Rhyme and Reason Rap for Health Care Providers

October 3, 2013

  1. Whether a MAC or RAC review, documentation is key when it comes to medical necessity.
  2. If you are a hospice provider, make sure you comply – have a physician certify the patient is expected to die.
  3. Follow a care plan to prevent accidents of residents or you could be in jeopardy and subject to a penalty
  4. If a resident receives undergarments bought from a store, it is the skilled nursing facility’s responsibility to check for proper size and fit, to prevent the resident from getting a pressure sore.
  5. In Medicare billing for a hospital stay, be sure to note if it is an inpatient or outpatient day.
  6. Avoiding a HIPAA breach is within reach, when  a health care provider follows HIPAA policies and procedures consistently.
  7. If you have received a Medicare overpayment and hardship is a factor, then apply for an extended payment plan by contacting your Medicare administrative contractor.
  8. Hospitals report quality measures to CMS, to avoid being paid even less.
  9. If you are a physician practice and bill Medicare as a provider based entity, make sure you meet the regulatory requirements to avoid a penalty.
  10. Post-acute providers – what will be their fate? Will they be paid based on a bundle or a site neutral rate?


If you would like to learn more about health care regulatory and administrative law, as well as HIPAA rules and regulations, please contact Rochelle H. Zapol, a partner in Prince Lobel’s Health Care Practice Group and author of this post. You can reach Rochelle at 617 456 8036 or

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