From Report on Medicare Compliance - CMS has instructed Medicare administrative contractors (MACs) to get off the sidelines and defend claim denials that are appealed to administrative law judges. In Medicare Transmittal 543, which takes effect Oct. 27, CMS says MAC physicians should make a case for some MAC medical review decisions that resulted in claim denials, were appealed by providers up the chain and are now scheduled for ALJ hearings. Not all ALJ hearings require their presence, but MAC physicians (e.g., contractor medical directors, employed physicians) should attend when certain planets align, CMS said. Read more
From Report on Medicare Compliance - Providers who fail meaningful-use audits apparently will face a second audit in addition to having their entire incentive payment recouped for the audit period. They have just one shot at reversing adverse audit findings through the informal appeal process established by CMS under the Medicare-Medicaid electronic health record (EHR) incentive payment program. But there may be more wiggle room in practice than on paper, possibly to keep providers from losing… Read more
From Report on Patient Privacy - Since the U.S. Supreme Court ruled in June 2013 that the portion of the federal law defining “marriage” as a legal union between a man and a woman was unconstitutional, federal agencies have been reviewing their regulations to see which may need to be altered to grant certain rights to married gay couples. Last month, the HHS Office for Civil Rights (OCR) issued guidance clarifying that, as a result of *Windsor… Read more
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