Roger Steven's Blog – May 2017 Archive (7)

When structuring and auditing medical director and administrative agreements; the provisions of the Stark Law need to be taken into careful and full consideration. This is because the Stark Law is the operative law for this kind of arrangement.

Implementation of best practices for negotiating and drafting administrative arrangements on behalf of health systems, hospitals, medical groups and…

In this age of outsourcing and globalization, and with it, the emerging potential phenomenon of the Internet of Things (IoT); it is quite a tempting proposition for HIPAA Business Associates or Covered Entities to think of outsourcing their processes relating to Protected Health Information (PHI). However, as is to be expected, there is risk involved in outsourcing this kind of critical information, given the critical importance of these healthcare records and in view of the fact that there…

MentorHealth webinars are designed to offer professionals in the healthcare industry the knowledge they need in all the areas of the healthcare industry that enables them to excel in their professions. MentorHealth’s trainings bring experts from all the core areas of healthcare and impart learning to help professionals understand and implement all the important issues that matter to their professions. To keep updating your knowledge of regulatory compliance in the healthcare industry, all…

A Claim Adjustment Reason Code (CARC) is a code used in medical billing to communicate a change or an adjustment in payment. CARCs have to be used to communicate why there was a difference between the amount paid in a claim or service line and the amount that was billed against it. CARCS are to be mentioned only if there is an adjustment of this kind. If there is no adjustment to a claim or…

One of the major fallouts of the passage of the Affordable Care Act (ACA) or Obamacare is the phenomenal rise in the number of physician practice acquisitions. These are some of the reasons for this rise:

-        Because of physician practice acquisitions, healthcare providers can consolidate and integrate their business better, since acquisition brings about alignment between the business prospects of the referral networks with the hospital’s strategic goals

-       …

The Comprehensive Error Rate Testing (CERT) is a program used by the Centers for Medicare & Medicaid Services (CMS) for calculating the rate or extent of improper payments of Medicare Fee-for-Service (FFS). The method used by the CMS under CERT is to pick up a stratified random sample of some 40,000 claims that are statistically valid and calculate and audit it to determine if the payments were made in accordance with the rules relevant to items such as coding, Medicare coverage, and…

In many years that it has been in existence, one of the noticeable changes that HIPAA has undergone is in its attitude. The earlier phase of advice and counseling has now given way to hardboiled and unforgiving enforcement. The Office of Civil Rights (OCR) no longer uses the cajoling and persuasive method. It wants to impose super harsh penalties on healthcare organizations which violate its rules.

For starters, healthcare organizations have to reckon with new, ominously higher fines,…