Your ambulatory surgery center (ASC) could be one of more than 125 ASCs to face surprise inspections by state officials starting sometime in August, according to an HHS announcement. Those 125 will be the first of thousands to face inspection.

Your practice may see tougher enforcement of HIPAA security and privacy rules now that authorities policing the law are under one roof, experts tell Part B News. HHS transferred authority to enforce HIPAA security rules from CMS to the Office for Civil Rights (OCR), which already handles enforcement of privacy rules. The move eliminates duplication and will make enforcement of HIPAA regulations more efficient, HHS stated on Aug. 3.

You can soon expect better and quicker customer service from your carrier after CMS outlined a series of new mandates in an Aug. 7 transmittal. CMS is setting the bar higher for your Medicare Administrative Contractor (MAC).

Picture this: During a visit for one covered, specific health issue, a patient brings up unrelated problems that are not covered, so you bill the patient for the additional work. The patient is upset by having to pay extra, complains loudly and the next thing you know, your local television station is camped outside trying to ask you questions. The result is an unfriendly headline: "Woman Charged Extra for Asking Doctor Too Many Questions."

You now know what targets your Recovery Audit Contractor (RAC) will be looking for if you're in one of the 17 Region D states. A total of seven CMS-approved audit targets were released by HealthDataInsights (HDI) on Aug. 12. They are the exact same targets Connolly Healthcare posted on Aug. 4 (PBN 8/10/09).

You're getting yet another reprieve from implementation of the Red Flag Rules. The Federal Trade Commission (FTC) announced it will not enforce the rules until Nov. 1. They were scheduled to take effect Aug. 1. This is the third delay for the rules, which are widely opposed in the physician community (PBN 10/27/08). They were initially set to take effect Nov. 1, 2008, which was later delayed until May 1 and now until Nov. 1, 2009.

Start checking your Recovery Audit Contractor's (RAC) website daily. CMS recently approved several issues for RACs to investigate through complex reviews of your patient records and charts. Important: RACs cannot request a patient record from you for a complex review unless CMS approves the issue the RAC is targeting. You'll only know what your RAC can request from you by tracking CMS-approved issues on its website.

My practice requires Medicare patients to complete and sign a five-question secondary payer questionnaire so we can determine if Medicare is primary or secondary. It states that we're required to ask these questions and verify the answers every 30 days. I can't find this form on my carrier's or CMS's website. Are we required to use this form? If so, how often should we update this information?

Recent Medicare Payment Advisory Commission (MedPAC) data shows controls to rein in spending are not working, which is why you're now seeing calls in Washington for MedPAC or some other independent agency to set payment rates (PBN 7/27/09).

This week's analysis shows 10 of the fastest-growing codes with high denials from 2007, the most recent year of data available. We determined the growth rate by comparing claims submitted in 2006 and 2007. To maximize the relevance, all codes billed less than 100,000 times annually were excluded from analysis. The results are still highly revealing.