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

Compliance Blog

By AIS Staff - July 15, 2014
The scandal at the Department of Veterans Affairs (VA) that has so outraged the nation over veterans’ access to medical care also has pointed the spotlight on whistleblowers and a covered entity’s compliance with whistleblower protection laws. This month’s issue of Report on Patient Privacy (RPP)...
By AIS Staff - June 16, 2014
Let’s say, for whatever reason, you wanted an electronic copy of your medical records. You have a right to them, by law, except that’s not what’s happening at many HIPAA covered entities. For its June issue, Report on Patient Privacy (RPP) took a look at the websites of several prominent health...
By Nina Youngstrom - March 10, 2014
Two recovery audit contractors have a bone to pick with some of the changes planned by CMS for the next round of the five-year RAC contracts and have filed “pre-award” protests with the Government Accountability Office (GAO), Emily Evans, a partner in Obsidian Research Group in Nashville, said at a...

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