Health Law Blog

The American Recovery and Reinvestment Act of 2009, in Section 13411 of the HITECH Act, requires the Department of Health and Human Services (HHS) to provide for periodic audits to ensure covered entities and business associates are complying with the HIPAA Privacy and Security Rules and Breach Notification Standards.  The HHS Office for Civil Rights (OCR) is piloting a program to perform up to 150 audits of covered entities that will conclude by December 2012.

I'm pleased to announce that as general counsel to the Pennsylvania Chiropractic Association (PCA), I am spearheading a seminar to help PA chiropractors understand the issues and trends regarding audits, coding and reimbursement.  I have put together a great lineup of speakers, including David Klein, CPC, CHC, a Highmark representative from the Financial Investigations and Provider Review Department, and lawyers with expertise in Workers' Compensation and Personal Injury.  The seminar is scheduled for Saturday, November 12, 2011, and it is to be held near Harrisburg, PA.  Early signups before October 20, 2011 receive a 20% discount.  You can download the seminar brochure and registration form by clicking on the button below. 

CMS Recovery Auditors

The Centers for Medicare and Medicaid Services (CMS), which protects the Medicare Trust Fund from improper payments, is now using Comparative Billing Reports to educate providers.  Comparative Billing Reports reveal utilization patterns and provide comparative data on how one individual health care provider varies from other providers within their state and across the nation.  CMS then communicates these findings to the providers by written correspondence.  Essentially, the Comparative Billing Report (CBR) is used to show that a health care provider’s billing patters are excessive or otherwise outside the norm. 

Federal Court Says ERISA Completely Preempts Breach of Contract and Fraud in the Context of Post-Payment Reviews and Audits

In 2006, Medicare inappropriately paid a total net $178 million (out of $466 million) for chiropractic claims for services that were maintenance therapy ($157 million), mis-coded ($11 million), or undocumented ($46 million).  Another study indicated that 83% of all chiropractic claims failed to meet one or more of the documentation requirements.  Of the 76% of records that reviewers indicated contained some form of treatment plan, 43% lacked treatment goals, 17% lacked objective measures, and 15% lacked the recommended level of care.  A medical reviewer indicated, “in my twenty-nine years of practice, I rarely saw documentation of a plan which included frequency, duration, goals and objective measures.  While these guidelines are in the Medicare manual, they apparently have not been incorporated into the profession.”