By
In the 1934 movie “Death Takes a Holiday,” Death, played by the venerable Fredric March, takes a three-day holiday to find out why everyone fears him. During his respite, no one dies from disease or accidents. Unlike in the movie, in real life Death doesn’t go on vacation but works…
By
Recent articles have described the regulatory complexity surrounding signatures and credentials in the world of healthcare. There’s a practical question associated with this: How do you train people to comply with a best practice without mischaracterizing the state of a law?  This question is really important. Perhaps my favorite activity as a lawyer…
By
While we’ve addressed this titular issue in prior articles, it is one of the most common issues about which we receive questions from the field in our consulting practice. Chapter 1, Section 110.2.4 of the Medicare Benefit Policy Manual outlines Medicare’s requirements for physician supervision of the patient in the…
By
The issue of patient status has long been a topic of confusion. As physicians finally developed a sense of understanding of the Centers for Medicare & Medicaid (CMS) two-midnight rule, status challenges regarding managed and commercial plans ramped up.  One point that seemed reasonably straightforward was the issue of status…
By
My Monitor Mondays segments are usually either informational, centering on a new policy or proposal, or one of my rants, often criticizing someone for something. But on the July 31 report and in this article, I wanted to start with one and move to the other. First, my rant. OK…
By
With rising healthcare costs and the number of Medicare beneficiaries growing rapidly nationwide, the pressure on the federal government to recover improper Medicare payments will only increase. A recent opinion piece in Forbes, written by a spokesperson for the Council for Medicare Integrity, presents a view of the prevailing thought…
By
The topic of Condition Code 44 is not new. Detailed by the Centers for Medicare & Medicaid Services (CMS) in September 2004 via MLN Matters SE 0622, titled Clarification of Medicare Payment Policy When Inpatient Admission is Determined not to be Medically Necessary, Including the Use of Condition Code 44:…
By
According to Patti Smith, the American laureate of punk rock, “You can't carve up the world. It's not a pie.” Perhaps you cannot carve up the world but Medicare has proposed carving up—or more accurately, carving in—the hospice pie to Medicare Advantage (MA) programs. To appreciate the potential import of…
By
More than 400 people across the country have been charged in connection with $1.3 billion in healthcare fraud losses as part of what the federal government has labeled the largest enforcement action of its kind in U.S. Department of Justice (DOJ) history. United States Attorney General Jeff Sessions and U.S.…
By
All of the talk in the news about obstruction of justice should serve as a reminder of the importance of knowing what you can and can’t do when a government investigation begins.  Several actions that may sound entirely normal and seem legal can be characterized as obstructing justice. For example,…