Federal Regulation news
A Summary of the OIG Sept 2015 Report on “Questionable and Inappropriate Payments for Chiropractic Services"
Written by Chris Dalrymple, DC   
Thursday, October 08, 2015 04:55 PM

In September of 2015 the Office of the Inspector General (OIG) of the Department of Health and Human Services, a federal agency, released a report highlighting its evaluation of chiropractic claims and questionable and inappropriate payments for chiropractic services.

This report begins a short series of articles investigating and reporting the findings of the OIG report explaining their methods, definitions, thresholds, findings and recommendations.  This series begins with an overview summary of the report.

Says the OIG: “Chiropractic services have the highest rate of improper payments among Part B services … Medicare covers chiropractic services to improve function, which it refers to as ‘active treatment,’ but does not cover ‘maintenance therapy,’ which is when further clinical improvement cannot be reasonably expected from ongoing treatment."

Welcome to ICD-10
Written by CMS   
Wednesday, October 07, 2015 05:02 PM

The CMS reports that the change to ICD-10 allows you to capture more details about the health status of  your patients and sets the stage for improved patient care and public health surveillance across our country. ICD-10 will help move the nation’s health care system to better, smarter care.

You may wonder when we’ll know how the transition is going. It will take a couple of weeks before we have the full picture of ICD-10 implementation because very few health care providers file claims on the same day a medical service is given. Most providers batch their claims and submit them every few days. Even after submission, Medicare claims take several days to be processed, and Medicare – by law – must wait two weeks before issuing payment. Medicaid claims can take up to 30 days to be submitted and processed by states. Because of these timeframes, we expect to know more about the transition to ICD-10 after completion of a full billing cycle.

HIPAA: May Not Apply When...
Written by Editor   
Wednesday, September 23, 2015 10:24 AM

Next year marks the 20th anniversary of the passage of the Health Insurance Portability and Accountability Act of 1996 (HIPAA). HIPAA's purpose is to protect the privacy and security of protected health information or PHI.

PHI is individually identifiable information in any form relating to an individual's healthcare, payment for healthcare, or physical or mental health condition. HIPAA serves as as the protector of PHI, limiting disclosures without patient authorization, and generally ensuring that people's private medical conditions are not broadcast in public. But HIPAA is often misunderstood and misapplied in practice. Incorrectly applied invocations of HIPAA can sometimes limit access to vital information and harm patients.

When providers don't understand how HIPAA applies to a particular situation, the knee-jerk response is often to err on the side of caution. It is important to recognize that HIPAA is not intended to interfere with a patient's medical care. In many cases, HIPAA permits disclosure of PHI without patient authorization. Providers may avail themselves of any applicable permissive disclosure exceptions at their discretion, but must comply with relevant requirements. 

Below are 10 clinical situations in the ED where HIPAA is commonly invoked and how HIPAA actually applies to those situations. 

FDA Moves to Prevent Foodborne Illness
Written by Editor   
Thursday, September 17, 2015 03:09 PM

About one in six Americans gets sick each year from foodborne illness, according to the CDC, and 3,000 Americans die from such illnesses every year. In an effort to prevent foodborne illness, the FDA has finalized requirements for food production facilities to have preventive plans and controls, the agency announced.

The finalization of the two steps would be the first of seven major ones outlined in the FDA Food Safety Modernization Act (FSMA), which was signed into law in 2011 by President Obama.

FDA Warns:  Diabetes Drugs Linked to Severe Joint Pain
Written by Editor   
Wednesday, September 09, 2015 05:23 PM

Dipeptidyl peptidase-4 (DPP-4) inhibitors, a class of type 2 diabetes drugs, may cause severe and disabling joint pain, the FDA said.  The agency said it was adding a new warning to all drugs in the class -- sitagliptin (Januvia), saxagliptin (Onglyza), linagliptin (Tradjenta), and alogliptin (Nesina), as well as seven other products that combine these agents with metformin or other antidiabetic drugs.

The FDA said it identified 33 cases of severe joint pain in patients from 2006, when sitagliptin was first approved, through the end of 2013.

Other symptoms reported by some of these patients included fever, chills, rash, and swelling, all "suggestive of an immunological reaction," the FDA said.

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