Corporate Compliance

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• Providers report first RAC denials in Florida, South Carolina

  Healthcare providers in several states received their first RAC denials. Connolly Healthcare, the Region C RAC for Florida, South Carolina, and several other states, has been behind many of them.

• Note: More on deductibles and coinsurance

  CMS recently published the Part A deductible and coinsurance and Part B deductible amounts for CY 2010. For most covered inpatient stays, as well as covered outpatient services, Medicare does not pay the entire Medicare allowable for those stays or outpatient services. Beneficiaries generally are responsible for a portion of the Medicare allowable in the form of deductibles and/or coinsurance.

• HealthDataInsights posts several new RAC DME claim issues

  HealthDataInsights (HDI) has added multiple new RAC issues to their CMS-approved list in late October and early November. The new issues are approved for RAC audits in Region D for DME claims.

• Note: Signature for Laboratory Tests, Clarification in the MPFS Final Rule

  This week, I would like to review a “clarification” regarding physician signatures on orders for clinical diagnostic testing that came out in the Final Rule for Payment Policies under the Physician Fee Schedule and Other Revisions to Part B for 2010. Although this publication is hospital-directed and we do not normally report on physician fee schedule issues, this “clarification” could affect hospital policies on obtaining signatures for the laboratory services they provide.

• Guidance on HIPAA implications of H1N1

  “Many of these documents help clear up questions on whether the subsequent 1135 waivers suspend HIPAA, the time frame related to these waivers, and those provisions of the HIPAA privacy rule where the Secretary of HHS may waive sanctions and penalties,” Ruelas says.

   

• Red Flags Rule enforcement delayed to June 1

  The previous delay announcement—from August 1 enforcement to November 1—came in July. The House Appropriations Committee requested the additional three months to educate small businesses about Red Flags Rule compliance. The delay also allowed financial institutions and creditors more time to implement written identity theft prevention programs, according to the FTC.

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