In an effort to improve the accuracy of payment under the acute care hospital inpatient prospective payment system and give hospitals incentives to improve quality, the Centers for Medicare and Medicaid Services (CMS) proposed a new rule. From the press release: Medicare’s inpatient rates for operating expenses will increase by 3.3 percent in FY 2008 for those hospitals that report quality data to CMS. Overall, the proposed rule is estimated to increase payments to more than 3,500 acute … [Read more...] about Payment Reforms for Inpatient Hospital Services
National Provider Identifier
A National Provider Identifier (NPI) is a 10-digit number used to identify providers under the 1996 Health Insurance Portability and Accountability Act (HIPAA). According to the Centers for Medicare and Medicaid Services, there are only 151 days left to comply with the NPI requirement. From the site: If you are a health care provider who bills for services, you probably need an NPI. If you bill Medicare for services, you definitely need an NPI! Getting an NPI is easy. Getting an NPI is … [Read more...] about National Provider Identifier
Private Lawsuits Under the False Claims Act
The recent decision in United States v. Regence Blue Cross (10th Cir 12/05/2006) illustrates the power of qui tam, or private, civil lawsuits under the False Claims Act (FCA). Under the FCA, an action can be commenced either by the United States itself, or as a “qui tam†action, by a private person acting “for the United States Government†against providers “in the name of the Government.†The false claim may take many forms: overcharging for a product, failing to perform a service, … [Read more...] about Private Lawsuits Under the False Claims Act
Fifth Circuit: No Private Cause of Action for HIPAA Violations
While HIPAA protects the health information of individuals, it does not create a private cause of action for those aggrieved (65 Fed. Reg. 82566).  This is made abundantly clear from the commentary to the regulations and HIPAA’s legislative history. And while many federal district courts have dismissed individual plaintiffs’ lawsuits under this rule, the Fifth Circuit, in the case of Acara v. Banks (5th Cir. Nov.13, 2006), has become the first federal appellate court to affirm the ruling. … [Read more...] about Fifth Circuit: No Private Cause of Action for HIPAA Violations
Medicare News Roundup
The Centers for Medicare and Medicaid Services (CMS) has made a series of announcements about Medicare: 1. Payment rates for home health services will increase by 3.3 percent for 2007. The acting administrator for CMS said this increase will “reward home health agencies who continue to report quality data and also provides beneficiaries with access to more affordable oxygen equipment.†(Source) 2. CMS also announced a final rule for Medicare payments for hospital outpatient services … [Read more...] about Medicare News Roundup
The False Claims Act–A Significant Hammer!
For an example of how whistleblowers and the False Claims Act interact, read this article, Home Health Care Industry Reels from Medicare Scandal. Whistleblowers can bring qui tam lawsuits against providers and benefit hugely. In this particular case, the whistleblower benefits as follows: The False Claims Act permits individuals to file qui tam lawsuits against companies that defraud the government. Liable companies pay as much as three times the government's losses plus penalties for … [Read more...] about The False Claims Act–A Significant Hammer!
More Money for Doctors Reporting Quality of Care Data
Physicians who provide care to Medicare patients with chronic conditions will have an incentive to do more paperwork. The Kaiser Network reports that the Centers for Medicare and Medicaid Services will begin a three-year pilot program that will pay physicians to report quality of care data. An excerpt: The three-year program will begin next year in 800 small- or medium-sized practices in Arkansas, California, Massachusetts and Utah. During the first year, physicians will be paid for … [Read more...] about More Money for Doctors Reporting Quality of Care Data
Provider Letters: Incident Reporting and Provider/Survey Conference
The Texas Department of Aging and Disability Services (DADS) issued a provider letter to Licensed Nursing Facilities, Medicare/Medicaid-certified Nursing Facilities, and Skilled Nursing Facilities about guidelines for reporting incidents. Superseding guidelines dated July 14, 2000, the revised guidelines require any facility staffer who believes a resident has been abused, neglected, or exploited by another staffer to report it, pursuant to Health and Safety Code §242.122 and 40 Texas … [Read more...] about Provider Letters: Incident Reporting and Provider/Survey Conference
Disaster Preparation At TexasOnline
Hopefully this hurricane season won't be as devastating as the last, but it's good to be prepared. Texas providers (and all residents) should visit the disaster preparation resource page at TexasOnline to stay up-to-date on current news and tips. You'll find links to organizations and agencies that specialize in preparing for disasters, including the Federal Emergency Management Agency and American Red Cross. There are links to state and local government agencies and organizations, and … [Read more...] about Disaster Preparation At TexasOnline
OIG Releases Report on Nursing Homes’ Response to Hurricanes
The Office of Inspector General (OIG) of the U.S. Department Health and Human Services has released a report titled, "Nursing Home Emergency Preparedness and Response During Recent Hurricanes." OIG reviewed 20 nursing homes for the study. According to the report, 94 percent of nursing homes met government guidelines for emergency plans, and 80 percent met guidelines for sufficient emergency training in 2004-2005. However, nursing homes didn't always follow the plans. For example, 5 of the … [Read more...] about OIG Releases Report on Nursing Homes’ Response to Hurricanes
