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CMS' fraud crackdown relies on high-tech analytics Print E-mail
Written by The Health Law Offices of Anthony C. Vitale   
Thursday, 23 July 2015 12:26

The government's crackdown on Medicare fraud is paying off and healthcare providers that bill the government program would be well advised to know that the Centers for Medicare & Medicaid Services is using a high-tech analytics system to identify inappropriate payments.

Aptly named the "Fraud Prevention System," the program has identified or prevented $820 million in inappropriate payments in its first three years. In 2014 alone the Fraud Prevention System identified or prevented $454 million in fraudulent billing, according to CMS.

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The CMS ICD-10 Announcement: What It Means to Your Practice Print E-mail
Written by Mary Pat Whaley | Manage My Practice   
Friday, 10 July 2015 15:03

First, the game-changing announcement below means that a sigh of relief is in order. Some of the anxiety surrounding potential financial disaster should be abated. CMS announced:

"Medicare review contractors [MACs and RACs] will not deny physician or other practitioner claims billed under the Part B physician fee schedule through either automated medical review or complex medical record review based solely on the specificity of the ICD-10 diagnosis code as long as the physician/practitioner used a valid code from the right family."

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Medicare Slow to Adopt Telemedicine Print E-mail
Written by Phil Galewitz | KHN   
Friday, 26 June 2015 17:10
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Donna Miles didn't feel like getting dressed and driving to her physician's office or to a retailer's health clinic near her Cincinnati home.
For several days, she had thought she had thrush, a mouth infection that made her tongue sore and discolored with raised white spots. When Miles, 68, awoke on a wintry February morning and the pain had not subsided, she decided to see a doctor. So she turned on her computer and logged on, a service offered by her Medicare Advantage plan, Anthem BlueCross BlueShield of Ohio. She spoke to a physician, who used her computer's camera to peer into her mouth and who then sent a prescription to her pharmacy.

"This was so easy," Miles said.

For Medicare patients, it's also incredibly rare.

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Kaiser Health News (KHN) is a nonprofit national health policy news service.

Last Updated on Friday, 26 June 2015 17:17
CMS Issues Final ACO Rules: Key Legal Implications for Hospital & Health System ACOs Print E-mail
Written by   
Friday, 19 June 2015 16:33

On June 4, 2015, the Centers for Medicare & Medicaid Services (CMS) released a final rule (Final Rule) containing changes to its Medicare Shared Savings Program (MSSP). These changes have important legal implications for accountable care organizations (ACOs), particularly those owned and operated by hospitals and health systems.

In many respects, the primary focus of the Final Rule is to make changes designed to ensure continued robust participation in the MSSP. Under the previous rule, an ACO was permitted to participate in Track 1 (with shared savings potential, but no risk for losses) for only the initial three-year agreement period. After the initial three-year period, ACOs were required to move to Track 2 (which includes down-side risk for losses). Without the changes adopted in the Final Rule, CMS estimated that fewer than 15 percent of ACOs would opt for continued participation under downside risk in Track 2. Under the Final Rule, ACOs can renew in Track 1. At the same time, CMS has made changes to Track 2, and created a new Track 3, to incentivize ACOs to move to a two-sided performance-based track. Under Track 2, ACOs will now have a choice among several options for their applicable minimum savings rate and minimum loss rate, allowing ACOs to more closely tailor Track 2 to their individual risk tolerance. In addition, the Final Rule creates a Track 3, which incorporates a higher shared percentage (75 percent), prospective assignment of Medicare beneficiaries, and the opportunity for a programmatic waiver of the three-day skilled nursing facility (SNF) rule (which permits payment for otherwise covered SNF services when a beneficiary is admitted to a SNF without a prior 3-day inpatient stay).

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Last Updated on Wednesday, 01 July 2015 15:47
Feds, state investigating St. Mary's pediatric heart surgery unit Print E-mail
Written by John Pacenti | Palm Beach Post   
Friday, 12 June 2015 17:03

The microscope on <West Palm Beach based> St. Mary's Medical Center's pediatric cardiac surgery program tightened its focus on Friday <6.5.15> with federal and state agencies saying they are investigating nine infant deaths at the hospital.

The federal Centers for Medicare & Medicaid Services said it was launching an investigation after CNN reported on Monday <6.1.15> that the mortality rate at St. Mary's 4-year-old program dwarfed the national average.

"We take these allegations very seriously. CMS is actively investigating these complaints," CMS spokesman Aaron Albright said.
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