Thursday, February 27, 2014

The Waiting Game: Reprieve on New RAC Requests and
Insight from the Office of Medicare Hearings and Appeals
Appellant Forum

Two recent developments leave healthcare providers with some welcome relief but much uncertainty in the Medicare claims audits and appeals arena. Effective on February 21, 2014, CMS ordered Recovery Audit Contractors ("RACs") to temporarily stop all medical record requests amid complaints from the provider community about RACs in particular and the overburdened appellate system generally. This development followed the Office of Medicare Hearings and Appeals ("OMHA") hosting a highly anticipated Medicare Appellant Forum ("Forum") on February 12, 2014 in Washington, D.C. to provide an opportunity for appellants to communicate and share ideas directly with OMHA in light of crippling delays in the appeals process. OMHA officials explained multiple factors behind the delays of more than two years in processing hearing requests and offered several initiatives in development to bring greater efficiency and transparency to the process. However, an appellant community looking for immediate fixes expressed its dissatisfaction with seemingly distant solutions. 

Wednesday, February 19, 2014

Regulation, Suboxone Clinics & Unintended Consequences

As we all know, prescription drug abuse is a significant problem in Kentucky; so significant that the Kentucky Legislature enacted the toughest and most cumbersome requirements for prescribing controlled substances in the United States.  By authorizing the Kentucky Board of Medical Licensure through its regulatory process to promulgate additional standards for prescribing, Kentucky’s physicians have become the most regulated and policed of any in the country and probably the entire Western Hemisphere.  In 2013, the number of Kentucky deaths from overdoses of controlled substances actually declined for the first time in many years.  Some have suggested that the decline is a direct result of the stringent prescribing regulations, but this is pure speculation.

Friday, February 7, 2014

Coming to a Medical Practice Near You: HIPAA and Hi-Tech Audits

On December 26, 2013, the U.S. Health and Human Services Office of Civil Rights announced its first settlement with a covered entity for not having policies and procedures in place to address the breach notification provisions of the Health Information Technology for Economic and Clinical Health Act. Adult & Pediatric Dermatology, P.C., of Concord, Massachusetts agreed to settle potential violations with a $150,000 penalty and corrective action plan.