OIG Cites Overpayments to Inpatient Rehabilitation Facilities

 

Fiscal intermediaries overpaid inpatient rehabilitation facilities more than $34 million during fiscal years 2004 and 2007, estimates the U.S. Office of Inspector General (OIG) in a recent report. The overpayments pertained to transfers that were improperly coded as discharges. The rehabilitation facilities generally attributed the miscoded claims to clerical errors and a lack of knowledge of where beneficiaries went after leaving their facilities.

Under Medicare’s transfer regulation, Medicare pays the full prospective payment to inpatient rehabilitation facilities that discharge beneficiaries to their homes. In contrast, Medicare pays a lesser amount for a transfer case, based on a per diem rate and the number of days that the beneficiary stayed in the rehabilitation facility.

According to the OIG final report, the Centers for Medicare & Medicaid Services plans to identify and recover overpayments to inpatient rehabilitation facilities. >read more>

Medicare to Eliminate Reimbursement of Consultation Codes in 2010

Effective January 1, 2010, CMS will eliminate reimbursement for all consultation CPT/HCPCS codes. This will include inpatient hospital consultation codes (99251-99255) and office/outpatient consultation codes (99241-99245).  Billing providers are to report initial hospital care (99221-99223), initial nursing facility care (99304-99306), initial office/outpatient visits (99201-99205) or established patient office/outpatient visits as appropriate based on the place of service and patient type/situation.  (Telehealth consultation G-codes (G0406-G0408) will remain).
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Medicare Advantage Health Plans Face Increased Scrutiny

As of Jan. 12, 2009, CMS forced suspension of WellPoint, Inc. Medicare Advantage (MA)plans and Part D marketing and enrollment until problems with member's access to prescription drugs and other identified issues are resolved. This suspension is the first of many to hit MA insurance plans. MA Plans must increase their compliance activities and awareness.
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CMS Approves RAC Audit Process Implementation- Providers Must Get Ready

Although there had been a temporary delay due to the protest of the award of the Recovery Audit Contractor (RAC) contracts, the protests were settled on February 4, 2009. The settlement means that the delay has been stopped and CMS will continue with the implementation of the RAC program. Get ready today!
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HIPAA Security Enforcement Becoming Much More of a Reality

It is difficult to remember a time without HIPAA Rules, yet, only a few years have passed since implementation of the HIPAA Security Rule. Not surprising are the number of health industry reports indicating many covered entities are not yet, years later, compliant with all of the specifications of the Security Rule. Get ready to respond to greater HIPAA scrutiny.
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Sinaiko Healthcare Consulting, Inc. is pleased to announce the hiring of Curtis Bernstein.  

Mr. Bernstein joins the firm as a Director. 

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Davina Lane and Derek Woo are quoted in the May 2010 issue of Managed Healthcare Executive.

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Michael Sullivan discusses the benefits of electronic health records and interoperable systems.

Playing Catch-up in Health Care Technology
By Michael Sullivan
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Sinaiko Healthcare Consulting is pleased to announce the published work of Dinh Nguyen and Jeffrey Sinaiko in The Health Care Compliance Professional's Manual.

Delivery of Behavioral and Mental Health Services in the US: Funding, Legal and Regulatory Challenges.
By Dinh Nguyen, Kathy Drummy & Jeffrey Sinaiko
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Sinaiko Healthcare Consulting, Inc. partners with Compliance 360 to provide comprehensive compliance, risk managment and claims audit solutions for the healthcare industry.
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Sinaiko Healthcare Consulting, Inc. advises Rockwood Clinic in transaction with subsidiary of Community Health Systems
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Sinaiko Healthcare Consulting, Inc. is pleased to announce the hiring of Kelly Nueske.  Ms. Nueske joins the firm as Director of Risk Management Services. 
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Sinaiko Healthcare Consulting, Inc. was named to Nightingale's Healthcare News' 2009 list of Full Service Healthcare Consulting Firms.
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Jeff Sinaiko interviewed on AMA's American Medical News on XM Radio.

June 15, 2009.

www.ama-assn.org/amednews/site/radio.htm

Sinaiko Healthcare Consulting is pleased to announce the published work of Jeff Sinaiko and Greg Endicott in this year's 2009 Health Law and Compliance Update.
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Please view Chapter 4: Fair Market Valuations in Health Care: A Better Understanding Breeds Better Compliance.
By Jeff Sinaiko & Greg Endicott.