Medicare Compliance & Reimbursement

If you’ve been waiting for the government to hear your Administrative Law Judge (ALJ) appeal, you’re not alone — but you might be waiting a lot longer than you originally expected before you get an answer to your case.

ALJ hearings are so behind that the government announced it wouldn’t process those appeals for the next two years, if not longer, angering practices that are at their fourth level of Medicare appeals and are waiting for answers.

Because of these delays, the American Hospital Association (AHA) filed a complaint in the U.S. District Court of Washington, DC to try and urge the Department of Health and Human Services (HHS) to rectify these backlogs.

“Lengthy, systemic delays in the Medicare appeals process, which far exceed statutory timeframes, are causing severe harm to providers of Medicare services,” the AHA says in the lawsuit, which was filed in May. “HHS’s unlawful delays are contrary to a clear statutory mandate requiring timely adjudication and must be eliminated.”

There’s no word on whether HHS will reopen its ALJ hearings process to speed these claims through the channel, but keep an eye on these pages for more on whether HHS responds.

Medical Records Sitting in the Driveway? That’ll Cost You $800,000

When a Midwestern physician retired in 2008, the last thing she expected to find on her doorstep were thousands of patient records just sitting on her residential property — but that finding prompted an $800,000 judgment against the entity that dumped them there.

The physician hired Parkview Health System, Inc. to transition her patients to new providers when she retired in 2008, according to a June 23 news release on the topic. But instead of filing the physician’s records in a safe, HIPAA-compliant location, Parkview took the 5,000 to 8,000 records and left them in cardboard boxes in the physician’s driveway, even though Parkview knew she wasn’t home. The 71 boxes were in clear view of a public road and were close to a heavily-traveled public shopping area, the HHS news release noted.

In addition to having to pay $800,000 in resolution, Parkview must revise its policies and procedures, train staff members and give the Office of Civil Rights (OCR) an implementation report.

“All too often we receive complaints of records being discarded or transferred in a manner that puts patient information at risk,” said Christina Heide, acting deputy director of health information privacy at OCR, in the release. “It is imperative that HIPAA covered entities and their business associates protect patient information during its transfer and disposal.”

To read the complete report, visit www.hhs.gov/news/press/2014pres/06/20140623a.html.