Here is the relevant text in the Change: 3.14 – Clinical Review Judgment (CRJ) (Rev. 338, Issued: 05-14-10, Effective: 04-23-10, Implementation: 06-15-10) A. Contractors to Which This Section Applies This section applies to ACs, MACs, CERT, RACs, PSCs, and ZPICs, as indicated below. B. General The CRJ involves two steps: (1) the synthesis of all […]

The Affordable Care Act: New Tools to Fight Fraud, Strengthen Medicare and Protect Taxpayer Dollars The Affordable Care Act will improve and expand consumer protections, strengthen Medicare, and reduce health care costs. One important way it achieves these goals is by improving government-wide efforts to fight fraud and waste. The new law contains some critical […]

The following resources are easily reached via the listed links: HealthcareReform.gov – archived main site for reports, timelines, news reports and contacts. After the Affordable Care Act became law, this site was launched to provide resources. Healthcare.gov Reports on Health Reform: HHS Reports (archived) Health Care Video Chats (archived) Online Series on Health Reform (archived) […]

Procedures That Will Only be Paid as Inpatient CY 2010 This is the Federal Register/Vol. 74, No. 223/Friday, November 20, 2009/Rules and Regulations Download Links: CMS Inpatient Only List for CY2010 67.58 kb           IP Only list begins on page 60947 Zip file of all addenda for CY2010 There are 14 […]

Summary Judgement Bars Prosecution of Former Compliance Officer A hospital system’s corporate integrity agreement (CIA) officer and in-house counsel successfully argued that the statute of limitations barred a False Claims Act (FCA) complaint against her, according a ruling filed by U.S. District Court for the Southern District of Florida (Court), dated April 16, 2010. The […]

Text of the Patient Protection and Affordable Care Act This bill was enacted after being signed by the President on March 23, 2010. Read the text of the bill as of Aug 25, 2010 (Passed Congress/Enrolled Bill).   For more links and information, or to research current legislation visit The Library of Congress

CMS Health Information Technology (HIT) Links and Documents   Health Information Technology The American Recovery and Reinvestment Act of 2009 (Recovery Act) was signed into law by President Obama on February 17, 2009. The law includes the Health Information Technology for Economic and Clinical Health Act, or the “HITECH Act,” which established programs under Medicare […]

CMS Announces Payment, Policy Changes for Physicians Services to Medicare Beneficiaries in 2010 Excerpts: The Centers for Medicare & Medicaid Services (CMS) today announced final changes to policies and payment rates for services to be furnished during calendar year (CY 2010) by over 1 million physicians and nonphysician practitioners who are paid under the Medicare […]