Corporate Compliance

Corporate Compliance Headlines

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  • Start date announced for recovery audit prepayment review demo

    On November 15, 2011, CMS unveiled three demonstration projects aimed at reducing improper payments in the Medicare program.

  • Tip: Perform your own internal investigation prior to government audit

    If the government is paying your facility a visit, you'd better understand what they're looking for and figure out whether your organization did something wrong, says Lawrence Vernaglia, a partner in the Boston office of Foley & Lardner, LLP. "I think the goal is always to conduct your own analysis," he says. "You want to understand what the rules are and what is billable and not billable.” This investigation is not necessarily something you want to share with investigators unless you are specifically requested to do so.
    One problem organizations may run into when they try to investigate a problem is the tight turnaround time they face as a result of the government's new 60-day rule. The Patient Protection and Affordable Care Act now requires all organizations that participate in Medicare and Medicaid to self-report and return overpayments within 60 days after the organization discovers the problem, says Vernaglia. This doesn't give the compliance officer a lot of time to evaluate the situation before responding, he says.
     

  • HIPAA 5010 deadline extended, but threat remains, says AMA

    CMS' Office of E-Health Standards and Services (OESS) has announced a 90-day period of "enforcement discretion" for compliance with the 5010 HIPAA transaction standards, but leading professional organizations say that is not enough, according to a February 6 HealthLeaders Media article.

    Expressing serious concerns about the ability of physician practices and payers to make the conversion to the 5010 electronic transaction standards and ICD-10 (a new code set for medical diagnoses) in time, both MGMA and the AMA are calling for change. The two agencies say that the government needs to form a comprehensive contingency plan permitting health plans to adjudicate claims that may not have all the required data content; or the government needs to call an outright halt to the transition.
     

  • MPPR to apply for certain diagnostic imaging procedures for Method II CAHs

    On January 26, CMS issued a transmittal that implements the multiple procedure payment reduction (MPPR) for physician services for certain diagnostic imaging procedures in critical access hospitals (CAHs).

  • Minnesota debt collector sued over stolen medical data

    Minnesota Attorney General Lori Swanson filed a lawsuit January 19 against a debt collection agency that she said violated state and federal health privacy laws when it lost a laptop containing patient information from two Minnesota hospitals, according to a press release from the Attorney General’s office.

  • Report: Breaches reach 19 million records

    Covered entities and business associates reported a total of 385 breaches of unsecured PHI affecting 500 or more individuals since OCR issued the August 2009 interim final breach notification regulation under HITECH, according to a report released by Redspin. This included more than 19 million records.