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Archives for May 2013

Office of Inspector General’s Advisory Could Affect Payment to All Healthcare Providers

OFFICE OF INSPECTOR GENERAL DEPARTMENT OF HEALTH AND HUMAN SERVICES SEALOn May 8, 2013, the Office of Inspector General (“OIG”) issued an Advisory Bulletin pertaining to exclusion and excluded healthcare providers.  Because exclusion could potentially affect every provider, it is important to learn more details about the designation.

If the OIG excludes a provider, then no Federal health care program payments may be made for items or services furnished by the excluded provider or prescribed or directed by the excluded provider.  If the excluded provider changes from one health care profession to another, the exclusion will still be in effect.

In addition, the prohibition is not limited to direct patient care; it also includes services such as review of treatment plans, preparation of surgical trays, or services provided related to filling prescriptions.  Transportation services provided by excluded individuals are also prohibited.

Finally, according to the Bulletin, excluded individuals are prohibited from providing any administrative or management services, even if they are not separately billable.

There are severe consequences if an excluded individual submits a claim or causes a claim to be submitted to a Federal health care program.  A civil monetary penalty of $10,000 per claimed item or service may be imposed.  In addition, any potential for reinstatement to Federal health care programs may be jeopardized.  Criminal penalties may also be imposed.

Civil monetary penalties may be imposed against providers that employ or enter into contracts with excluded individuals to provide items or services payable by a Federal health care program.  Further, there may be civil monetary penalties for health maintenance organizations that contract with or employ excluded individuals.  This does not mean that entities cannot hire or contract with excluded individuals at all.

If the services or items provided are not paid for by a Federal health care program, then there isn’t a prohibition against hiring or contracting with an excluded individual.  If the excluded individual only provides services or items to patients that are not covered by a Federal health care program, then there is no prohibition.

All individuals and entities should search the OIG program exclusion information that is available on the OIG Web site prior to employing or contracting with any provider of health care services and keep documentation of the search. 

In addition, individuals and entities should proactively monitor the exclusions database to ensure that none of its current employees or contractors is listed as an excluded provider.  Due diligence will help mitigate the risk of civil monetary penalties in the future.

How To Request The Georgia Special Needs Scholarship – What You Need To Know

IEP Education LawIf you have a child whom receives special education services in Georgia and meets certain eligibility requirements, you have the right to transfer your child to:

  1. another public school within your district of residence, or
  2. another public school outside your district of residence, or
  3. one of three state schools for the blind or deaf, or
  4. a private school authorized to participate in the scholarship program

if you believe your child would be better served.

If you are interested in offsetting the costs of sending your child to a private school, you must select a private school that participates in the Georgia Specials Needs Scholarship (GSNS) Program.  To qualify for the GSNS Program, your child must meet the following requirements:

  1. A student must have a parent/guardian who currently lives in Georgia and has been a resident for at least one calendar year.
  2. A student was enrolled and attended a Georgia public school (grades K-12) the entire 2012-2013 school year. Pre-school special education students do not quality. A student must complete a full year in kindergarten before he/she can be eligible.
  3. A student was reported by a school district(s) during mandatory student counts conducted in October 2012-2013 and March 2013 by public schools.
  4. A student does not need to have an Individualized Education Program (IEP) for the entire school year to qualify for the scholarship program. A student *must* have received special education services at some point during the 2012-2013 school year under an IEP. A student must be reported by a school district(s) in either the October 2013 or March 2013 student counts or in final student record as a student receiving special education services by the end of the school year.

Scholarship funds received through the GSNS Program can only be used to offset tuition and fees at a private school authorized by the State Board of Education. Funds *cannot* be used to offset the costs of out of district tuition, charter schools or other options available under public school choice.

The deadline to have a student enrolled in a private school through the GSNS Program for the 2013-2014 school year is September 16, 2013. No exceptions.

For more information about the scholarship program or if you need assistance with your child’s IEP , please contact DJ@Jeylaw.com at Jeyaram & Associates.

 

ICD-10 Deadline for Healthcare Providers Fast Approaching – Jeyaram & Associates Can Help

ICD DeadlineThe October 1, 2014 deadline to switch to the ICD-10 codes set is less than five months away. This mandatory requirement replaces the ICD-9 codes set used to report medical diagnoses and inpatient procedures.

All healthcare providers covered by the Health Insurance Portability Accountability Act (HIPAA) must adhere to this new requirement. Please note, the change to ICD-10 does not affect CPT coding for outpatient procedures and physician services.

All healthcare practices currently using the ICD-9 codes must transition to the new codes. The transition to the new codes set will take several months. If you have not started the transition, we strongly urge to begin now. 

ICD consists of two parts:

1. ICD-10-CM for diagnosis coding
2. ICD-10-PCS for inpatient procedure coding 

ICD-10-CM is for use in all U.S. health care settings. Diagnosis coding under ICD-10-CM uses 3 to 7 digits instead of the 3 to 5 digits used with ICD-9-CM, but the format of the code sets is similar.

ICD-10-PCS is for use in U.S. inpatient hospital settings only. ICD-10­ PCS uses 7 alphanumeric digits instead of the 3 or 4 numeric digits used under ICD-9-CM procedure coding. Coding under ICD-10-PCS is much more specific and substantially different from ICD-9-CM procedure coding.

The Centers for Medicare and Medicaid Web site provides detailed check lists to help healthcare providers make the transition. However, if you have questions or need help with the transition to the ICD-10 codes set, Jeyaram & Associates can help. Contact DJ Jeyaram at DJ@Jeylaw.com or 678-708-4705.

 

Center for Medicaid & Medicare Services Shows Georgia Hospital Charges Vary

Center for Medicare & Medicaid ServicesA new study released by the Center for Medicaid and Medicare Services demonstrates that hospital charges for in-patient surgical and life threatening procedures vary greatly – including those in Georgia. The report looks at hospital-specific charges for the more than 3,000 U.S. hospitals that receive Medicare Inpatient Prospective Payment System (IPPS) payments for the top 100 most frequently billed discharges, paid under Medicare based on a rate per discharge using the Medicare Severity Diagnosis Related Group (MS-DRG) for Fiscal Year (FY) 2011. These DRGs represent almost 7 million discharges or 60 percent of total Medicare IPPS discharges.

Discrepancies for in-patient services in Georgia include:

Joint replacement or reattaching a limb:

  • Saint Josephs: up to $28,000
  • Northside: on average $62,000
  • Grady: up to $85,000

Treatment of pneumonia or pleurisy:

  • Grady: up to $19,000
  • Atlanta Medical Center: up to $41,000
  • North Fulton Regional in Roswell: up to $55,000

Admissions and treatment for life threatening conditions such as heart failure and stroke:

  • DeKalb Medical Center: up to $15,000
  • Atlanta Medical Center: up to $40,000
  • North Fulton: up to $58,000

The Center for Medicaid and Medicare Services issued the report in response to President Obama’s efforts to make the country’s health care system more affordable and accountable. To review the Center’s findings in Excel, click here. 

 

 

Jeyaram & Associates Volunteers in Local Community

Georgia Mision of MercyPlease join Jeyaram & Associates at the Georgia Mission of Mercy from June 13-16 , to provide free dental care for low and no income adults. Georgia Mission of Mercy’s goals are to:

  • Provide free access to dental care for 2,000 low- and no-income adults while placing a high priority on patients suffering from dental infections or pain.
  • Educate patients and family members in attendance about the importance of obtaining and maintaining optimal oral health.
  • Raise awareness of the increasing difficulty low-income Georgia adults face in accessing critical dental care.
  • Challenge patients, policymakers, and dental professionals to work together to improve the oral health of those who have been promised care by the state.

Jeyaram & Associates’ attorneys will assist the dentists and dental assistants and register patients. You can learn more by watching a short documentary here.

Dental DashAlso, on March 30, 2013, Jeyaram & Associates sponsored the Dental Dash at Dawn, a 5K run/walk benefiting the DDD Foundation. The DDD Foundation supports a dental office that solely treats patients that have developmental disabilities. To learn more about the Dental Dash at Dawn, you can view a mini documentary here.

Georgia Medicaid Providers Can Now Access HP Online Portal

Georgia Health PortalAccording to a press release issued by the Georgia Chapter of the American Academy of Pediatrics, currently enrolled and future Georgia Medicaid providers can now access the HP online portal to submit their attestation to become eligible for the Affordable Care Act (ACA) Rate Increase. The initial enrollment period will last until July 31, 2013. When accessing the site, click on “Provider Information”, then select “Forms”, and then select the “Enrollment” link.

For more information, click here