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Showing 4 posts from June 2013.

Categorizing Nurses under the Fair Labor Standards Act

There has been a surge of nursing lawsuits in recent years, with nurses arguing they have been denied overtime pay, meal breaks, and fair wages as guaranteed to them by the Fair Labor Standards Act (“FLSA”). The FLSA makes a distinction between exempt and non-exempt employees, with the latter receiving overtime and wage protection. More >

CMS Ruling on Part B Rebilling

Increasingly, Administrative Law Judges (“ALJs”) and the Medicare Appeals Council were upholding Part A denials on RAC audit appeals based on determinations that inpatient admissions were not reasonable and necessary, and then ordering payment under Part B as if services were rendered at an outpatient or “observation level” of care. The problem with this practice is that Medicare Benefit Policy Manual (“MBPM”) allows hospitals to bill a Part B inpatient claim for only a limited set of medical and other health services. Additionally, the providing for payment of all reasonable and necessary Part B services under these circumstances are contrary to CMS policy that the services be billed within the usual timely filing restrictions. The Centers for Medicare & Medicaid Services (“CMS”), concerned about this practice, recently released both a Ruling and a Proposed Rule to seemingly help the hospital community. How much relief it will actually provide is yet to be seen. More >

EHR Systems: Contracting for Change

On Tuesday, I discussed the recent decertification of two EHR Technology systems previously certified under ONC standards and, therefore, ineligible for use to meet “meaningful use” requirements.  Recently, these products failed a retest conducted by an ONC-authorized certification body.  The decertification was the first following the push to adopt EHR Technology to qualify for meaningful use incentives and to avoid an eventual reduction in Medicare program reimbursement. More >

EHR Systems: Is Certification Ever Certain?

The 2009 Health Information Technology for Economic and Clinical Health (“HITECH”) Act provides the Department of Health & Human Services (“HHS”) with the authority to establish programs to improve health care quality, safety, and efficiency through the implementation of health IT, including electronic health record technology (“EHR Technology”). Under HITECH, eligible health care providers can qualify for Medicare and Medicaid incentive payments when they adopt certified EHR technology and use it to achieve specifically outlined objectives, known as “meaningful use" requirements. More >

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