CMS Refuses to Count Family Practice Residents Who Train in Family Practice Settings

Last Friday Eastern Maine Medical Center sued Health & Human Services over the way CMS counted the number of residents in its graduate medical education program.  According to the complaint, CMS refuses to count some of the hospital’s family practice residents. Guess why. Because their training occurred …

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CMS Charges $13 Million Late Payment Fee on $1 Million Medicaid Overpayment

New York City’s Mt. Sinai Hospital refunded a one million dollar Medicaid overpayment. CMS said thanks for the repayment, but you still owe us a late payment fee: $13 million. To add insult to injury, the overpayments were inadvertent—the result of electronic coding errors on about 900 Medicaid claims. On …

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D.C. Circuit Declines Hospitals’ Plea for Relief from CMS Catch-22

Yesterday the D.C. Circuit dismissed a lawsuit brought by the American Hospital Association and five hospitals seeking relief from a notorious Catch- 22 recognized by everyone in the industry—and by the court itself.  As usual, it involves the hated Recovery Audit Contractors (RACs). Here’s how the catch …

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OIG Criticizes CMS’s 16-Year Delay in Issuing Regulations; CMS Yawns

Turns out it’s not just health care providers that notice CMS’s foot-dragging. Last Thursday the Office of Inspector General (OIG) of Health & Human Services (HHS) published its report on what CMS has done—or rather, has not done—in response to a Congressional mandate issued in 1997. The mandate …

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Dark Clouds Over Sunshine Act

Once again the Obama administration has been tripped up in launching a healthcare-related online system.  This time the problem concerns the Physician Payments Sunshine Act—the act that is supposed to enable the public to see whether a physician has a financial relationship with a drug or device manufacturer.  …

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Bundling Gains Momentum, Even as New Study Raises Questions

Health care cost bundling—the aggregating of all the costs of an episode of medical care into a single bill—seems to be here to stay. After all, it’s the way most all other billing is done. When your car is serviced, you don’t get a separate bill from each mechanic and vendor of parts and fluids. And …

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