CMS Releases Updated Guidance for LTC Surveyors

On November 26, 2014, CMS issued revisions to State Operations Manual (SOM) Appendix PP for health and safety in long-term care facilities.  The majority of the revisions were explained in advance guidance through survey and certification letters (… Read More
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Categories: Client Advisory

HHS Releases Guide to Medicare Enrollment and Claims Submission

The Department of Health and Human Services recently released an informational booklet to help providers navigate the Medicare system. Specifically, the booklet contains helpful guidance on wide range of issues relevant to Medicare providers and supp… Read More
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Categories: Uncategorized

In 2015 Work Plan, OIG Targets HIPAA Compliance

Each year, the U.S. Department of Health and Human Services Office of Inspector General (OIG) releases a Work Plan that informs the public of planned audits, evaluations, and other legal and investigative activities that the agency plans to pursue du… Read More
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Categories: Client Advisory

Submit Claims Without Getting the RUG Pulled Out from Under You: Using PEPPER to Season SNF Compliance Programs

May 2014 marked the second annual release of the Program for Evaluating Payment Patterns Electronic Reports (PEPPER) for skilled nursing facilities. The PEPPER contains billing data for episodes of care in six “target areas” that CMS has identifi… Read More
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Categories: Client Advisory

The New Medicaid Reimbursement System Rolls Out Today: The Nursing Facility Price-Based Payment Methodology

In a June 9, 2014 Medicaid Memo, the Department of Medical Assistance Services (DMAS) announced the upcoming implementation of the Nursing Facility Price-Based Payment Methodology. [i] This new payment system will be effective for all Medicaid claims… Read More
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Categories: Client Advisory

Payments for Evaluation and Management Services: Where OIG Sees Smoke, Physicians Come Under Fire

On May 28, 2014, the Office of Inspector General (OIG) published its findings from a study aimed at determining the error rate in physician coding for Evaluation and Management (E/M) services. The study focused on E/M services billed in 2010, noting… Read More
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Categories: Client Advisory

Provider Pocketbook Penalties: Changes to CMP Regulations on the Horizon

In a notice published on May 12, 2014, the Office of Inspector General (OIG) proposed changes and clarifications to regulations governing health care fraud and abuse and Civil Monetary Penalties (CMPs). In addition to a general reorganization of the… Read More
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Categories: Client Advisory

Security Risk Assessment Tool Released to Aid in HIPAA Compliance

The U.S. Department of Health and Human Services (HHS) has released a Security Risk Assessment (SRA) Tool to aid small and medium sized providers in their compliance with the HIPAA Security Rule. The Tool was developed in collaboration with the Natio… Read More
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Categories: Client Advisory