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Keeping you afloat admidst the rising sea of regulations

Is Anyone Listening? CMS Appoints Provider Relations Coordinator to Field Gripes about RACs

The CMS announced this week the appointment of a Provider Relations Coordinator “to help increase program transparency and offer more efficient resolutions to providers affected by the medical review process.” The “medical review process” garnering the most attention these days is the Recovery Audit Contractor (RAC) program.

OIG Releases Supplemental Guidance for Bona Fide, Charitable Patient Assistance Programs

On May 21, 2014, the Department of Health and Human Services Office of Inspector General (OIG) released a Supplement Specialty Advisory Bulletin entitled “Independent Charity Patient Assistance Programs” (the Supplemental SAB, available here), to supplement its Special Advisory Bulletin on Patient Assistance Programs for Medicare Part D Enrollees (2005 SAB) (70 Fed. Reg. 70623) (Nov. 22, 2005, available here).

Initiative to Amend California’s Medical Injury Compensation Reform Act Qualifies for the November Ballot

On May 15, 2014, an initiative to amend California’s Medical Injury Compensation Reform Act (MICRA) and other statutes qualified for the November ballot. If passed, the initiative titled “The Troy and Alana Pack Patient Safety Act of 2014,” would make several amendments to California law, including:

New York-Presbyterian and Columbia Hospitals to Pay Record HIPAA Settlement

On May 7, 2014, the US Department of Health and Human Services Office of Civil Rights (OCR) announced settlements with two New York-based hospitals totaling $4.8 million for violations of the Health Insurance Portability and Accountability Act of 1996 (HIPAA) Privacy and Security Rules. The settlements related to the hospitals’ failure to secure the electronic protected health information (ePHI) of thousands of patients held on their networks and are the latest example of OCR’s increased enforcement action.

The Federation of State Medical Boards Adopts Guidelines to Govern the Safety of Telemedicine

On April 26, 2014, the Federation of State Medical Boards approved updated model guidelines addressing the use of telemedicine technology.

Tales from the Unencrypted: DHHS Steps Up Enforcement of Unsecured Electronic Devices

On April 22, 2014, the US Department of Health and Human Services Office of Civil Rights (OCR) announced settlements of close to $2 million with two health care entities for violations of the Privacy and Security Rules promulgated under the Heath Insurance Portability and Accountability Act (collectively HIPAA) related to the theft of unencrypted laptops.

Not So Fast! Federal Court Holds ERISA Plans Can’t Recoup Overpayments without Following Procedural Steps

In an important victory for health care providers, a federal district court in Illinois recently held that health plans may not simply unilaterally recover overpaid funds from health care providers, but rather must provide the appeal and other procedural protections required under the federal Employee Retirement Income Security Act (ERISA) and its implementing regulations.

Medicare Appeals at a Standstill: Providers Convene, Press CMS to Intervene

A December 31 memo from Nancy Griswold, Chief Administrative Law Judge (ALJ) of the Office of Medicare Hearings and Appeals (OMHA), delivered bad news to health care providers and suppliers awaiting resolution of long-standing health care appeals. The news confirmed what many who have waited years to have their cases heard had suspected — that OMHA is buckling under the backlog of 357,000 appeals awaiting adjudication by 64 ALJs across its four regional offices.

Michalski v. Scripps Mercy Hospital: A Win for Both Peer Reviewers and Hospital Boards

Earlier this month, Arent Fox Health Care partner Lowell C. Brown  published an article in California Healthcare News that provides insight into a key peer review case involving legal principles and individual behaviors that provide critical lessons for hospitals.

RAC Audits are Becoming Increasingly Frequent and Costly to Hospitals but Appeals can Succeed

The latest report published by the American Hospital Association (AHA) detailing the results of its RAC Trac survey1 reveals that RAC activity in hospitals has significantly increased in 2013. Not surprisingly, the financial impact of this increased RAC activity has grown substantially as well, both in terms of claims denials and the costs associated with responding to the RACs.