Wachler & Associates

Medicare Eases Rule on Termination of Provider Medical Records Review

Medicare providers and suppliers targeted for prepayment complex medical review understand the financial burden that review of records prior to payment places on a medical practice. Prior to the Medicare Prescription Drug, Improvement and Modernization... Read >

Medicare’s Anti-Markup Rule-Partially Delayed Until 2009

On December 28, 2007, the Centers for Medicare and Medicaid Services (CMS) displayed a final rule announcing that it was delaying the effective date of the majority of the newly revised anti-markup rule until January 1, 2009. CMS' announcement came just a... Read >

CMS Finalizes Major Stark Changes

On August 19, 2008, the Centers for Medicare and Medicaid Services ("CMS") published final Stark rules in its 2009 Final Hospital Inpatient Prospective Payment Systems Rule ("Final Rule"). The Final Rule contains several significant modifications to ... Read >

HIPAA Privacy and Security Enforcement: Assessing and Reducing Risks

As of April 14, 2003, covered entities are expected to be in compliance with the HIPAA Privacy Rule and the April 21, 2005 deadline for Security is rapidly approaching. Health care providers and their attorneys are now left wondering where the liability ... Read >

Medicare’s Physician Quality Reporting Initiative: The New Frontier on Pay for Performance

Recently, the Centers for Medicare and Medicaid ("CMS") entered into the pay for performance arena with the Physician Quality Reporting Initiative ("PQRI" or "Initiative") aimed at improving the quality of health care. Participants in the Initiative, whi... Read >

New Evidence of Need Requirements for Participating Ambulatory Surgical Facilities

In order to manage the growth of independent ambulatory surgery facilities ("ASF") throughout Michigan, Blue Cross Blue Shield of Michigan ("BCBSM") created Evidence of Need ("EON") standards for ASFs participating with BCBSM. However, BCBSM recently rev... Read >

Stark II Phase II Is Here – Have You Analyzed Your Health Care Clients’ Financial Relationships?

Introduction When structuring many common business relationships involving health care providers, attorneys must be aware of the myriad of Federal and State laws that may be implicated as a result of the arrangement. The health care industry is heavi... Read >

Third Party Payor Audits – Impact on Physician and Health Care Provider Clients

Overview A health care provider's claims for medical services may be audited by payors (e.g., Medicare, Blue Cross Blue Shield of Michigan ("BCBSM") and Medicaid) for a number of reasons. Some audits are a result of random selection or some result fr... Read >

Get Ready for Increased Medicare Audit Activity: Recovery Audit Contractors to Begin Auditing Natio

The financial pressure on hospitals, physicians and other healthcare providers, as a result of increased scrutiny of claims and audit activity by third party payors, will not end soon. To the contrary, as part of the Tax Relief and Health Care Act of 20... Read >

Be There Or … Pay Up: Developing a Patient No-Show Policy for Your Practice

"No-show" patients are a part of any medical practice. Over the years, physicians and other practitioners have developed numerous policies in an attempt to prevent no-shows. Most practices institute such policies as a deterrent rather than for the purpo... Read >

Stark II Phase III

The long-awaited third and final phase of the rulemaking that amends the Stark regulations (Stark) was released by the Centers for Medicare and Medicaid Services (CMS) on August 27, 2007. The phase III final rule (Phase III) will be effective December 4... Read >

The Medicare Appeals Process and Strategies for Successful Appeals

Introduction The Centers for Medicare and Medicaid Services (CMS) issued its final rule regarding changes to the Medicare appeal procedures on March 5, 2005. This final rule was effective May 1, 2005. Legal counsel for providers and suppliers underg... Read >

Detroit Medical Center – Wayne State University Joint Residency Programs: Progress Made, But Work

On November 22, 2006, the Detroit Medical Center ("DMC") and Wayne State University ("WSU") announced a temporizing resolution to a long-standing contractual dispute. This dispute threatened both the future of the DMC/WSU jointly sponsored residency prog... Read >

The RACs Are Coming -- Are You Ready?

I. INTRODUCTION The Centers for Medicare and Medicaid Services ("CMS" or "Medicare") Recovery Audit Contractor ("RAC") program has been made permanent and is expanding nationwide, beginning this year. Medicare providers, suppliers and their legal cou... Read >

The 2009 Medicare Physician Fee Schedule: The Anti-Markup Rule and IDTF Developments Impacting Diag

In recent years, the Centers for Medicare and Medicaid Services ("CMS") has heavily scrutinized the terms and conditions under which Medicare will pay for diagnostic testing services, resulting in heightened regulatory action targeting certain diagnostic ... Read >