House Passes ICD-10 Delay Bill

The U.S. House of Representatives passed a bill on March 27 that would delay the ICD-10 implementation deadline by one year to October 1, 2015. A similar bill in the Senate is expected to be voted on soon. The bill, H.R. 4302, Protecting Access to Medicare Act of 2014, also adjusts Medicare’s sustainable growth rate (SGR) formula to prevent the 24 percent cut to physician reimbursement rates scheduled to begin April 1. Medicare payment cuts to physicians would be delayed until April 1, 2015.

Opposition to the bill focuses on the need for a permanent replacement of the Medicare physician payment system instead of the proposed one year “patch” currently being considered. Opponents of the ICD-10 implementation provision claim that the delay could cost the industry billions of dollars. Others support the measure noting that providers are not prepared for the October 1, 2014 implementation.

Written by: Traci Thompson

Reporting Crimes Against Patients

The HIPAA privacy rules have a number of disclosure exceptions, but those exceptions are only effective when state law also allows the disclosure. When there is no state-law exception, it is irrelevant that HIPAA would allow the disclosure. One such common situation involves crimes against patients. Continue reading

Consultants as Whistleblowers – A New Wrinkle in the FCA

An interesting wrinkle in the development of False Claims Act cases has been the increase in whistleblowers who come from a position of trust. A recent example was an August 19, 2013 $26 million settlement with the Department of Justice by Shands Healthcare, a network of health care providers in Florida for which the complaint was recently unsealed. Continue reading

The New Two-Midnight Rule – Scrutiny Delayed until March 31, 2014

CMS indicated on its website in early November that it is extending the implementation period for another three months, until March 31, 2014. The website says that, “in general, CMS will not conduct post-payment patient status reviews for claims with dates of admission of October 1, 2013 thru March 31, 2014.” CMS also issued two new guidance documents on its website that describe selecting and reviewing hospital claims for patient status.

Written by: Emily Grey

Grey, Emily headshot

 

The New Two-Midnight Rule – Scrutiny Delayed for 90 Days

The Center for Medicare and Medicaid Services (CMS) released what has become known as the “Two Midnight Rule” on August 2, 2013 in the Inpatient Prospective Payment System (IPPS). The Final Rule is available in the August 19, 2013 Federal Register.
Last week, in response to provider concerns and a letter from more than 100 members of Congress asking for postponement of the rule, CMS announced a 90 day implementation period beginning on October 1, 2013. Continue reading