Ruminations on Observation: OIG Report Highlights Inpatient vs. Observation Status

Posted by Judy Mayer on August 22, 2013
Medicaid / No Comments

On July 29, 2013, the OIG released a memorandum report finding that Medicare paid more on average for short inpatient stays than for observation stays in 2012.  The report, Hospitals’ Use of Observation Stays and Short Inpatient Stays for Medicare Beneficiaries, OEI-02-12-00040, touches on observation versus inpatient status, which has been and continues to be a hot button issue.


Medicare beneficiaries receiving care at a hospital are classified as either inpatients or observation patients.  Observation patients are outpatients who receive treatments and assessments to determine whether they require further treatment as inpatients or can be discharged.  CMS policy provides that observation services are usually needed for 24 hours or less.   Continue reading…

About The Author

Tags: , , ,

Are You Prepared? The ACA’s Compliance Program Mandate for All Health Care Providers

Posted by Judy Mayer on April 15, 2013
Affordable Care Act, Medicare / No Comments

While the implementation of compliance programs to encourage the development and use of internal controls to monitor adherence of the health care industry to applicable statutes, regulations, and program requirements has long been considered a best practice, the Patient Protection and Affordable Care Act (“ACA”) has made them mandatory. Continue reading…

About The Author

Tags: , , ,

Highlights of the Omnibus HIPAA/HITECH Final Rule

Posted by Judy Mayer on March 12, 2013
Affordable Care Act, HIPAA, HITECH / No Comments

On January 25, 2013, the Office of Civil Rights (OCR) of the Department of Health & Human Services (HHS) published the long-awaited omnibus final regulation governing health data privacy, security and enforcement (Omnibus Rule).[i]  The Omnibus Rule is a group of regulations that finalizes four sets of proposed or interim final rules, including changes to the Health Insurance Portability and Accountability Act (HIPAA) Privacy and Security Rules mandated by the Health Information Technology for Economic and Clinical Health (HITECH) Act[ii] and proposed in 2010;[iii] changes to the interim final breach notification rule;[iv] modifications to the interim final enforcement rule; and implementation of changes to the Genetic Information Nondiscrimination Act of 2008 (GINA).  The Omnibus Rule goes into effect on March 26, 2013, and compliance is required by September 23, 2013.  As expected, the Omnibus Rule did not finalize the May 31, 2011 proposed regulation regarding accounting for disclosures. Continue reading…

About The Authors

Tags: , , , , , ,

The SMART Act: A Bipartisan Attempt to Make the MSP Act Workable

Posted by Judy Mayer on January 23, 2013
Uncategorized / No Comments

On January 10, 2013, President Obama signed into law H.R. 1845, which includes the Strengthening Medicare and Repaying Taxpayers Act of 2011 (SMART Act).[1] The SMART Act,  amends several portions of the Medicare Secondary Payer (MSP) Act that apply to non-group health plans, including liability (including self-insurance) and no-fault insurance and workers’ compensation plans (together, NGHPs).  Although the SMART Act makes significant substantive and procedural amendments to the MSP Act, many practical issues will continue to bedevil parties who are trying to settle a personal injury claim. Continue reading…

About The Authors

Tags: , , ,

Health Care Providers’ Use of Groupon Stirs Up Controversy

Posted by Judy Mayer on August 01, 2012
Fraud and Abuse / No Comments

Every day Groupon, Living Social, Buy With Me, and a host of other social coupon websites flood  the inboxes of millions of consumers with daily deals.  These websites offer discounts on a variety of products and services, and are extremely popular among restaurants and businesses for their ability to bring in new customers and generate revenue. 

 But what if the deal is for a dental exam, laser vein removal, or Botox® treatments?  The general public probably doesn’t care about the ramifications of using social coupons for health care services, because, let’s face it, everyone likes a great deal.  Health care providers, however, definitely should. 

 Why?  Because, depending on the nature of the daily deal, a health care provider who offers a discount through these types of social coupon websites could be violating federal and/or state laws. Continue reading…

About The Author

Tags: ,

Reading the Tea Leaves in Regard to the Medicare Secondary Payer Act and Future Medicals

Posted by Judy Mayer on July 16, 2012
Medicare / No Comments

On June 14, 2012, the Centers for Medicare & Medicaid Services (“CMS”) released an Advance Notice of Proposed Rulemaking (the “Proposed Rule”) soliciting comments on a proposal to clarify how Medicare beneficiaries and their representatives can protect Medicare’s interests and satisfy their obligations under the Medicare Secondary Payer (“MSP”) Act when “future medical care” is claimed or the settlement, judgment, award, or other payment releases claims for future medical care. Continue reading…

About The Authors

Tags: , ,