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Master Medicare’s latest in 20 minutes

discharge, she explains. The overall length of stay for
Medicare patients is 30 days.
Providence St. Joseph Care Center takes patients with
mechanical hearts, wound vacs, TPN, and multiple IV
antibiotics. The nursing facility doesn’t accept patients
with vents but will take someone with a fairly wellestablished tracheostomy, Denton says.

Industry News 


“We are a place in the community where people with
mechanical hearts can go to transition to the community,”
Denton reports. Sometimes the patients who receive
the mechanical hearts are waiting to receive a human
heart transplant. If not, the mechanical heart becomes “a
prosthesis and a way of life,” she adds. “The patients with
the mechanical hearts can go home if they have a 24/7
caregiver in case of equipment malfunction.”  q

HHS Slaps $1 Million HIPAA Fine On Provider For Lost Data
Warning: HIPAA enforcement is ramping up.
The feds don’t seem afraid to use their HIPAA fining
power, and it was one employee’s innocent mistake that
cost $1 million.
The Department of Health and Human Services’ Office
of Civil Rights (OCR) has fined the General Hospital
Corporation and Massachusetts General Physicians
Organization Inc. in Boston $1 million over an incident
where a Mass General employee left files on a subway
train that were never recovered.
“We hope the health care industry will take a close look
at this agreement and recognize that OCR is serious about
HIPAA enforcement,” OCR Director Georgina Verdugo
says in a release about the settlement. “It is a covered
entity’s responsibility to protect its patients’ health
And OCR has fined insurance plan Cignet Health of
Prince George’s County, Md., more than $4.3 million for
breaching the HIPAA Privacy Rule. “The fine is the first
civil monetary penalty (CMP) ever imposed for a covered
entity’s violations of the HIPAA Privacy Rule,” notes law
firm Sidley Austin on its website.
Cignet’s fine came from failing to give patients’ access to
their protected health information (PHI) in their medical
records, rather than accidentally revealing PHI.
“These cases, and HHS’s apparent willingness to put
them in the spotlight, demonstrate the agency’s newfound
commitment to investigating, uncovering and imposing
penalties for HIPAA violations,” notes law firm Duane
Morris in an alert on the topic.
And HHS now can more easily track possible violations,
thanks to HITECH Act provisions that require providers
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to notify the agency of HIPAA data breaches, Duane
Morris points out.
OIG Offers Free, Pre-Written Presentation for
Teaching New Physicians About Compliance.
When your practice hires a new physician, the job of
training the doctor on healthcare compliance may fall
to more than one person in your practice, including the
office manager, compliance officer, coder, and fellow
physicians. But that job may be a little bit easier now
that the OIG has created a ready-made presentation that
teaches new physicians how to steer clear of fraud.
(Continued on next page)

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If the nurse opens the case and performs the start of care assessment. Anti-Kickback Statute. 6 © 2011 Eli Research Industry News (cont. For the single MSW visit. No. If your home health agency is submitting claims for five-visit episodes with a single nurse or social worker Medicare Compliance & Reimbursement . ZIP Phone Fax E-mail To help us serve you better. entitled.)   The presentation.pdf. . And don’t forget that the therapist can perform a SOC assessment. Date: ________/________/________ Name Signature: Title Company Address City.” covers the five main areas of Medicare abuse: the False Claims Act. visit http://oig. Exclusion Statute. Subscription Version Options: (check one) ❑ Print ❑ Online* ❑ Both*(Add online to print subscription FREE) E-mail Payment Options Charge my: ❑ MasterCard ❑ AMEX ❑ VISA ❑ Discover Card # * Must provide e-mail address if you choose “online” or “both” option to receive issue notifications Exp..   Extend! I already subscribe.pdf format. which the OIG offers in a . CPC Editorial Director maryc@codinginstitute. For the single nurse visit edit. it says in its March newsletter for providers. you’re at high risk of denials.” Cahaba reports. there is greater need than a one-time visit..O.” Cahaba says. 37. and Civil Monetary Penalties Law. reminds new doctors that prohibited kickbacks include “cash for referrals. free rent for medical offices. GA.Vol. “the top denial reason … was related to medical necessity of the one-time skilled nurse visit. that visit is not billable — unless the nurse also delivers a medically necessary skilled nursing service. State. and that you should always consider gift reporting requirements when accepting gifts. “Avoiding Medicare and Medicaid Fraud and Abuse.” More information is in the Newsline at www. along with a booklet for physicians’ self-study regarding how to avoid Medicare and Medicaid fraud.” It also reminds physicians that it’s illegal to sell free samples. Regional home health intermediary Cahaba GBA is continuing to run widespread edits on these two types of claims.cahabagba. Box 933729 Atlanta.hhs. To read the entire presentation. and excessive compensation for medical directorships. com/rhhi/news/newsletter/201103_rhhi. Tip: “If the skilled need for the nurse is observation and Order or Renew Your Subscription!  Yes! Enter my: one-year subscription (12 issues) to Medicare Compliance & Reimbursement for just $297. 75 percent for the claims with one medical social worker and four other visits. please provide all requested information p48 ❑ Check enclosed (Make payable to Eli Healthcare) ❑ Bill me (please add $15 processing fee for all billed orders) Medicare Compliance & Reimbursement Eli Healthcare Melanie Parker Publisher (919) 605-5454 melaniep@eliresearch. “Routine evaluations for community resources where no needs were previously identified would not be considered a covered MSW service. Please extend my subscription for one year for just $ PhysicianEducation/. For example. Physician Self-Referral Statute. 31193-3729 Call (800) 874-9180 Fax (800) 508-2592 E-mail: subscribe@eliresearch. And both types of claims are turning up high denials rates — 83 percent for the claims with one nurse and four therapy visits. the PowerPoint presentation.” Cahaba explains. “many of these denials are related to the medical necessity of nursing and/or the MSW visit.  q We welcome your comments and suggestions! Mary Compton PhD.

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