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  • Tom Boyd

5% criminal convicts

Hospitals Waste Valuable Resources Fighting Unfounded Denials by RACs (excerpt)

AIS’s Health Business Daily, February 25, 2011

Reprinted from Report on Medicare Compliance

Some compliance officers continue to fight denials from recovery audit contractors that they say defy logic, and are frustrated with the lack of feedback from RACs that hospitals could use to improve their claims submissions ….


The Medicare Fraud Strike Force has expanded its operations to Dallas and Chicago

Reprinted from REPORT ON MEDICARE COMPLIANCE, February 21, 2011

The Medicare Fraud Strike Force has expanded its operations to Dallas and Chicago, the Department of Justice said Feb. 17.  That means the DOJ-HHS fraud fighters are now in nine cities.  DOJ also announced the largest-ever takedown with 111 defendants, who were charged for their alleged participation in schemes to defraud Medicare of $225 million.  The defendants include doctors, nurses, health care company owners and executives, and others.  Read more at


OIG Report (excerpt)

Nursing Facilities’ Employment of Individuals With Criminal Convictions


Our analysis of criminal history records maintained by the Federal Bureau of Investigation (FBI) revealed that 92 percent of nursing facilities employed at least one individual with at least one criminal conviction.  Overall, 5 percent of nursing facility employees had at least one criminal convictions.


Magic Number for Medical Record Retention is 6 years, CMS Says

Medicare Compliance & Reimbursement

Eli Research Vol. 36, No. 20

If your state laws require a period longer than that, then that’s the time required, but six is the federal minimum.

Medical practices often hear conflicting advice regarding how long they must hang on to a patient’s medical records, but CMS intends to clear up any misinformation with new MLN Matters article SE1022, issued this month.

Although many physicians follow state laws when determining whether they can discontinue retaining a patient’s records, it’s important to keep in mind that you must hang onto the patient’s records for at least six years, according to HIPAA laws.  If your state requires a period longer than that, you must extend the length of time to meet state laws, but six years is the federal minimum.

“HIPAA administrative simplification rules require a covered entity, such as a physician billing Medicare, to retain required documentation for six years from the date of its creation or the date when it last was in effect, whichever is later,” the MLN Matters article states.  “HIPAA requirements preempt state laws if they require shorter period.  Your state may require a longer retention period.”

If you submit cost reports, you must retain the original or copies for at least five years following the cost report’s closure, and Medicare managed care programs providers must retain records for ten years, the article notes.

To read the complete MLN Matters article on record retention, visit


Receive a 10% discount on AudioEducator events when you use the promo code BDINCNL during checkout.  (Web orders only.)Upcoming Events from AudioEducator — April 2011DatesTitleWebpageList PriceApril 5How to Use Mid-Level Providers to Get More Work Done and More Revenue InDetails$197 2011 Cardiology Coding Updates and TechniquesDetails$197 There’s a Monster Hiding IN Your Organization and its Name is “Identity Fraud”Details$249April 6Anesthesia Compliance: Self Audit or RAC Penalty?Details$197 Courtroom Testimony Tips, Pointers & Commandments for Healthcare ProfessionalsDetails$197 The Move from Facilities to Home: Is it All Good News for Home Health?Details$197April 7The ABCs of Incident-to & Shared Billing: Update 2011Details$197 Hospitals: Check and Double-Check Your Coding for Drug Administration ServicesDetails$197April11Steer Clear of Penalties with Easier and More Effective HIPAA Risk AnalysisDetails$249April 12New Changes to HIPAA: The latest regulations and what they  mean to youDetails$249April 13Medical Review – Key Steps in the ADR ProcessDetails$197HIPAA Business Associates Rules – What They Mean for BAs and YouDetails$249April 14Observation Services Demystified Part 2: Advanced Concepts You Need to KnowDetails$197 HITECH and HIPAA – The Final RulesDetails$249 Linking Work and Revenue: What You May Not Know (But Should) about Basic CodingDetails$197 Diabetes Coding Essentials for Home Health – What You Need for Accurate ReimbursementDetails$197April 15“Email that to me.” – Electronics, Health Information, and HIPAADetails$249April 19Diagnosis Coding for Anesthesia, Including ICD-10 ImplementationDetails$197 Nursing and Physician Documentation in the ED: How to Bridge the Gap for Facility and Professional CodingDetails$197 Treat ‘Em Right — Using Customer Service to Increase Patient VolumeDetails$197 Taking the Guesswork Out of Pelvic Reconstruction SurgeryDetails$197April 20How to Clearly Establish Homebound Status and Guarantee Medicare CoverageDetails$197 Modifier Knowledge: Learn to Append for OtolaryngologyDetails$197April 21Evaluating Child Abuse and Neglect for Care ProvidersDetails$197 Know Your Audit Risk Areas before the RACs Do: 2011 UpdateDetails$249 Electronic Discovery Meets Healthcare Information – Don’t Lose Thousands in LitigationDetails$249 PQRI – The Basics: Efficiently Identifying and Reporting MeasuresDetails$197April 26Maximize Reimbursement for Orthopedic Repair of Tendons, Blood Vessels and NervesDetails$249 Modifiers 25 and 57 – Are You Using Them Right or Just Trying to Unbundle?Details$197April 27Urology Coding101 prostate treatment coding and related proceduresDetails$197 Plug Revenue Leaks with Financial Policies and Reimbursements Tips that Really WorkDetails$249 Hold Tight to Your Practice’s Revenue with These Vital ERISA BasicsDetails$197April 28Cardiology Coding Update for 2011Details$197 Claim Boosters: Bridge the Gap between Medical Billing and Medical CodingDetails$197 Document and Bill for Non-Physician PractitionersDetails$197

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