Nancy Beckley's Compliance Rules

07/25/2025

https://racmonitor.medlearn.com/2026-proposed-physician-fee-schedule-good-news-on-direct-supervision/

The Proposed Rule on the Medicare Physician Fee Schedule (MPFS) for the 2026 fiscal year is out, and if adopted, it’s got very good news about direct supervision. Hopefully, you know that for the last several years, it has been possible to provide direct supervision off-site as long as the supervi...

02/13/2025

Artificial intelligence has been the subject of no shortage of hype about its capabilities. As AI has evolved in the past few years it has often been touted as the force that will finally drive major changes in healthcare.

Artificial intelligence has been the subject of no shortage of hype about its capabilities. As AI has evolved in the past few years it has often been touted as the force that will finally drive maj…

11/07/2024

Potential Impact on under new administration.

With Donald Trump set to return to the White House to serve another four-year term as U.S. president, what might the healthcare sector expect to see when it comes

09/27/2024

Medicare Home Health Coverage Was Expanded by Congress in 1980 - But where are we now?

Great article by Center for Medicare Advocacy. Therapy advocacy both within and from outside the home health agency is likely necessary for beneficiaries to access benefit to which they are legally entitled. Beneficiaries may be intimidated by the HHA, and want to offer cash for services for which they qualify, cash therapists need to understand the benefit before reaching for the cash. Comments?

Medicare home health coverage has no hospital stay requirement, and no limit on visits. Let's start implementing it correctly.

09/20/2024

Preparing for a

Is your practice prepared? "Having plans, such as a disaster recovery plan or breach mitigation plan, is one key component. Not only are those plans good idea, but the HIPAA Security Rule calls for them to be in place."

When will a healthcare organization suffer its first or next cyberattack? The phrasing of that question is intentional because reality has certainly moved into the “it’s a matter of whe…

09/19/2024

When to challenge a denial, and how to win. Excellent article by compliance attorney David Glaser.

"When one of the participants has a statute, regulation, or NCD that answers the question, they beat anyone pointing to a local coverage determination (LCD), Medicare manual, Medicare contractor bulletin, or anything else, because LCDs, manuals, and bulletins are merely guidance, and not binding."

Yet seem to focus on , rather than underlying authority.....

This article will feature one part poll, one part legal discussion. First, the poll: do you have the sense that administrative law judge (ALJ) hearings are getting harder to win? Last month I participated in a hearing in a case with a million-dollar overpayment. The hearing seemed to go really well....

09/15/2024

Items and Services Not Covered Under Medicare

08/28/2024

Do you know the difference between and ?

Service animals and emotional support animals both do important jobs, but there are several differences between the two. Educate yourself about the distinctions and policies here: https://adata.org/service-animal-resource-hub/differences

07/26/2024

As a therapist do you know how to return an overpayment? Do you know the legal (the law - False Claims Act) for identifying and returning an overpayment? This article will help you understand current law, and proposed changed in the 2025 Physician Fee Schedule Proposed Rule.

The 60-day Refund Rule, created by the 2010 Patient Protection and Affordable Care Act (PPACA), requires providers to report and return Medicare and Medicaid overpayments within 60 days of identifying them. Failure to comply with the 60-day Refund Rule can result in the imposition of a civil monetar...

07/24/2024

Are you looking for a compliance text message solution? . This handy reference guide white paper provides good information.

note: This is vendor prepared. I have no affiliation with the vendor, just offer for interest and information.

Explore the risks posed by non-compliant consumer apps like Instagram and WhatsApp in healthcare settings. Learn about potential HIPAA penalties and use a self-evaluation flowchart to determine your organization's need for HIPAA-compliant messaging. Discover straightforward steps to implement secure...

06/29/2024

Update per Court Order - [please review link].

On June 20, 2024, the U.S. District Court for the Northern District of Texas issued an order declaring unlawful and vacating a portion of this guidance document. See Am. Hosp. Ass’n v. Becerra, — F. Supp. 3d ----, No. 4:23-cv-1110, 2024 WL 3075865 (N.D. Tex. June 20, 2024).

Specifically, the Court vacated the guidance to the extent it provides that HIPAA obligations are triggered in “circumstances where an online technology connects (1) an individual’s IP address with (2) a visit to a[n] [unauthenticated public webpage] addressing specific health conditions or healthcare providers.” Id. at *2. HHS is evaluating its next steps in light of that order.

The Office for Civil Rights at the U.S. Department of Health and Human Services is issuing this Bulletin to highlight the obligations of Health Insurance Portab

06/04/2024

Interestingly enough this sounds a bit like "cash" therapy.

"OPIB is defined as an outpatient medical record designation that identifies a patient bedded in the hospital who initially or no longer warrants medically necessary services, from a billing perspective. These patients are often placed in the hospital setting because their social situation leaves them with no other alternative, or they remain in the hospital until an alternative location can be secured, despite the completion of observation services. To date, the Centers for Medicare & Medicaid Services (CMS) has not recognized this level-of-care designation in hospitals."

The implementation of outpatient in a bed (OPIB) classifications in hospital settings presents unique challenges, particularly regarding billing, patient care, and regulatory compliance. These challenges may vary across hospitals, depending on electronic medical record (EMR) classifications and inte...