OIG Report on Non-Physicians Performing Medicare Physician Services Download the full OIG Report, HERE. (PDF Format, 40 pgs, 1,070 KB) The following is directly quoted from the report: EXECUTIVE SUMMARY OBJECTIVES For days that Medicare allows more than 24 hours of services billed by a single physician: Identify the services physicians bill to Medicare but […]

Are you in the business of offering or maintaining personal health records? Does your company offer products or services that interact with personal health records – for example, an online weight tracking program that sends information to a personal health record or pulls information from it? If that describes your line of work – and […]

Breach Notification for Unsecured Protected Health Information Published by HHS in Federal Register on 08/24/09 Includes: 45 CFR Parts 160 and 164 RIN 0991–AB56 Human Services (HHS) is issuing this interim final rule with a request for comments to require notification of breaches of unsecured protected health information. Section 13402 of the Health Information Technology […]

Three papers summarizing possible options for health system reform, coverage reform and financing reform were released recently by the Senate Finance Committee. The papers summarize a large variety of potential reform mechanisms, as part of Chairman Baucus’ and Ranking Member Chuck Grassley’s (R-IA) health reform effort. “Transforming the Health Care Delivery System: Proposals to Improve […]

The RAC Appeals Process is not too different from Medicare’s standard Appeals Process. CMS offers this explanation of the process.  We have pulled out the most useful links for providers: New Final Rule dated January 17, 2017 updates portions of the Appeals Process. Read the Rule in the Federal Register.  A booklet from MLN explaining […]

May 2009: CMS issued a sample Demand Letter from a RAC. This particular letter is a demand relating to a Complex Review for a Part A Medicare Claim. Sample Demand Letter (PDF format, 5 pgs, 46 KB)

Links to all Chapters and Crosswalks. The Internet-only Manuals (IOMs) are a replica of the Agency’s official record copy. They are CMS’ program issuances, day-to-day operating instructions, policies, and procedures that are based on statutes, regulations, guidelines, models, and directives. The CMS program components, providers, contractors, Medicare Advantage organizations and state survey agencies use the […]

Medicare Program Integrity Manual Links to all Chapters and Exhibits. The Internet-only Manuals (IOMs) are a replica of the Agency’s official record copy. They are CMS’ program issuances, day-to-day operating instructions, policies, and procedures that are based on statutes, regulations, guidelines, models, and directives. The CMS program components, providers, contractors, Medicare Advantage organizations and state […]

Medicare Internet-Only Manuals Links to all Manuals. The Internet-only Manuals (IOMs) are a replica of the Agency’s official record copy. They are CMS’ program issuances, day-to-day operating instructions, policies, and procedures that are based on statutes, regulations, guidelines, models, and directives. The CMS program components, providers, contractors, Medicare Advantage organizations and state survey agencies use […]