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Archive for September, 2009

Detroit Rehab Pleads Guilty: $18.2 Million PT Fraud Scheme

September 30, 2009 0 Comments
Detroit Rehab Pleads Guilty: $18.2 Million PT Fraud Scheme

 The indictment of a Detroit area sham therapy operation was announced this summer, and in a United States Department of Justice (USDOJ) press release on Monday, the main conspirator plead guilty to a $18.2 million scheme to defraud the Medicare program.  According to the DOJ press release “…Chand admitted that in order to create the […]

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NGS Announces “Virtual” Medicare University Convention

September 25, 2009 0 Comments
NGS Announces “Virtual” Medicare University Convention

National Government Services (NGS) has posted the schedule for their first ever virtual Medicare University Convention to be held November 16-20, 2009.  Last year this convention was held as a live event in Indianapolis, and citing the significant savings in travel and expense, NGS has announced a reduction in the registration fee from $175 to […]

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CMS DME Accreditation Requirements – PT & OT Exemptions

September 24, 2009 1 Comment
CMS DME Accreditation Requirements – PT & OT Exemptions

There seems to be a bit of panic spreading in the therapy community, that is more of a misunderstanding regarding the standing of private practice therapists providing DME supplies for their patients.  There seems to be a particular concern for those providing hand therapy services including splints, and wondering if they have to meet the […]

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CMS Issues Final Rule on Recoupment – Impacts RACs

September 23, 2009 0 Comments
CMS Issues Final Rule on Recoupment – Impacts RACs

CMS Issued New “Final” Recouping Regulation, at 42 CFR 405.370, 405.378, 405.379.  The effect of this rule is to shorten providers decision making time in making appeals on overpayment demands.    Recouping involves a Medicare Contractor holding back reimbursement to offset monies that a provider is deemed to owe to the Medicare Program.  According to CMS […]

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Does Your RAC Know How to Contact You?

September 21, 2009 0 Comments
Does Your RAC Know How to Contact You?

With the Region A RAC adding three issues over this past weekend, including a new issue of Pharmacy Supply and Dispensing Fees, all four of the Recovery Audit Contractors are now on board with automated review underway.  During the RAC roll-out process, often referred to as ‘town hall meetings” CMS as well as the four […]

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Recovery Audit Contractors & Local Coverage Determinations for Therapy

September 17, 2009 0 Comments
Recovery Audit Contractors & Local Coverage Determinations for Therapy

 Automated reviews of rehab untimed codes are underway by the Recovery Audit Contractors in Region C & Region D.  It is entirely possible that rehab providers have received recoupment letters as you read this.  Simultaneously within CMS the conversion from fiscal intermediaries and carriers to the Medicare Administrative Contractor format has resulted in the development/conversion […]

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Physician Supervision in Hospital OP Settings – Rehab Implications

September 9, 2009 0 Comments
Physician Supervision in Hospital OP Settings – Rehab Implications

On July 20, 2009, CMS published a proposed rule regarding the Medicare Hospital Outpatient Prospective Payment System (HOPPS) for CY 2010.  Among other items, the Proposed Rule addresses “long-standing” physician supervision requirements for hospital outpatient diagnostic and therapeutic services. From 42 CFR 410.27(f) “Services furnished at a provider-based department of a hospital must be furnished […]

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Connolly, RAC Region C, Untimed: Alabama & Georgia

September 9, 2009 0 Comments
Connolly, RAC Region C, Untimed: Alabama & Georgia

The Region C RAC (Connolly) has posted approved issues for two new states, including the addition of untimed codes for Alabama & Georgia.  Connolly originally posted the CMS approved issue of untimed codes for automated reviews for South Carolina, and shortly after added the issue for Florida.

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