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Corporate Compliance

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  • Single accreditation system for GME gets the go-ahead

    The Accreditation Council for Graduate Medical Education (ACGME), the American Osteopathic Association (AOA), and the American Association of Colleges of Osteopathic Medicine (AACOM) have agreed to a single accreditation system for graduate medical education (GME) programs in the U.S. The single accreditation system will allow graduates of allopathic and osteopathic medical schools to complete their residency and/or fellowship education in ACGME-accredited programs and demonstrate achievement of common Milestones and competencies. 

  • Draft NPDB Guidebook open for public comment

    The National Practitioner Data Bank (NPDB) is revising the NPDB Guidebook to incorporate legislative and regulatory changes adopted since its last edition, including the merger of the NPDB with the Healthcare Integrity and Protection Data Bank. The revised Guidebook will offer more and clearer examples of when and how to report and query, more useful tables explaining Data Bank policies, and live links to statutes, regulations, and the NPDB website.

     

  • CMS cites rising participation in PQRS program

    The latest Physician Quality Reporting System (PQRS) and Electronic Prescribing (eRx) Experience Report shows significant increases in participation in two volutnary programs. More than 430,000 professionals participated in the PQRS and more than 340,000 in the eRx programs, according to Patrick Conway, MD, CMS’ deputy administrator for innovation and quality and chief medical officer. CMS is in the beginning stages of adding this information to the Physician Compare website, which can be viewed by patients, he said.

    Source: CMS

  • Lawsuits: Ky. physicians performed unnecessary surgeries

    Physicians at King’s Daughters Medical Center in Ashland, Ky. performed “medically unnecessary and harmful” heart procedures on more than 500 people, two lawsuits filed Tuesday claim. The lawsuits, filed in state court, alleged that physicians at the medical center misrepresented the severity of patients’ heart conditions to justify surgeries such as installing stents to get payments from federal healthcare programs. 

  • CMS finalizes two-midnight inpatient presumption as part of 2014 IPPS final rule

    CMS finalized a major change to its inpatient admission guidelines as part of the 2014 IPPS final rule, released August 1.

    As part of the rule, CMS finalized the two-midnight presumption for inpatient admissions. If a patient the physician expects a patient’s treatment, testing, or surgery to require an inpatient stay covering two midnights, and admits the patient based on that belief, CMS will presume that the stay is be medically necessary.

    CMS emphasized that the physician must formally order an inpatient admission, but added that the physician can consider the time the patient has already spent in the ED or observation when deciding whether to admit the patient.

    CMS made the change in part to reduce long outpatient or observation stays.

    CMS also finalized the timely filing requirement for Part A to Part B rebilling. In March, CMS released a ruling and a proposed rule allowing hospitals to rebill Part A inpatient services as Part B outpatient services if the inpatient stay was not medically necessary and the services would have been covered in the outpatient setting. The ruling, which went into effect in March, did not including a filing timeframe. Under the final rule, hospitals will have one year from the date of service to rebill claims.

    CMS finalized the criteria to rank hospitals with a high rate of hospital-acquired conditions (HAC). Hospitals in the lowest quartile for HACs will see a payment reduction of 1%.

    Look for more analysis of the rule from HCPro next week.

  • CMS proposes sweeping changes to E/M visits, increased packaging, and new comprehensive APCs

    CMS released a number of proposed changes to the OPPS payment system July 8. The 2014 OPPS Proposed Rule is shorter than normal at 718 pages, but the proposed changes are significant and probably the most sweeping changes since the inception of OPPS, says Jugna Shah, MPH, president and founder of Nimitt Consulting.

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