News

August 13, 2020

Pfizer Fights Back, Claiming First Amendment Right to Partake in Charitable Giving

By Mary Inman, Esq. and Max Voldman, Esq.
The government has been cracking down on pharmaceutical companies’ nefarious use of charities to steer Medicare patients toward more expensive drugs, costing taxpayers millions of dollars. The schemes take a few forms, but the fact pattern generally goes something like this: a pharmaceutical company sets up a charity (or makes…
August 13, 2020

A View into Proposed Medicare PFS and Policy Changes for 2021

By Terry Fletcher, BS, CPC, CCC, CEMC, CCS, CCS-P, CMC, CMSCS, CMCS, ACS-CA, SCP-CA, QMGC, QMCRC
The Centers for Medicare & Medicaid Services (CMS) in the past week has proposed Medicare payment rules for outpatient services and physicians for 2021 and finalized payment rules for inpatient rehabilitation facilities (IRFs) and psychiatric facilities.Looking specifically at the 2021 Physician Fee Schedule (PFS) proposed rule, scheduled to be published…
August 5, 2020

Do Hospitals Have a Target on their Back?

By Terry Fletcher, BS, CPC, CCC, CEMC, CCS, CCS-P, CMC, CMSCS, CMCS, ACS-CA, SCP-CA, QMGC, QMCRC
 The headlines have been coming fast and furious: Judge rules against hospitals in price transparency lawsuit (June 2020) Hospitals to challenge loss on site-neutral payments (July 2020) Hospitals lose legal battle to 304B Drug Cut (July 2020) CMS Proposes eliminating “inpatient only” list (August 2020) Does anyone see a pattern…
August 6, 2020

EXCLUSIVE: Audits Attack Osteopathic Medicine

By Edward Roche, PhD, JD
The Unified Program Integrity Contractors (UPICs) may need lessons in reading patient notes. Should they be "defunded?" These days, everyone has a horror story about an audit. There are arrogant know-it-alls that show up unexpected, embarrassing the provider in front of their patients. "He must have done something wrong, otherwise…
August 6, 2020

Hospital Price Transparency Rule: A Common Misconception

By David M. Glaser, Esq.
 The misconception is having to charge everyone the same price. There are so many misunderstandings about healthcare pricing and how it works. One of the most common is that that many believe there is a legal requirement to charge everyone the same price. This is not even close to accurate.…
The confusion over what code to use when hospital-employed physicians perform virtual visits with patients has reared its head again in the latest FAQ from Medicare (released on July 28). Based on this latest iteration, the service billed by the hospital seems to be dependent on where the physician is…
August 6, 2020

Feds Recover More Than $3.5 Billion in FY 2019

By Sean M. Weiss, CEMA, CMCO, CPMA, CPC-P, CMPE, CMPM, CPC-P
Information is provided in a breakdown of the annual HHS-DOJ fiscal report. On July 27, the U.S. Department of Health and Human Services (HHS) and the U.S. Department of Justice (DOJ) issued the healthcare fraud and abuse control program annual report for the 2019 fiscal year (FY 2019). This report…
 Federal officials seek enhancements to the Medicare program through payment realignment. The Centers for Medicare & Medicaid Services (CMS) has finalized Medicare rules adjusting payments for three types of providers: inpatient psychiatric facilities (IPFs), skilled nursing facilities (SNFs), and hospices. First, the CMS final rule applying to IPFs issued last…