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https://www.readbyqxmd.com/read/27330654/emergency-medical-treatment-and-labor-act-emtala-2002-15-review-of-office-of-inspector-general-patient-dumping-settlements
#1
Nadia Zuabi, Larry D Weiss, Mark I Langdorf
INTRODUCTION: The Emergency Medical Treatment and Labor Act (EMTALA) of 1986 was enacted to prevent hospitals from "dumping" or refusing service to patients for financial reasons. The statute prohibits discrimination of emergency department (ED) patients for any reason. The Office of the Inspector General (OIG) of the Department of Health and Human Services enforces the statute. The objective of this study is to determine the scope, cost, frequency and most common allegations leading to monetary settlement against hospitals and physicians for patient dumping...
May 2016: Western Journal of Emergency Medicine
https://www.readbyqxmd.com/read/27212562/nursing-home-self-assessment-of-implementation-of-emergency-preparedness-standards
#2
Sandi J Lane, Elizabeth McGrady
UNLABELLED: Introduction Disasters often overwhelm a community's capacity to respond and recover, creating a gap between the needs of the community and the resources available to provide services. In the wake of multiple disasters affecting nursing homes in the last decade, increased focus has shifted to this vital component of the health care system. However, the long-term care sector has often fallen through the cracks in both planning and response. Problem Two recent reports (2006 and 2012) published by the US Department of Health and Human Services (DHHS), Office of Inspector General (OIG), elucidate the need for improvements in nursing homes' comprehensive emergency preparedness and response...
August 2016: Prehospital and Disaster Medicine
https://www.readbyqxmd.com/read/26524770/medicare-program-final-waivers-in-connection-with-the-shared-savings-program-final-rule
#3
(no author information available yet)
This final rule finalizes waivers of the application of the physician self-referral law, the Federal anti-kickback statute, and the civil monetary penalties (CMP) law provision relating to beneficiary inducements to specified arrangements involving accountable care organizations (ACOs) under section 1899 of the Social Security Act (the Act) (the "Shared Savings Program''), as set forth in the Interim Final Rule with comment period (IFC) dated November 2, 2011. As explained in greater detail below, in light of legislative changes that occurred after publication of the IFC, this final rule does not finalize waivers of the application of the CMP law provision relating to "gainsharing'' arrangements...
October 29, 2015: Federal Register
https://www.readbyqxmd.com/read/25732445/evolution-in-reimbursement-for-sleep-studies-and-sleep-centers
#4
James M Parish, Neil S Freedman, Scott Manaker
Because of the rapid increase in the volume and costs of polysomnography and other sleep medicine diagnostic services, the Centers for Medicare & Medicaid Services (CMS) recently commissioned the Office of Inspector General (OIG) to review claims submitted for these services. The OIG found numerous cases of inappropriate payment for submitted claims and recommended significant changes in the CMS auditing process for polysomnography claims review. Additionally, a local Medicare Administrative Contractor released the most specific rules and regulations to date regarding billing and payment for sleep medicine services...
March 2015: Chest
https://www.readbyqxmd.com/read/23877460/assessment-of-the-escalating-growth-of-facet-joint-interventions-in-the-medicare-population-in-the-united-states-from-2000-to-2011
#5
Laxmaiah Manchikanti, Vidyasagar Pampati, Vijay Singh, Frank J E Falco
BACKGROUND: Both the Office of Inspector General (OIG) and reports from studies of the utilization of facet joint interventions have expressed that explosive increases in facet joint interventions provided to spinal pain patients are a major concern. STUDY DESIGN: The study is designed to assess the growth of facet joint interventions in managing spinal chronic pain in Medicare beneficiaries from 2000 to 2011. OBJECTIVE: To assess the use of facet joint interventions in chronic pain management...
July 2013: Pain Physician
https://www.readbyqxmd.com/read/23159982/utilization-of-interventional-techniques-in-managing-chronic-pain-in-the-medicare-population-analysis-of-growth-patterns-from-2000-to-2011
#6
REVIEW
Laxmaiah Manchikanti, Frank J E Falco, Vijay Singh, Vidyasagar Pampati, Allan T Parr, Ramsin M Benyamin, Bert Fellows, Joshua A Hirsch
BACKGROUND: Reports from the United States Government Accountability Office (GAO), the Institute of Medicine (IOM), the Medicare Payment Advisory Commission (MedPAC), and the Office of Inspector General (OIG) continue to express significant concern with the overall fiscal sustainability of Medicare and the exponential increase in costs for chronic pain management. STUDY DESIGN: The study is an analysis of the growth of interventional techniques in managing chronic pain in Medicare beneficiaries from 2000 to 2011...
November 2012: Pain Physician
https://www.readbyqxmd.com/read/22996859/cms-proposal-for-interventional-pain-management-by-nurse-anesthetists-evidence-by-proclamation-with-poor-prognosis
#7
REVIEW
Laxmaiah Manchikanti, David L Caraway, Frank J E Falco, Ramsin M Benyamin, Hans Hansen, Joshua A Hirsch
The Office of Inspector General (OIG), Department of Health and Human Services (HHS), in a 2009 report, showed that unqualified nonphysicians performed 21% of the services. These nonphysicians did not possess the necessary licenses, certifications, credentials, or training to perform the services. Since the time the medical profession was founded, advances in treatments and technology, as well as educational and training standards, have promoted a desire to go beyond the basic scope of practice. Many have sought to broaden the scope of practice through legislative efforts and proclamation rather than education and training...
September 2012: Pain Physician
https://www.readbyqxmd.com/read/21323005/oig-report-adverse-events-still-too-common-cms-expand-hac-list
#8
(no author information available yet)
No abstract text is available yet for this article.
January 2011: Hospital Peer Review
https://www.readbyqxmd.com/read/21287774/medicare-medicaid-and-children-s-health-insurance-programs-additional-screening-requirements-application-fees-temporary-enrollment-moratoria-payment-suspensions-and-compliance-plans-for-providers-and-suppliers-final-rule-with-comment-period
#9
(no author information available yet)
This final rule with comment period will implement provisions of the ACA that establish: Procedures under which screening is conducted for providers of medical or other services and suppliers in the Medicare program, providers in the Medicaid program, and providers in the Children's Health Insurance Program (CHIP); an application fee imposed on institutional providers and suppliers; temporary moratoria that may be imposed if necessary to prevent or combat fraud, waste, and abuse under the Medicare and Medicaid programs, and CHIP; guidance for States regarding termination of providers from Medicaid and CHIP if terminated by Medicare or another Medicaid State plan or CHIP; guidance regarding the termination of providers and suppliers from Medicare if terminated by a Medicaid State agency; and requirements for suspension of payments pending credible allegations of fraud in the Medicare and Medicaid programs...
February 2, 2011: Federal Register
https://www.readbyqxmd.com/read/20666182/regulatory-compliance-the-regulatory-framework-for-qualifying-ehr-donations
#10
Daniel F Gottlieb
A healthcare organization considering the roll-out of EHR technology to physicians or other referral sources should prepare a careful plan to assure that the expectations of CMS and/or the OIG are met. In particular, donation recipient selection criteria and the proper allocation of EHR technology acquisition expenses can be complex and fact-specific and prevent one size fits all approaches.
July 2010: Healthcare Informatics: the Business Magazine for Information and Communication Systems
https://www.readbyqxmd.com/read/20562537/medicare-clarified-support-surface-policies-and-coverage-requirements
#11
Kathleen D Schaum
Before providers order pressure-reducing support surfaces for Medicare beneficiaries, they should obtain and read (1) the LCD and attached articles that pertain to their DME MAC jurisdiction and (2) the Special Edition SE1014 educational article released by the Medicare Learning Network of CMS. Providers should be sure that the patient's medical record contains the required order (including the dated and signed physician order) and documentation that proves medical necessity for the support surface ordered...
July 2010: Advances in Skin & Wound Care
https://www.readbyqxmd.com/read/20353602/explosive-growth-of-facet-joint-interventions-in-the-medicare-population-in-the-united-states-a-comparative-evaluation-of-1997-2002-and-2006-data
#12
Laxmaiah Manchikanti, Vidyasagar Pampati, Vijay Singh, Mark V Boswell, Howard S Smith, Joshua A Hirsch
BACKGROUND: The Office of Inspector General of the Department of Health and Human Services (OIG-DHHS) issued a report which showed explosive growth and also raised questions of lack of medical necessity and/or indications for facet joint injection services in 2006.The purpose of the study was to determine trends of frequency and cost of facet joint interventions in managing spinal pain. METHODS: This analysis was performed to determine trends of frequency and cost of facet jointInterventions in managing spinal pain, utilizing the annual 5% national sample of the Centers forMedicare and Medicaid Services (CMS) for 1997, 2002, and 2006...
2010: BMC Health Services Research
https://www.readbyqxmd.com/read/19911510/with-federal-aid-nephrologists-will-benefit-from-evolving-technologies
#13
Terry L Ketchersid
As we approach the end of the first decade of the 21st century, we are witnessing the confluence of a number of factors that, taken together, have the opportunity to fulfill the promise of health information technology. CMS is bringing substantial financial pressure to bear through ARRA, PQRI, and the e-prescribing initiatives. The OIG safe harbor and the Stark exception for EHR donations facilitate the provision of additional incentives to many nephrologists. Technological advances related to speed, interoperability, and mobile platforms are converging to allow EHRs to offer the right information at the right time to support the nephrologist's delivery of the best care possible to an increasingly complex patient population...
October 2009: Nephrology News & Issues
https://www.readbyqxmd.com/read/19165296/analysis-of-growth-of-interventional-techniques-in-managing-chronic-pain-in-the-medicare-population-a-10-year-evaluation-from-1997-to-2006
#14
Laxmaiah Manchikanti, Vijay Singh, Vidyasagar Pampati, Howard S Smith, Joshua A Hirsch
BACKGROUND: Recent reports of the United States Government Accountability Office (GAO), the Medicare Payment Advisory Commission (MedPAC), and the Office of Inspector General (OIG) expressed significant concern with overall fiscal sustainability of Medicare and exponential increase in costs for interventional pain management techniques. Interventional pain management (IPM) is an evolving specialty amenable to multiple influences. Evaluation and isolation of appropriate factors for increasing growth patterns have not been performed...
January 2009: Pain Physician
https://www.readbyqxmd.com/read/19068869/what-does-the-future-hold-for-hospice-in-the-present-envirornment
#15
Janet E Neigh
This has been a monumentalyear for Medicare Hospice Benefit (MHB) providers. Rapid growth in expenditures ($10 billion in 2007) and anticipated doubling of that figure in the next 10 years has drawn more attention, notably from the Centers for Medicare & Medicaid Services (CMS), the Congress, the Medicare Payment Advisory Commission (MedPAC), and Office of Inspector General (OIG). In 2007, about 40 percent of Medicare decedents used hospice compared to about 27 percent in 2000. Between 2004 and 2005, spending on hospice increased by 20 percent as compared to about a nine percent increase for overall Medicare spending...
November 2008: Caring: National Association for Home Care Magazine
https://www.readbyqxmd.com/read/18972999/recent-hospital-charity-care-controversies-highlight-ambiguities-and-outdated-features-of-government-regulations
#16
Charles MacKelvie, Michael Apolskis, James J Unland
For years the hospital industry has been embroiled in controversies involving pricing, charity care, and collection practices. Unfortunately, Medicare regulations and policies governing hospital charge-setting and collection practices have not helped bring much clarity to the situation, nor has related CMS and OIG guidance. Coordinated effort by hospitals and regulatory bodies can help clarify unclear government regulation of charity care, pricing, and collections and end potentially destructive controversies that sap valuable time, energy, and resources from efforts addressing much graver long-term threats to hospital viability...
2005: Journal of Health Care Finance
https://www.readbyqxmd.com/read/17966313/oig-critical-of-cms-oversight-of-the-medicare-hospice-benefit
#17
Janet E Neigh
No abstract text is available yet for this article.
August 2007: Caring: National Association for Home Care Magazine
https://www.readbyqxmd.com/read/17444082/medicare-retiree-drug-subsidy-compliance-considerations
#18
Ed Pudlowski
Employers and plan sponsors have struggled with many issues associated with Medicare's retiree drug subsidy program. Recent reviews of employer methods for collecting the subsidy from the Centers for Medicare and Medicaid Services (CMS) identified significant gaps that would affect the subsidy payment and create issues in case of an audit. In fact, the Department of Health and Human Services Office of Inspector General (OIG) has placed audits of employer retiree drug subsidy processes in its work plans for 2006 and 2007...
2007: Benefits Quarterly
https://www.readbyqxmd.com/read/17288067/estimating-payment-error-for-medicare-acute-care-inpatient-services
#19
W Mark Krushat, Anita J Bhatia
CMS recently assumed responsibility for estimating the Medicare fee-for-service (FFS) error rate from the Office of the Inspector General (OIG). Here, the method used to calculate national, by State, and by error type, estimates for the inpatient acute care portion of this rate is presented. For fiscal years (FYs) 1998 and 2000 discharges, national estimates for the net error rate were 2.6 and 2.8 percent, respectively, about $2 billion annually. Wide variation in State rates illustrates that estimates to the State level are essential for targeting and monitoring interventions to reduce improper Medicare inpatient acute care reimbursements...
2005: Health Care Financing Review
https://www.readbyqxmd.com/read/16496506/regulatory-changes-that-affect-coding-for-immunotherapy
#20
J Spencer Atwater
BACKGROUND: During the past decade, a variety of federal regulations have had a significant impact on the way allergen immunotherapy is reimbursed and how Current Procedural Terminology (CPT) codes are used for this purpose. As mandated by the US Congress, the Centers for Medicare and Medicaid Services (CMS) through the Office of the Inspector General (OIG) targeted immunotherapy codes for scrutiny, because they are some of the most frequently used codes. OBJECTIVE: To examine how federal regulations have affected reimbursement for allergy immunotherapy and other allergy services...
February 2006: Annals of Allergy, Asthma & Immunology
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