March 18, 2022 | By Rachel Rose, JD, MBA Enacted in 1972, the Anti-Kickback Statute (42 U.S.C. § 1320a-7b(b)) remains a government enforcement favorite, despite being described by some as archaic. As articulated by the U.S. Department of Health and Human Services – Office of the Inspector General (HHS-OIG), “[t]he five most important Federal…
January 21, 2022 | By Sean Weiss, CHC, CEMA, CMCO, CPMA, CPC-P, CMPE, CPC While I am sure you have heard it several dozen times by now, I want to welcome you to 2022 because that is where the pleasantries end. 2022 will see Medical Necessity put front & center not only in audits…
September 24, 2021 | By Sean Weiss, CHC, CEMA, CMCO, CPMA, CPC-P, CMPE, CPC Sean Weiss, DoctorsManagement Partner and Vice President of Compliance recently sat down with Ronald Chapman II, Esq. LLM of The Chapman Law Group to discuss and break down the Biden-Harris Executive Order and its impact on approximately 100 million American…
August 6, 2021 | By Sean M. Weiss, CHC, CMCO, CEMA, CPMA, CPC-P, CMPE, CPC 2021 has lived up to what, in my mind, I’ve dubbed back in December of 2020 “The Year of The Audit”. The number of “raids”, resolution agreements, settlement agreements, and audits by RACs, SMRCs, UPICs, and SIUs have…
July 23, 2021 | By Rachel Rose, JD, MBA In June 2021, the U.S. Department of Health and Human Services Office of the Inspector General (HHS-OIG) issued Issue Brief, OEI-01-20-00220 (hereinafter “Issue Brief”), which highlighted the results of its review of cybersecurity for networked medical devices in hospitals. The impetus behind the review was…
April 23, 2021 | By By Rachel Rose, JD, MBA Early in 2019, the U.S. Department of Health and Human Services – Office for Civil Rights (HHS-OCR) announced the creation of an initiative to target violations of 45 CFR §164.524(b)(2) for not providing an individual with his/her requested protected health information (PHI) within…
April 9, 2021 | By Amanda Waesch In December 2016, Congress passed the 21st Century Cures Act (often simply called the “Cures Act”). Woven within the Cures Act is Section 4004 titled “Information Blocking.”[1] The purpose of this section is to prohibit any action or practice that interferes with or prevents access to electronic…
January 22, 2021 | By Sean M. Weiss, CHC, CMCO, CEMA, CPMA, CPC-P, CMPE, CPC Welcome to 2021, “y’all” – as we say down yonder in the beautiful South! Let me begin by making it clear that the issues discussed in this article are not specific to any particular commercial or federal healthcare payer…
January 8, 2021 | By David Glaser In early December, the Centers for Medicare and Medicaid Services (CMS) issued new rules that dramatically revise the Physician Self-Referral Law, commonly called the “Stark law” after Pete Stark, the Congressman credited with introducing it. While many of the changes loosen the law’s restrictions, focused particularly on…
December 15, 2020 | By By Grant Huang, CPC, CPMA At long last, CMS has published its Medicare Physician Fee Schedule (PFS) final rule, and while some of the provisions will be widely felt across many specialties, there are no major or unexpected deviations from the proposed rule. The agency typically releases the PFS…