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CMS Issues Final Rule Governing the Return of Overpayments within 60 Days Print E-mail
Written by   
Thursday, 18 February 2016 00:00

On February 11, 2016, the Center for Medicare and Medicaid Services (CMS) issued the much-anticipated final rule concerning Section 6402(a) of the Affordable Care Act, the so-called "60 Day Rule". This section requires Medicare and Medicaid providers, suppliers and managed care contractors to report and return an overpayment by the later of "60 days after the date upon which the overpayment was identified or the date any corresponding cost report was due, if applicable." CMS delayed adopting the rule to address public comments concerning, among other things, (1) the meaning of "identify" (i.e., what starts the 60-day clock); and (2) the length of the "lookback period." This rule is of critical importance to healthcare providers seeking to avoid liability for reverse false claims under the False Claims Act (FCA).

Under the new regulation, 42 C.F.R. ยง 401.305, the 60-day clock starts when a provider has identified an overpayment, which is defined as "when the person has, or should have through the exercise of reasonable diligence, determined that the person has received an overpayment and quantified the amount of the overpayment. A person should have determined that the person received an overpayment and quantified the amount of the overpayment if the person fails to exercise reasonable diligence and the person in fact received an overpayment." Backing off from the proposed 10-year lookback period, CMS finalized a 6-year lookback period.

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Additional Guidance to the Medicare EHR Incentive Program Hardship Exception Process Print E-mail
Written by HealthFusion   
Thursday, 04 February 2016 00:00

As we mentioned in our blog post, How the Feds Botched Meaningful Use, Part 2, Congress recognized the impact that CMS' delayed rule-making in the final quarter of 2015 had on providers and vendors, and acted in bipartisan fashion. The "Patient Access and Medicare Protection Act" (PAMPA), Pub. L. No. 114-115 was signed into law by President Obama on December 28, 2015, which includes a number of Medicare provisions designed to reduce burdens on clinicians, hospitals and critical access hospitals (CAHs) These provisions are part of an ongoing effort to "smooth things over" and improve the Medicare EHR Incentive Program on the part of CMS.

The law will extend the deadline and streamline the application process for the hardship exception from Meaningful Use penalties by reducing the amount of information that must be submitted to apply for an exception.

Legal Issues Relating to Telemedicine Expected to Increase Print E-mail
Written by The Health Law Offices of Anthony C. Vitale   
Monday, 25 January 2016 00:00

While the days of the Marcus Welby house call have, for the most part, been relegated to the history books, technology has spawned another kind of house call - telemedicine. Although the use of electronic communications between doctor and patient has been gaining ground in recent years, many barriers to treatment via telemedicine continue to exist depending on where it is being practiced.

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Last Updated on Tuesday, 26 January 2016 18:57
Government's Antitrust Activity Sends Confusing Signals to Healthcare Entities Print E-mail
Written by FHI's Week in Review   
Tuesday, 29 December 2015 17:33

Two back to back reports from detail antitrust activities in PA and IL:

The Federal Trade Commission
and Pennsylvania Attorney General have challenged the proposed combination of The Penn State Hershey Medical Center and PinnacleHealth System in Harrisburg, Pennsylvania, alleging that the combination would create a dominant provider, reduce the number of competing health systems in the area from three to two, and result in a 64 percent share of the market for general acute care inpatient hospital services.
Meanwhile, in a 12.23.15 post entitled FTC Challenges Chicago-Area Health System Combination
The Federal Trade Commission (FTC) has issued an administrative complaint challenging the proposed combination of Advocate Health Care Network (Advocate) and NorthShore University Health System (NorthShore) in the Chicago area as a violation of both FTC Act Section 5 and Clayton Act Section 7. The FTC, joined by the Illinois Attorney General, also filed a complaint in federal district court in Chicago seeking a temporary restraining order and preliminary injunction to prevent Advocate and NorthShore from consummating their merger pending completion of the FTC's administrative trial on the merits of the transaction.

Read more in the current issue of Week in Review

Last Updated on Sunday, 10 January 2016 16:59
EPCS: Understanding the Regulations Print E-mail
Written by Seth Flam, DO   
Thursday, 10 December 2015 00:00

On June 1, 2010 the government enacted the Electronic Prescriptions for Controlled Substances law. The purpose of the EPCS law was to revise DEA regulations to provide practitioners with the option of transmitting prescriptions for controlled substances electronically. In fact, you may have received a letter from the DEA in 2010 that said a law was passed that allowed for EPCS. Legally, there was a path to EPCS but the law was just the first baby step toward that goal. The letter that most providers received was misleading, though, because it presented the notion that EPCS was an immediate possibility - but that was just not true. The passage of the law made EPCS theoretically possible, but at that time the ecosystem was not even close to being ready. It has taken a full five years for the EPCS ecosystem to mature.

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