Master Medicares 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 doesnt accept patients
with vents but will take someone with a fairly wellestablished tracheostomy, Denton says.

Industry News

2011

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 dont seem afraid to use their HIPAA fining
power, and it was one employees 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
entitys responsibility to protect its patients health
information.
And OCR has fined insurance plan Cignet Health of
Prince Georges 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
entitys violations of the HIPAA Privacy Rule, notes law
firm Sidley Austin on its website.
Cignets 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 HHSs apparent willingness to put
them in the spotlight, demonstrate the agencys 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
World Copyright 2011 by Eli Research. To Order Call 1-800-874-9180

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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Vol. 37, No. 6

2011 Eli Research

Industry News (cont. ...)

The presentation, entitled, Avoiding Medicare and

Medicaid Fraud and Abuse, covers the five main areas
of Medicare abuse: the False Claims Act, Anti-Kickback
Statute, Physician Self-Referral Statute, Exclusion
Statute, and Civil Monetary Penalties Law.
For example, the PowerPoint presentation, which the
OIG offers in a .pdf format, reminds new doctors that
prohibited kickbacks include cash for referrals, free
rent for medical offices, and excessive compensation
for medical directorships. It also reminds physicians
that its illegal to sell free samples, and that you should
always consider gift reporting requirements when
accepting gifts.
To read the entire presentation, along with a booklet for
physicians self-study regarding how to avoid Medicare
and Medicaid fraud, visit http://oig.hhs.gov/fraud/
PhysicianEducation/.
If your home health agency is submitting claims for
five-visit episodes with a single nurse or social worker
visit, youre at high risk of denials. Regional home
health intermediary Cahaba GBA is continuing to run
widespread edits on these two types of claims, it says
in its March newsletter for providers. And both types of
claims are turning up high denials rates 83 percent
for the claims with one nurse and four therapy visits, 75

percent for the claims with one medical social worker and
four other visits.
For the single nurse visit edit, the top denial reason
was related to medical necessity of the one-time skilled
nurse visit, Cahaba explains. If the nurse opens the case
and performs the start of care assessment, that visit is
not billable unless the nurse also delivers a medically
necessary skilled nursing service.
Tip: If the skilled need for the nurse is observation
and assessment, there is greater need than a one-time
visit, Cahaba says. And dont forget that the therapist
can perform a SOC assessment. For the single MSW
visit, many of these denials are related to the medical
necessity of nursing and/or the MSW visit, Cahaba
reports. Routine evaluations for community resources
where no needs were previously identified would not be
considered a covered MSW service.
More information is in the Newsline at www.cahabagba.
com/rhhi/news/newsletter/201103_rhhi.pdf. q
We welcome your comments and suggestions!
Mary Compton PhD, CPC
Editorial Director maryc@codinginstitute.com
Melanie Parker Publisher (919) 605-5454
melaniep@eliresearch.com

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