CMS, on July 27, 2012, issued new chapters in the Managed Care Manual (Pub. 100-16, Chapter 21) and in the Prescription Drug Benefit Manual (Pub. 100-18, Chapter 9). These chapters lay out the requirements for the compliance program that all sponsors are required to adopt and implement. Front and center, we see a familiar seven elements that are to be the core of the program. CMS provides plenty of details on the seven elements but leaves room for each program to be tailored to a sponsor's unique organization, operations and circumstance while cautioning that in order for a program to be effective, sufficient resources must be devoted to it. CMS will consider a sponsor’s size, structure, business model, activities, the extent of its delegation of responsibilities to other entities, the breadth of its operation, and the risks it faces in evaluating whether adequate resources have been devoted to the compliance program.
Are you looking for a short, yet comprehensive, source of training material for physicians regarding Medicare and Medicaid Fraud and Abuse? Look to the OIG.
MediRegs' ComplyTrack modules are discussed as a model for legal technology and automation of compliance efforts in health and other industries on the November edition of Law Technology Now! Attorney Christian Liipfert, president of Houston-based Christian Liipfert Consulting, and Chicago-based Theodore L.
As many of you know, ONC is emerging as the player agency in things health IT. ONC (and sometimes you see ONCHIT) stands for the Office of the National Coordinator for Health Information Technology. ONC is the principal Federal entity charged with coordination of nationwide efforts to implement and use the most advanced health information technology and the electronic exchange of health information.
Wow! The OIG has just launched its "Most Wanted Fugitives List". Yes, you read that right. The OIG now has a website where they have posted a list, complete with photos and profiles, of their most wanted individuals sought on charges of health care fraud and abuse. The OIG is asking for the public’s help in tracking down the fugitives as the public has a stake in the fight against fraud, waste, and abuse.
As you know, the Medicare EHR Incentive Program will provide incentive payments to eligible professionals, eligible hospitals, and CAHs that demonstrate "meaningful use" of certified EHR technology. Registration for the program began on January 3, 2011.
We are pleased to announce that the question sets for the 2011 OIG Work Plan for Hospitals are now available!
The new question sets are:
- Non-IPPS Hospital Payments for Nonphysician Outpatient Services
- Medicare Excessive Payments
- Hospital Occupational Mix Data Used to Calculate Inpatient Hospital Wage Indexes
- Early Implementation of Medicare’s Policy for Hospital-Acquired Conditions
- Hospital Reporting for Adverse Events
- Hospital Reporting for Restraint and Seclusion Related Deaths
- Medicare Brachytherapy Reimbursement
- Hospitals Compliance With Medicare CoP Intensity-Modulated and Image-Guided Radiation Therapy Services
- Medicare Inpatient and Outpatient Hospital Claims for Replacement of Medical Device
- Hospital Inpatient Outlier Payments
If you missed webinar on Tuesday October 5th, 2001, click here to download a copy of the presentation slides from the "How to Succeed as a Compliance Professional" Webinar.
For all of you out there who were waiting with baited breath (oh, wait, that was just me)...the Office of the Inspector General released the 2011 Work Plan. But, I have noticed a couple of things right off the bat and wanted to share. First, it is longer than last year! This may not mean a lot, but for those of us who sit and read the whole document, it is significant. Last year it was 128 pages, this year it is 159 -- 31 more pages. Sigh. Second, in addition to being able to download the entire .pdf, the OIG has also provided .pdf's to the individual Wor
On August 5, 2010, four major insurers announced meaningful use incentives. Aetna, Highmark, UnitedHealth Group and WellPoint, at minimum, will align their pay-for-performance programs with federal meaningful use criteria. In a joint statement, National Coordinator for Health Information Technology David Blumenthal, M.D., and Centers for Medicare and Medicaid Services' Principal Deputy Administrator Marilyn Tavenner, stated:
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