North Carolina’s Medicaid RAC Program – Don’t Let Your Guard Down – With Section 6411(a) of the Patient Protection and Affordable Care Act (ACA) and the Final Rules found at 42 CFR Part 455, the Recovery Audit Contractor (RAC) program has been expanded to the North Carolina Medicaid program, sending a strong message to hospitals that the government’s focus on program integrity will be around for a long time.

A Primer on Medicare Requirements for Physician Supervision of “Incident to” Services – Services provided by a physician’s auxiliary staff that are “incident to” the physician’s services are paid under the physician fee schedule at a higher rate, as though the physician had personally furnished the services.

Hospital Options for Unused Long Term Care Beds – A number of hospitals in North Carolina have skilled nursing beds in their bed inventory. According to the Proposed 2015 State Medical Facilities Plan (SMFP), 1,652 of the 45,724 (or approximately 4 percent) of the licensed nursing home beds in North Carolina are located in hospitals.

Hospitals File Lawsuit Over Medicare ALJ Hearings Delays – Over 460,000 appeals requesting hearings before an ALJ were pending in the Office of Medicare Hearings and Appeals (OMHA) at the end of 2013 with 15,000 new appeals being submitted each week.

Our Health Law Group Expands – On June 1, 2014, the boutique health care law firm Bode Hemphill, LLP joined Poyner Spruill, bringing our health law team to 14 members. Ken Burgess, health law practice group leader, said, “We are extremely pleased to have Todd Hemphill, Matt Fisher, David Broyles, as well as their assistant, Janet Plummer join our law firm. Todd and his team have ably served their clients and are recognized as leaders in their field. Merging their significant skills and talents with the health law professionals of Poyner Spruill will enable us together to expand the array of legal services available to our health care clients.”

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