Search Publications:
Payment Matters
March 10, 2011
CMS Proposes Rule for Medicaid Nonpayment in the Event of Health Care Acquired Conditions
By: Mark A. Stanley
CMS has released a proposed rule [PDF], which would implement the Affordable Care Act’s requirement that state Medicaid plans must disallow payment for care and services related to health care acquired conditions (HCACs) and other provider-preventable conditions (OPPCs). The proposed rule would require states to adopt Medicare’s existing payment prohibitions for hospital acquired conditions, and would extend those prohibitions to conditions acquired by Medicaid beneficiaries in non-hospital settings. Under the proposed rule, states would be required to establish a provider self-reporting mechanism for HCACs and OPPCs.
Click to continue...HHS Office of Civil Rights Levies First Civil Money Penalty for Violations of the HIPAA Privacy Rule - $4.3 Million
By: James B. Wieland and Joshua J. Freemire
Cignet Health Center (Cignet), a provider of physician, imaging, and laboratory services, was recently ordered to pay $4.3 million as a Civil Money Penalty (CMP) for its failure to comply with the HIPAA privacy rule and its failure to cooperate with the HHS Office of Civil Rights (OCR) in the OCR’s investigation of the underlying HIPAA complaint. This is the first CMP levied by the OCR for a failure to comply with Privacy Rule requirements and reflects an increased focus by OCR on Privacy Rule compliance, an assumption supported by the language of the OCR’s Press Release. Providers can take some solace, however, in the facts that led to the OCR’s imposition of the substantial CMP – Cignet’s seemingly inexplicable failure to cooperate with (or even respond to) the OCR’s repeated requests for information, cooperation, or explanations led to the imposition of such a substantial CMP. So far as can be determined from the public record, Cignet has not told its side of the story.
Click to continue...CMS Issues Its Second Billing Compliance Newsletter for Fee for Service Providers and Suppliers
In an earlier issue of Payment Matters we advised readers that the Centers for Medicare and Medicaid Services (CMS) had commenced publishing a quarterly newsletter identifying billing issues based on problems identified in reviews conducted by Medicare Claims Processing Contractors, Recovery Audit Contractors, Program Safeguard Contractors, Zone Program Integrity Contractors, and other governmental organizations, such as the Office of Inspector General (OIG). The newsletter is intended for fee for service providers and suppliers, such as hospitals, physicians, skilled nursing facilities, labs, ambulance companies, and durable medical equipment, prosthetics, orthotics, and supplies suppliers. CMS recently issued its second compliance newsletter [PDF], which addresses seven billing issues that are discussed below.
Click to continue...Two More Courts Invalidate CMS’s Regulations for Calculating Hospice Cap
Two United States district courts recently struck down CMS’s regulations for calculating hospice caps, joining nearly a dozen other federal courts that found the regulations to be contrary to the Medicare statute. Autumn Light Hospice v. Sebelius [PDF], No. CIV-09-178-M (W.D. Okla. Jan. 12, 2011), Harris Hospice, Inc. v Sebelius [PDF], Nos. 4:10cv252, 4:10cv275 (E.D. Tex. Jan. 6, 2011).
Click to continue...
