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Compliance Monitor

This HTML e-mail newsletter delivers news on Medicare and Medicaid fraud and abuse, as well as recent documents and targets of the Office of Inspector General, CMS, and the Department of Justice each week. A second e-mail newsletter, Compliance Monitor Q&A, answers compliance questions from your peers.

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Compliance Monitor

Issue 89, December 28, 2006

• Report: Officials altered records to hinder probe

  State officials interfered with an investigation into whether Texas’ Department of State...

• Radiology cover sheets

  Q: Must our radiology group send a cover sheet with every radiology report we fax to referring...

• Insurer fined for issuing misleading information

  UnitedHealthcare, a unit of UnitedHealth Group, will pay $45,000 in fines and costs to the state of...

Issue 88, December 22, 2006

• Pay-for-performance programs

  We are a multi-specialty group practice that has been asked to participate in a pay-for-performance...

Issue 87, December 14, 2006

• Congress saves physicians from Medicare pay cut

  Members of Congress approved a bill December 9 that would reverse a 5.1% reduction in Medicare...

• Patient access compliance

  Q: Do research participants have any right to see research records or results? How about clinical...

• Tennessee back on track for DSH payments

  The state of Tennessee will begin to receive disproportionate share hospital (DSH) payments for...

Issue 86, December 8, 2006

• Complying with HIPAA

  Q: When calling patients regarding appointment times, how much information can we leave on an...

Issue 85, November 28, 2006

• Commission: New York may need to privatize university hospitals

  State University of New York hospitals may be privatized to save the state money, if New York...

• CPT code 97001

  Is it appropriate to report CPT code 97001 when a physical therapist does an inpatient consult that...

• A hospital money-back guarantee? Two groups think it’s a good idea

  Two large Midwestern groups are suggesting that hospitals become more accountable for mistakes...

Issue 84, November 22, 2006

• Monitor finds fraud at New Jersey medical school

  The University of Medicine and Dentistry of New Jersey illegally billed the Medicare and Medicaid...

• CMS issues transmittal on Medicare provider/supplier enrollment

  CMS updated chapter 10 of is Medicare Program Intregity Manual with changes that went into effect...

Issue 83, November 15, 2006

• Authorities investigate hospital for restraint death

  Federal and Florida authorities are investigating Sarasota Memorial Hospital on claims that a...

• Be careful when helping referring physicians with precertification

  Q: Can an independent diagnostic testing facility (IDTF) help referring physicians obtain...

• Grand jury to probe dealings of former hospital executive

  Grand jurors will soon hear testimony on whether Dorsey Miller, former chairman of the North...

Issue 82, November 8, 2006

• Employees charged in hospital fraud

  Ten employees from the University of Maryland Medical Center face prison sentences and fines for...

• CPT code 93501

  CPT code 93501 includes conscious sedation as an inherent part of providing the procedure...

• How to create a compliance hotline report sheet

  A hotline report sheet is a one-page form that outlines the essential information an operator needs...

Issue 81, November 1, 2006

• Tenet names new compliance chief

  Tenet Healthcare named Audrey T. Andrews as its new chief compliance officer effective November 15.

• Pay-for-performance arrangements

  We are a multi-specialty group practice that has been asked to participate in a pay-for-performance...

• Tip: Make compliance training interesting

  As a compliance officer, you’re expected to develop and implement a program that will get...

Issue 80, October 25, 2006

• CMS eyes new referral rules

  CMS plans to propose new rules that would limit the "in-office ancillary services" exception to...

• Including 46600 in E/M leveling systems

  Q: A question recently came up regarding coding an anoscope to perform anal/rectal examinations in...

• Start at the beginning when defining the legal health record

  Defining any term in the healthcare industry is a treacherous process. The industry is constantly...

Issue 79, October 17, 2006

• CMS offers information about NPI, Medicare

  Providers using paper claims to bill Medicare must obtain an NPI and use it by May 23, 2007...

• OIG adjusts annual work plan

  The OIG has issued two changes to its 2007 Work Plan. Both sets of changes were made to the fifth...

• Order errors

  Can a radiologist change the physician orders in the physician setting if they are clearly wrong...

• Audit: University innapropriately claims more than $11,000

  Boston University transferred more than $11,000 in unallowable salary cost transfers, according to...

Issue 78, October 10, 2006

• Supreme Court refuses HIPAA consent case

  The United States Supreme Court on October 2 refused to hear a HIPAA privacy case that could have...

• Court refuses HIPAA case

  The United States Supreme Court on October 2 refused to hear a HIPAA privacy case that could have...

• Court refuses HIPAA case

  The United States Supreme Court on October 2 refused to hear a HIPAA privacy case that could have...

Issue 77, October 4, 2006

• Blue Cross California fined for improperly denying coverage

  California regulators imposed a $200,000 fine on Blue Cross of California for revoking health...

• DOJ charges two under HIPAA

  Florida prosecutors indicted two people for charges that include a criminal violation of HIPAA...

• Auditing policies

  If a health system were audited by an external agency and the audit findings determined the system...

• Arkansas agrees to pay restitution for not reporting overpayment collections

  Arkansas failed to report $3.7 million worth of Medicaid overpayments collected by contractors...

Issue 76, September 29, 2006

• Outpatient testing billing practices

  It has been proposed that we allow outpatient testing patient encounters to be coded by admitting...

Issue 75, September 27, 2006

• OIG unveils 2007 priorities

  The OIG released its fiscal year 2007 Work Plan this week, which establishes its intention to work...

• Business associate misusing PHI

  Q: What should we do if a business associate (BA) misuses our PHI?

• CMS pushes for indentifier compliance

  Providers across the country have until May 23, 2007 to obtain a National Provider Indentifier...

• Indiana OKs disclosure of medical errors

  Indiana residents will have more access to information about serious medical errors made by...

Issue 73, September 15, 2006

• Honoring individual requests on uses or disclosures

  Q: Must we honor individual requests for restrictions on uses or disclosures?

Issue 69, September 1, 2006

• Liability issues with resident physicians

  Q:I work in a multi-specialty, free-standing ambulatory surgery center and I am concerned that our...

Issue 67, August 25, 2006

• Adopting electronic prescribing and electronic health records

  Q: Our hospital is moving quickly towards adopting electronic prescribing and electronic health...

Issue 65, August 18, 2006

• Billing for NP or PA services in a hospital

  Q:Can a physician bill for nurse practitioner or physician assistant services performed in a...

• EMTALA and patient transfers

  When a hospital accepts patients from other hospital inpatient settings, does the transferring...

Issue 64, August 16, 2006

• Iowa doctor facing charges of health care fraud

  An Iowa ear, nose and throat physician has been convicted on 82 counts of healthcare fraud related...

• VA missing second computer containing data on 38,000 patients

  Information related to about 38,000 patients may be at risk after a second Department of Veteran...

• Government continues Kaiser probe

  Regulators plan to investigate Kaiser Permanente to assess how well the health maintenance...

Issue 63, August 11, 2006

• Releasing information to law enforcement

  Q: Can we notify police when our hospital discharges a patient who is a suspect or has a warrant...

Issue 61, August 4, 2006

• Recovery rooms for high paying patients

  Q: I am a physician who provides minor surgery to patients with a wide range of payers. I am...

Issue 59, July 28, 2006

• Defining an emergency department under EMTALA

  Q: We are a free-standing psychiatric hospital without an ED. We don't advertise or hold ourselves...

Issue 57, July 21, 2006

• Access to electronic health records

  We prohibit employees, including physicians, from accessing their medical records in our electronic...

Issue 55, July 14, 2006

• Notifying person exposed to communicable disease

  Q: Can we notify a person who's been exposed to a communicable disease?

Issue 53, July 7, 2006

• Disclosing sensitive patient information to payers

  Q: Can we disclose information about a patient's alcohol/drug abuse or HIV status to a payer to get...

Issue 50, June 30, 2006

• Family members in the ED

  Should we prevent family members from entering the emergency department because they might overhear...

Issue 48, June 23, 2006

• Using patient information in staff meetings

  Q: Can we use patient information to demonstrate operational processes during staff meetings?

Issue 47, June 16, 2006

• Billing related to postponed surgery

  Q:I have a question regarding proper billing procedures in the following scenario: The patient was...

Issue 46, June 14, 2006

• Brothers sentenced in insurance fraud case

  Two brothers were sentenced last week on charges of healthcare fraud for allegedly making some $2...

• Giving information to patient's family members

  If a patient who is the friend or relative of an employee seeks treatment at our facility, can the...

• Gartner: Data protection costs less than breach cleanup

  Paying for cleanup after a data breach is more than five times as expensive as using tools-such as...

• Preparing an audit report

  An audit is not complete until the results are reported in writing to the auditee. The written...

• Ensure proper coding in wake of hip/knee revisions

  The American Medical Association released the new ICD-9 procedure codes for revisions of hip and...

Issue 45, June 9, 2006

• Nursing documentation

  Q:I understand nursing documentation can not be used to support codes, however if you are looking...

Issue 44, June 7, 2006

• OIG expects to recover more than $1 billion in first quarter of 2006

  The OIG reported that it expects to recoup $1.02 billion in audit and investigative-related...

• Locking the server room

  Does HIPAA require us to keep the server room locked at all times?

• Privacy group calls for immediate review of VA breach

  HHS Secretary Mike Leavitt should immediately conduct a full compliance review of the U.S...

• OIG releases reports on drug pricing and Nebraska cost claims

  Some government requirements for determining the average manufacturer price (AMP) for prescription...

• Ensuring an effective hotline

  Anybody can get a special phone number and claim they have a hotline. You must be able to show that...

Issue 42, May 31, 2006

• Connecticut man pleads guilty to healthcare fraud

  A Westport, CT man pleaded guilty last week to one count of healthcare fraud for allegedly creating...

• Inpatient procedure billed as outpatient

  Q:We recently billed incision of the heart sac (33025) as an outpatient procedure. Medicare denied...

• Notification related to complaints

  Q: Can someone file a complaint with HHS without first notifying the covered entity of the problem?

• OIG posts Lincare CIA and a new audit report

  The OIG has posted its corporate integrity agreement (CIA) with Lincare Holdings -- the supply...

• Aetna gives nonparticipating healthcare providers access to site

  Healthcare providers who do not participate in Aetna's network can now register to use the...

Issue 41, May 26, 2006

• Billing for kyphoplasty under anesthesia

  Q:Staff place a Medicare patient scheduled to undergo kyphoplasty under anesthesia, but the...

Issue 40, May 24, 2006

• Florida Supreme Court says state anti-kickback statute is unconstitutional

  The Florida Supreme Court has found that the state’s anti-kickback statue is...

• Structuring an arrangement with medical office building staff

  Q: Our hospital is considering building a medical office building (MOB) adjacent to our hospital...

• Stolen computers found on eBay

  Twenty-five laptop computers for sale on eBay appear to have come from Des Moines-based Iowa...

• OIG releases three new audit reports

  The OIG, Friday, released three new audit reports dealing with a range of issues, from ambulance...

• Auditing against the OIG’s Compliance Program Guidance for Hospitals

  To see whether your facility correctly follows compliance guidelines, determine whether employees...

Issue 39, May 19, 2006

• Nursing documentation to support coding

  Q:When can nursing documentation be used to support the selection of a diagnostic code? If an E...

• Complying with a subpoena

  Q: How much information should we provide when complying with a subpoena for documents?

Issue 38, May 17, 2006 - VIEW THE FULL ISSUE

• Durable equipment supplier to pay largest civil penalty on record

  A Florida durable equipment company accused of paying illegal kickbacks and violating the Stark Law...

• AHA report: State laws, not HIPAA, are obstacles to information exchange

  HIPAA provides "parameters but not roadblocks" to health information exchange (HIE) projects...

• Ensure employee policies outline whistleblower rights

  Does your facility’s employee handbook include a detailed description of whistleblower...

Issue 37, May 12, 2006

• When to charge drug administration services

  Q:I audit emergency department (ED) procedures and am confused about how to charge for an IV...

• Single sign-on (SSO) technology and security

  Q: Will single sign-on (SSO) technology help us meet certain security rule requirements?

Issue 36, May 10, 2006

• OIG intends to exclude hospital from federal health care programs

  The OIG said it intends to exclude Alvarado Hospital Medical Center (Alvarado) from participation...

• IG continues wage data crackdown

  Citrus Memorial Hospital of Inverness, FL is the latest provider on the OIG's hit list for stating...

• NPI bulk enumeration begins

  Healthcare organizations can begin submitting applications for national provider identifiers (NPI...

• Verify compliance committee responsibilities

  The following are some tips to help verify compliance committee responsibilities when auditing...

Issue 35, May 5, 2006

• Self-disclosing potential liability issues

  Q:We are a community hospital that has a compliance program. What is the appropriate way to...

• Patient access to information

  Q: When patients request access to their information, must we provide information that is held by a...

Issue 34, May 3, 2006

• Fugitive from justice sentenced in healthcare fraud case

  A Michigan man who spent 17 years as a fugitive from justice was sentenced last month on charges of...

• Privacy groups criticize HHS agreement to access DHS data

  Privacy advocates and airline associations are attacking a data-sharing agreement that HHS and the...

• OIG recommends United Government Services refund $516,303

  Medicare overpaid United Government Services (UGS) in Milwaukee by $516,303 for inpatient...

• Deficit Reduction Act of 2005

  The Deficit Reduction Act of 2005 ("DRA"), which was signed into law on February 8, 2006, contains...

Issue 33, April 28, 2006

• Developing an audit plan

  Q:Can you offer any tips for creating an audit plan?

• Addressing complaints

  Q: What does HIPAA require us to do when we receive a complaint?

Issue 32, April 26, 2006

• Texas man facing charges of Medicare fraud

  A Houston man faces charges of fraud for allegedly falsely billing Medicare for motorized...

• Study: Percentage of noncompliant facilities grows

  A drop in the number of facilities that report they are fully or mostly HIPAA-compliant should warn...

• Information on healthcare technology

  While health information technology improves quality of care, most healthcare providers need more...

Issue 31, April 21, 2006

• Correct coding related to AP & Lateral of the abdomen

  Q: When performing an AP & Lateral of the abdomen, what CPT is recommended for billing? Code 74000...

• Vulnerability assessments

  Q: Should we include wireless keyboards and mice in our vulnerability assessments?

Issue 30, April 19, 2006

• New Jersey man facing charges of health care fraud

  A New Jersey man pleaded guilty yesterday to forging prescriptions for Oxycontin, a painkiller, and...

• CMS issues NPI guidance, revised resources

  Submit legacy identifiers for all payers-not just Medicare- when applying for an NPI, CMS advised...

• OIG: New Jersey hospital overstated wage data by $311,908

  The OIG has determined that Hackettstown (NJ) Regional Medical Center overstated its wage data by...

• Assessing your compliance program

  Assessing the effectiveness of your organization’s compliance program is critical to...

Issue 29, April 14, 2006

• Pre-checking consults on a new CPOE system

  Q: We are switching to computerized physician order entry (CPOE) and are building order sets for...

• Disposing of ePHI

  How should we dispose of ePHI?

Issue 28, May 12, 2006

• Chiropractor pleads guilty to defrauding insurance companies of $8.2 million

  A Pittsburgh chiropractor pleaded guilty of one count of health care fraud on Monday and could face...

• Thieves steal patient records, attempt to auction them

  Thieves stole patient records from now-defunct Danvers State Hospital in Massachusetts and posted...

• OIG continues hunt for errant GME payments

  The OIG continues to audit hospitals for appropriate graduate medical education (GME) Medicare...

• Checking up on consultants

  It’s important to protect your facility from bad advice from consultants that can lead to...

Issue 27, April 7, 2006

• Gathering information about the competition

  Q: Our health system would like to obtain information about patients who receive services from...

• Sanctioning whistleblowers

  Q: Can we sanction whistleblowers who disclose PHI to the government?

Issue 26, April 5, 2006

• CEO of mental health clinic indicted on charges of Medicare fraud

  The CEO at a Washington D.C. mental health clinic was indicted last week on charges that he used a...

• CEO of mental health clinic indicted on charges of Medicare fraud

  The CEO at a Washington D.C. mental health clinic was indicted last week on charges that he used a...

• OIG: Hospital should refund $4.9 million in GME costs payments

  The OIG is recommending that Boston Medical Center amend its cost report to effectively refund $4.9...

Issue 25, March 31, 2006

• Anti-kickback issue related to physician payment

  Q: Our board has decided to compensate orthopedics and neurosurgery panel members who treat...

Issue 24, March 29, 2006

• Cardiologist indicted on charges of health care fraud

  A Lafayette, LA cardiologist has been indicted for allegedly performing unnecessary procedures on...

• Ohio Supreme Court rules state disclosure law supersedes HIPAA

  The Cincinnati Enquirer can obtain copies of lead-contamination notices issued to Cincinnati...

• OIG: CMS should determine whether $3 million in payments were allowable

  The OIG has recommended in an audit that CMS determine whether $3 million in questionable payments...

• Misconception related to self auditing

  The significance of compliance has redefined medical records, coding, auditing in general. In the...

Issue 23, March 24, 2006

• Billing a non-qualifying inpatient

  Q: If hospital staff perform a utilization review and the patient does not meet inpatient criteria...

• Using peer review committee findings to defend a lawsuit

  Q: At a recent departmental meeting, we were presented with a risk management scenario in which a...

Issue 22, March 17, 2006

• Business associate agreements

  Q: We have a business health department at our hospital that performs pre-employment testing for...

• Universal Health Services under investigation for Medicare and Medicaid fraud

  HHS Inspector General subpoenaed Universal Health Services Inc. as part of an ongoing investigation...

• Denying privileges for off-color remarks

  I am a hospital administrator and serve on my hospital’s credentialing committee. A physician...

• OCR posts new FAQ on releasing PHI to people acting on behalf of others

  The privacy rule allows a health plan-or other covered entities-to disclose PHI to a person who...

• OIG: Hospital should resolve $338,490 in questional GME reimbursements

  The OIG has recommended that the University of Iowa Hospitals and Clinics work with CMS to resolve...

• Modifier -58

  Are you being paid properly for postsurgical procedures? Using modifier -58 ensures that your...

Issue 21, March 15, 2006

• Miami hospital excluded from federal healthcare programs

  The OIG has excluded South Beach Community Hospital from participating in all federal healthcare...

• Survey: Organizations still behind in compliance efforts

  It's been almost three years since the compliance date for HIPAA's privacy rule, and many...

• OIG: Hawaii should refund $9,532 for ancillary services

  The OIG determined that Hawaii overpaid nursing facilities for a small number of ancillary services.

• Complying with the OIG Work Plan

  The 2006 OIG Work Plan contains a lot of information about potential problem areas for your...

Issue 20, March 10, 2006

• Noncompliant prescriptions

  Q: I have a few questions related to noncompliant scripts. Do lab requisitions printed with...

• Disclosing information to person in charge of patient’s care

  What can we disclose to a friend or family member who is involved in the patient's care?

Issue 19, March 8, 2006

• Miami Hospital files for bankruptcy

  Last year South Beach Community Hospital received word that it might be excluded from Medicare and...

• Four employees leave Providence in wake of data breach

  Oregon-based Providence Health System fired one employee and had three employees resign in the...

• OIG: Arkansas should refund $238,928 to the feds

  The OIG asked Arkansas to repay the federal government $238,928 in Medicaid provider overpayments.

• Handling compliance officers who perform double duty

  If your lab needs to assign the compliance role to someone already responsible for another...

Issue 18, March 3, 2006

• No payment bills

  Q: Can you give me some information regarding the implementation of "no payment bill?" Medicare is...

• Verifying the identities of public officials

  How can we verify public officials’ identities when they request PHI?

Issue 17, March 1, 2006

• AHA and CMS establish HCPCS clearinghouse

  The American Hospital Association (AHA) and the CMS are joining forces to establish a clearinghouse...

• Robber steals laptop containing HIV information

  A thief stole a laptop containing the HIV test results of almost 2,000 clients of the Sacramento...

• OIG: Hospital should refund $15,759

  The OIG is recommending that the University of Louisville Hospital repay $15,759 after the hospital...

• Confusing observation status can cost facilities

  Physicians sometimes confuse observation status with clinical observation and fear that an...

Issue 16, February 24, 2006

• Inpatient status and billing

  Q: If a patient has a lengthy stay in the emergency department where he or she is treated and...

• Establishing an organized healthcare arrangement

  What are the benefits of establishing an organized healthcare arrangement (OHCA)?

Issue 15, February 22, 2006

• Illinois hospital settles Medicare fraud investigation for $1.34 million

  A hospital that fraudulently received $450,000 in Medicare funds on the advice of a Kentucky...

• HHS releases final enforcement rule

  On February 16, HHS published the final enforcement rule, which now applies to all of HIPAA’s...

• OIG: Kansas should refund $13.9 million

  The OIG has recommended that Kansas refund $13.9 million to the federal government to repay...

• Take care when providing technology to physicians

  When it comes to providing technology to physicians it's important to steer clear of compliance...

Issue 14, February 17, 2006

• Updating a conflict of interest policy

  Q: We believe our hospital’s conflict of interest policy for employed staff physicians is...

• Indirect treatment relationships

  What is an indirect treatment relationship?

Issue 13, February 15, 2006

• Tools to help states recoup more from False Claims Act litigation

  Under the Deficit Reduction Act of 2006 the federal False Claims Act was expanded to allow states...

• Boston hospital faxed patient information to bank for six months

  Boston-based Brigham and Women's Hospital mistakenly faxed patient data to a local investment bank...

• OIG: New Jersey needs to repay $6.6 million

  The OIG has determined that New Jersey failed to report all overpayments in accordance with federal...

• Appealing a denial

  Knowing when and when not to appeal is the first step in the denials-management process. Following...

Issue 12, February 10, 2006

• Billing for injection codes

  Q: Our hospital routinely bills an injection CPT code (i.e., 90782, now 90772) along with the...

• Separating psychotherapy notes from the rest of the medical record

  Q: Why should we separate psychotherapy notes from the rest of the medical record?

Issue 11, February 8, 2006

• CMS issues new guidance on subpart NPIs

  A covered healthcare organization’s subpart must obtain a national provider identifier (NPI...

• North Carolina balks at OIG audit results

  North Carolina is disputing an OIG audit recommending the state revise its Medicaid policy to...

• Ensure proper resources when working under a CIA

  Working under a corporate integrity agreement (CIA) can be incredibly difficult, requiring...

Issue 10, February 3, 2006

• MRI coding

  Q: When performing an MRI brain with or without contrast and an MRI pituitary with or without...

• Posting a notice of privacy practices

  Q: Should we put a notice of privacy practices on our Web site?

Issue 9, February 1, 2006

• Thief steals data for 365,000 patients from car

  A thief stole the medical records of 365,000 patients, smashing the window of a van that contained...

• OIG: Fallon Community Health Plan received an extra $154,970 in MMA funding

  The OIG has found that Fallon Community Health Plan of Worcester, MA received $154,970 more than it...

• Navigating drug administration codes

  It is unlikely that private payers will recognize the new Medicare drug administration HCPCS codes...

Issue 8, January 27, 2006

• Disclosing psychotherapy notes

  Q: Can we disclose psychotherapy notes when there is a serious threat to health and safety?

Issue 7, January 25, 2006

• Alleged joint venture sham indicates Siemans’ imvolvement

  Five defendants-two companies and three individuals-were charged with fraud related to a $49...

• Facilities offering Internet access to patients, visitors

  Some covered entities are offering patients and visitors the opportunity to access the Internet via...

• OIG: Vermont should refund $323,367 claimed for family planning services

  The OIG has recommended that the state of Vermont refund $323,367 it received in improper claims...

• Accountability a key factor in ongoing records review

  Accountability triggers results when it comes to creating an ongoing records review process, said...

Issue 6, January 20, 2006

• Billing related to non-credentialed physicians

  Q: Our practice is credentialing a new physician with hospitals and insurance companies. This...

• Disclosing information to family members

  Q: Should we obtain authorization prior to disclosing a patient’s location to family members?

Issue 5, January 18, 2006

• Tenet settles class-action suit for $215 million

  Tenet Healthcare Corporation announced this week that it has agreed to a $215 million settlement...

• NAHIT report: Paper records are more vulnerable

  Paper health records are more vulnerable to a variety of security threats-including loss, theft...

• OIG: Massachusetts used incorrect methodology to calculate UPL

  The OIG has found that Massachusetts' methodology for calculating the upper payment limit (UPL) for...

• Don't let mobile devices walk away with important information

  Mobile devices such as laptop computers, personal digital assistants (PDA), and tablet personal...

Issue 4, January 13, 2006

• Designated record sets under HIPAA

  What records are not part of the designated record set under HIPAA?

• Avoid a HIPAA emergency in the ED

  Although one of the goals of HIPAA is to protect patient privacy, the regulations should never get...

Issue 3, January 11, 2006

• CMS proposes expansion to cardiac rehabilitation services

  Three new groups of patients may be eligible for cardiac rehabilitation services under a proposed...

• E-prescribing issues

  Q: Our hospital is considering implementing an e-prescribing system. Is it okay to provide this...

• Rhode Island hospital facing corruption charges

  Roger Williams Medical Center in Rhode Island is facing federal corruption charges. A grand jury...

• OIG: CMS overpaid $5.9 million for interrupted rehab stays

  The OIG has recommended that CMS direct its fiscal intermediaries to recover $5.9 million in...

• Appealing denied claims

  The best medicine for denied claims is preventive, but if you must appeal denied claims, Terri...

Issue 2, January 6, 2006

• Defining an inpatient

  Q: What are the qualifications to classify a patient as an inpatient?

• Formatting a patient history form

  What is the best way to format a patient history form?

Issue 1, January 4, 2006

• Audit finds state of Mississippi overstated hospital upper limit payments

  The OIG has found that the state of Mississippi overstated upper payment limits for private, state...

• Limit incidental HIPAA disclosures with a clear policy, practical steps

  Your HIPAA policy should suggest ways to limit incidental disclosures. Frank Ruelas, compliance...

• OIG: Mutual of Omaha must recover $4,109

  The OIG has recommended that Mutual of Omaha recover $4,109 in overpayments related to inproper...

• Auditing wage data is critical

  It's important to audit cost reports for one reason in particular: wage data. CMS uses hospital...

Issue 5, April 5, 2006

• Texas woman pleads guilty to selling medical information

  A Texas woman pleaded guilty on March 6, 2006 to wrongfully using a unique health identifier with...

Issue 13, March 29, 2006

• Enrollment in Part D surges to 25 million

  As the May 15 deadline for Medicare Part D looms, enrollment in the program is accelerating at a...

• Patient's charity care options decreasing

  As the number of Americans without health insurance reaches 43 million, a new study released by the...