CMS Archive

Court Decision Supports Data Mining of Provider-Patient Encounter Details

In a decision that could have broad implications for physicians and patients alike, the United States District Court for the District of Columbia has recently ordered the Centers for Medicaid and Medicare Services (“CMS”) to disclose claim information regarding hundreds of thousands of patient encounters. The Lawsuit In March 2006, Consumers’ Checkbook, a consumer group

Medicare will Deny Claims Relating to Hospital-Acquired Conditions

Newly adopted Medicare regulations make it clear that Medicare intends to stop reimbursing hospitals for expenses associated with “hospital-acquired conditions”. Background Pursuant to the Deficit Reduction Act of 2005 (Pub. L. 109-171), the Secretary identified certain high cost and/or volume preventable conditions that result from inadequate hospital care and are identifiable by unique ICD-9-CM codes.

Compliance Update – Providers and the Pharmaceutical Industry

Regulators are increasingly focusing on the propriety of certain relationships and interactions between health care providers and the pharmaceutical industry. Since this issue is on the minds of many providers, I am including below an article I recently wrote for Florida Medical Business Journal, the region’s leading medical business publication. Avoiding Dangerous Medicine Developing an

Why utilize ERAs and EFTs?

A provider recently asked me whether she should register to receive Electronic Funds Transfer (“EFT”) and Electronic Remittance Advice (“ERA”) for her Medicare Part B claims. I answered “yes” and also encouraged her to consider registering for EFT and ERA with regard to any other payers with whom she participates. Since so many providers have

How to Earn Your PQRI Bonus

My last two blogs addressed the ‘what’, ‘when’ and ‘why’ aspects of PQRI (if you haven’t yet read them, you may want to do so prior to reading today’s blog). Today’s blog focuses on the issue of how a health care provider can obtain a PQRI bonus. You are not required to formally register in

Now is the Time to Get Ready for PQRI

As of July 1, 2007, providers must begin reporting information regarding certain quality measures (I’ll describe this in greater detail tomorrow). While the official kickoff for reporting activities is still months away, NOW is the time to make certain that you will be ready. If you are using an EMR, your new reporting responsibilities will

CMS Relaxes NPI Deadline

The Centers for Medicare & Medicaid Services (CMS) has just announced that it is relaxing the enforcement of its May 23, 2007 deadline concerning the mandatory use of the National Provider Identifier (“NPI”) in conjunction with all standard transactions. Section 1173(b) of the Health Insurance Portability and Accountability Act of 1996 (“HIPAA”) set into motion