Healthcare Regulatory Update 2009
Hospital Services
• CMS - more accurate payments for
Inpatient Rehabilitation Services in FY09
• CMS - Medicare Premiums / Deductibles for 2009
• IRS Instructions for New Form 990
• Hospital Inpatient PPS full basket rate of 3.6%
• Medicare Improvements for Patients and
Providers Act of 2008 (MIPPA)
• CMS - 3 Conditions to 'Never Events'
Physician/Ambulatory Services
• MIPPA requires accreditation for advanced imaging services
• Prepare for claims transaction system upgrade
to 5010 HIPAA electronic standard
• MedPAC - prior authorization for imaging services
Compliance Regulations
• OIG Advisory Opinion Hospital and Surgeons can Invest in ASC
• CMS Bans MD Signature Stamps on Medical Records
• Hospital Outpatient Rebilling Limited under RACs
• Recovery Audit Contractors (RACs) National
Implementation
Healthcare Services
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Healthcare Regulatory 2009 Update
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2009 Diagnosis Code Changes
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2009 HAC & POA Indicator Reporting
Preparing for the RACs
Top 10 RAC/OIG Targets
OIG Work Plan
Employee Benefit Plan Alert: Fiduciaries must focus on Plan Fees
The Potential Liability of Self-Funded Health Insurance Plans
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Health Claims Authorization, Processing and Payment Act
Healthcare Organizations Start to Adopt Sarbanes-Oxley Regulations
The OIG Stresses the Importance of Internal Controls for Hospitals to Reduce Risk
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October 2008 Program
Presented by
Amper’s Healthcare Services Group
Regulatory Update
- CMS Adds Three Conditions to "Never Events"
- CMS Announces More Accurate Payments for Inpatient Rehabilitation Services in FY09
- IRS Issues Instructions for New Form 990
- HHS Proposes Adoption of ICD-10 Code Sets and Updated Electronic Transaction Standards
- Moody's Says Operating Performance for Hospitals Good in FY07, Cautions for Future
- CMS Announces Medicare Premiums, Deductibles for 2009
- HHS Takes New Steps to Accelerate Adoption of Electronic Prescribing
- Hospital Inpatient PPS full basket rate of 3.6%
- A reduction of 2% for a hospital that does not submit quality data
- Medicare Improvements for Patients and Providers Act of 2008 (MIPPA)
- "Never Events" Responsible for One Out of Six Professional Liability Claims
- MIPPA requires accreditation to perform advanced imaging services
- Boost revenue to cope with tough times
- MA Enrollment hits an all-time high
- Countdown begins for ICD-10
- The update to the physician fee schedule contains new modifiers for sleep test codes
- Physicians are exempt from DMEPOS accreditation
- Revised ABN deadline to March 2009
- CMS suspends the Competitive Acquisition Program (CAP)
- Artificial hearts will be covered in clinical trial
- Prepare for claims transaction system upgrade to 5010 HIPAA electronic standard
- MedPAC discusses prior authorization for imaging services
- ASC services paid at a 50/50 blend of the 2007 ASC payment and the 2009 ASC payment (i.e., 65% of the hospital outpatient rate)
- OIG Advisory Opinion Hospital and Surgeons can Invest in ASC
- CMS Narrows "Stand in the Shoes" - Stark
- Case Management protocol for Hospital Admissions
- CMS Bans MD Signature Stamps on Medical Records
- Recovery Audit Contractors (RACs) National Implementation
- Attorney Client Privilege is not at Risk under new DOJ Guidelines
- CMS Deploys Data Analysis Tools
- Hospital Outpatient Rebilling Limited under RACs
- OCR Releases Guidelines on Sharing Information with Family and Friends
- Billing for Consultations versus Transfers of Care
- OIG Workplan Targets Provider-Based Status
- CMS Reveals Majority of MUEs
Amper’s Healthcare Services Group
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