Recent Publications

New Guidance Issued by Medicare Involving Extrapolation
In today’s healthcare climate, many providers have been subject to an audit by Centers for Medicare & Medicaid Services (CMS) whereby CMS (through one of its contractors) requests a sample of records and subsequently determines that the documentation does not substantiate the codes billed. Accordingly, CMS requests that money be “repaid” in connection with the services previously provided and paid. In some instances, CMS limits the overpayment request to those documents it has actually reviewed, while in other instances CMS takes the amount involved and corresponding error rate and “extrapolates” that amount to extend over a larger universe of claims spanning several years, resulting in a significantly increased overpayment demand which can be millions of dollars.

Eliminating Kickbacks In Recovery Act
The newly enacted federal Eliminating Kickbacks in Recovery Act (“EKRA”) impacts the way healthcare providers may compensate certain employees and referral sources. EKRA prohibits healthcare providers from giving or receiving remuneration for referring a patient to a recovery home, clinical treatment facility or laboratory. For purposes of EKRA, a “clinical treatment facility” is defined as “a medical setting, other than a hospital, that provides detoxification, risk reduction, outpatient treatment and care, residential treatment, or rehabilitation for substance use, pursuant to licensure or certification under State law.” A violation of EKRA may lead to fines of up to $200,000 and up to 10 years imprisonment. Accordingly, healthcare providers should evaluate the structure of their current arrangements with certain employees and referral sources.

Greenway Health, LLC Improper EHR Calculation
The NY Medicaid Electronic Health Records (“EHR”) Incentive Program (now known as the Promoting Interoperability Program) provides eligible professionals and hospitals with incentive payments as they demonstrate adoption, implementation, upgrading, or meaningful use of certified EHR technology. The purpose of the program is to support providers as they transition to and integrate the use of EHRs in meaningful ways, with an overarching goal to help improve the quality, safety, and efficiency of patient health care. In their first year, all providers will be required to attest to adoption, implementation, or upgrade of certified EHR technology.

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