider that involves a "per patient" payment structure, you could be running serious risks under the anti-kickback statute. The HHS Office of Inspector General made that point once again in an advisory opinion released April 10 (No. 03-8). In the opinion, the OIG takes the measure of one company's proposal to develop and manage distinct part rehabilitation units located within acute care hospitals. The company's management fee would be based on a per patient, per day basis. That sounded quick alarm bells with the watchdog agency. "'Per patient,' 'per click,' 'per order,' and similar payment arrangements with parties in a position, directly or indirectly, to refer or recommend an item or service payable by a federal health care program are disfavored under the anti-kickback statute," the OIG warns. The agency notes that the deal may have passed muster under the safe harbor for personal services and management contracts if compensation was set in advance, consistent with fair market value, and not determined in a way that's based on volume.
Medicare Compliance & Reimbursement
- Medicare Drug Benefit:
CONGRESS DESPERATELY SEEKING WAYS TO RETOOL DRUG BILLS
With the White House's 2003 Medicare prescription-drug proposal now in the mix, members of Congress [...] - Medicaid:
NGA MEDICAID PANEL MULLING MORE THAN WHITE HOUSE PLAN
The ten-member governors' task force convened by the National Governors Association hopes to come up [...] - Medicare Reform:
HEALTH PLANS FIGHTING NEGATIVE PERCEPTIONS IN REFORM BATTLE
Health plans hoping to see a larger population of Medicare beneficiaries move into private plans [...] - Dual Eligibles:
COULD STATE CONCERNS BE KEY TO FATE OF MEDICARE Rx?
High on states' wish list for Congress is legislation to shift Medicaid costs for beneficiaries [...] - Litigation:
GALLUP SUES SCULLY OVER ALLEGED BULLYING
The Gallup Organization polling firm has filed suit against Centers for Medicare & Medicaid Services [...] - Hospitals:
HOSPITAL-PHYSICIAN BUSINESS DEALS UNDER SCRUTINY
Heads up hospitals and physicians: The feds are looking ever more closely at medical group-hospital [...] - Reimbursement:
HOSPITALS BEMOAN OUTLIER CHANGES
Hospitals should brace themselves for potential reimbursement shortfalls under the Centers for Medicare & Medicaid [...] - Physicians:
PHYSICIANS CAN EARN CMEs THROUGH QIOs
Physicians have one more incentive to get involved with the Centers for Medicare & Medicaid [...] - Medicare:
OIG SLAMS CODING SEMINAR COMPANY
Have you been duped by coding and billing education companies that tout non-existent formal affiliations [...] - Fraud & Abuse:
YOUR PATIENTS ARE WATCHING YOU
Your Medicare patients are more likely than ever to have been trained on ferreting out [...] - Business Arrangements:
PER-PATIENT FEE STRUCTURES RAISE COMPLIANCE RED FLAGS
If you're about to ink a business deal with another health care provider that involves [...] - Hospitals:
OUTLIER BLUNDERS GO BOTH WAYS
Hospitals face ever-mounting attention on Medicare outlier payments - and are bracing for a new [...] - Overpayments:
EPOGEN, Rx CHARGES STAND OUT IN OUTPATIENT PAYMENT REVIEW
Providers of outpatient services should take note that their claims are under scrutiny by the [...] - Long-Term Care:
SNFs FACE ELIGIBILITY SCRUTINY
Skilled nursing facilities across the country could soon be asked to hand back Medicare dollars [...] - Coverage:
MRA COVERAGE EXPANDS
Health care providers will soon have more opportunities to collect Medicare reimbursement for magnetic resonance [...] - HIPAA:
EXPECT THE EXPECTED IN HIPAA ENFORCEMENT
Curious about what it will be like if you get slapped with allegations that you [...] - OASIS:
HHAs MIGHT HAVE TO PLAY 'DOCTOR, MAY I?' FOR CODING
Everyone knows it's the physician and not the home health agency that officially diagnoses a [...] - Reimbursement:
CMS SHOOTS DOWN PRRB REVERSAL OF PTs' SALARY ADJUSTMENTS
Despite numerous Provider Reimbursement Review Board and federal court decisions decreeing that directly employed physical [...] - Hospitals:
NEW RULES HIT HOME FOR HOSPITAL SURVEYS
With new hospital quality rules in effect for Medicare, surveyors will be taking a different [...] - Coverage:
WINS, LOSSES AND TIES IN MEDICARE PET SCAN POLICIES
Health care providers will soon be able to bill Medicare for positron emission tomography scans [...] - PROGRAM MEMO ROUNDUP
Durable medical equipment suppliers have a host of new "K" codes to get familiar with, [...] - REGISTER WATCH
The Centers for Medicare & Medicaid Services' tardiness in implementing a national fee schedule for [...] - BILL WATCH
The following House bills were introduced:
H.R. 1784. A bill to amend title XVIII of [...] - WHO'S WHO IN MEDICARE
Centers for Medicare & Medicaid Services Deputy Administrator Ruben King-Shaw has left the agency. King-Shaw, [...]
