CMS Issues Stricter DMEPOS Supplier Qualifications

On Friday, August 27, 2010, the Centers for Medicare & Medicaid Services (CMS) issued new regulations (75 Fed. Reg. 52629) that make qualifying for and retaining Medicare billing privileges more stringent for durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) suppliers. The new …

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Time Period to Submit Medicare Claims Is Shortened to Twelve Months

The proposed Medicare Physician Fee Schedule for 2011 (PFS) includes a proposal that Medicare fee-for- services claims for services furnished on or after January 1, 2010, must be filed within one calendar year after the date of services. This proposal by CMS is aimed at implementing Section 6404 of the Affordable …

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Proposed CMS Rule Would Require Group Practices to Notify Medicare Beneficiaries of Alternative Advanced Imaging Suppliers

Section 6003 of the Patient Protection and Affordable Care Act (PPACA) amended the Stark Law in-office ancillary service exception as applied to physician practices furnishing MRI, CT, PET, and potentially other diagnostic imaging services. The Stark Law prohibits a physician from making a referral for certain …

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The Sixty Day Rule: Reporting & Returning Overpayments Under PPACA

Among numerous changes to the Medicare and Medicaid Program Integrity Provisions, Section 6402 the Patient Protection and Affordable Care Act (“PPACA”) contains urgent requirements for reporting and returning overpayments. The new provision requires certain entities – including providers, suppliers, …

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New Statute Sheds Light on Three-Day Rule for Hospital Billing

On June 25, 2010, President Barack Obama signed into law the Preservation of Access to Care for Medicare Beneficiaries and Pension Relief Act of 2010. Among other provisions, Section 102 of the legislation broadens the interpretation of what is known as the three-day rule, Medicare's policy for payment for …

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