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MiraMed’s eAlerts are distributed via email every Wednesday, and contains the latest industry information regarding business process outsourcing solutions, helpful coding news, or any number of relevant topics in the fast-paced, ever-evolving world of healthcare. To subscribe, simply complete the form below. Below the subscription form, you will find the archived eAlerts available.

OIG Turns its Attention to Physician-Owned Distributorships

March 27, 2013

In its first new Special Fraud Alert in the past decade, the Office of Inspector General (OIG) focused its attention on physician-owned entities deriving revenue from selling, or arranging for the sale of, implantable medical devices ordered by their physician-owners, commonly known as physician-owned distributorships or PODs.  The issue of whether PODs are permissible under the Federal fraud and abuse laws has been an issue of debate as of late.  In fact, in light of the controversy, in 2011, the Senate Finance Committee issued letters to the OIG that insisted the two bodies to take a position and issue guidance on PODs and how they fit within the current legal structure governing healthcare transactions and relationships.  The Special Fraud Alert: Physician-Owned Entities (Alert) appears to be a response to the 2011 letter to the OIG.

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CMS’s New Part B Rebilling Rule and its Impact on Hospitals

March 20, 2013

Typically, when a patient presents at a hospital in need of care, the physician (or other qualified practitioner) may either admit the patient for inpatient care or treat the patient as an outpatient.  Oftentimes, when the patients are admitted as an inpatient, an audit conducted by Medicare auditors and contractors (e.g., Medicare Administrative Contractors (MACs), Recovery Auditors (RAs) or Comprehensive Error Rate Testing (CERT) Contractors) results in denial of the Part A claims as not being reasonable and necessary.  Currently, hospitals may bill a subsequent Part B inpatient claim for a limited set of medical and other health services, commonly referred to as “Part B inpatient” or “Part B  only” services, even if additional services furnished would have been medically necessary had the beneficiary been treated as an outpatient.  The American Hospital Association, alongside Missouri Baptist Sullivan Hospital, Munson Medical Center, Lancaster General Hospital and Trinity Health Corporation filed a law suit in November of last year regarding this issue of denials for Part A claims.  

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Strategies for Reducing Hospital Readmissions

March 13, 2013

The issue of reducing hospital readmissions has been one that hospitals and physicians have faced for years.  However, with the passing of the Patient Protection and Affordable Care Act (PPACA), the issue has become much more personal.  Now, hospitals with higher-than-expected readmission rates must be penalized. 

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Are Your Computer and Mobile Networks Secure Enough for Today’s Healthcare Environment?

March 6, 2013

While much of the healthcare world has been focused on the Health Insurance Portability and Accountability Act of 1996 (HIPAA), especially with the release of the new omnibus rule, it is not without good reason.  In a recent publication in the New England Journal of Medicine, Protecting Patient Privacy and Data Security, Julie K. Taitsman, MD, JD, Christi Macrina Grimm, MPA and Shantanu Agrawal, MD—all of who work for the Office of Inspector General (OIG)—state that the issue of privacy and security of patient information is still at the forefront of the government’s focus.

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The Countdown to Sequester and the Impact on Healthcare

February 27, 2013

This Friday, March 1, marks the day in which across-the-board spending cuts (to the tune of $85 billion) take effect.  Regardless of one’s political position and opinion, it is undeniable that the impact on the healthcare industry will be great. This alert summarizes some of the anticipated affects the sequester will have on the industry.

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