What is the purpose of the Physician Payment Sunshine Act?
What is the purpose of the Physician Payment Sunshine Act?
The Physician Payments Sunshine Act (Sunshine Act), which is part of the Affordable Care Act (ACA), requires manufacturers of drugs, medical devices, and biologicals that participate in U.S. federal health care programs to report certain payments and items of value given to physicians and teaching hospitals.
Which is a Hospital Payment Monitoring Program data analysis tool that provides administrative hospital and Statespecific data for specific CMS target areas?
FATHOM: First-Look Analysis Tool for Hospital Outlier Monitoring is a Microsoft Access application that allows CMS to provide each State with hospital-specific Medicare claims data statistics, which identify areas having high payment errors. These target area statistics serve as relative indicators of payment errors.
Which legislation protects and compensates railroad workers who are injured on the job?
The Federal Employers Liability Act, also known as FELA, is a federal law enacted in 1908, that protects and compensates railroad workers – including BMWED members – that are injured on the job. FELA is essentially the form of Workers’ Compensation in the railroad industry.
What was established by the payment error prevention program?
The Payment Error Prevention Program (PEPP): reducing Medicare payment errors in prospective payment system hospitals.
Who does the Sunshine Act apply to?
This OPEN PAYMENTS program applies to any manufacturer that makes at least one product covered by Medicare, Medicaid or CHIP. The GPO’s and manufacturers are required to collect the information on these financial interactions with physicians/hospitals from Aug 1, 2013- Dec 31, 2013 and report to CMS by March 31, 2014.
Who falls under the Sunshine Act?
The Sunshine Act requires manufacturers of drugs, medical devices, biological and medical supplies covered by the three federal health care programs Medicare, Medicaid, and State Children’s Health Insurance Program (SCHIP) to collect and track all financial relationships with physicians and teaching hospitals and to …
Which does a hospital use to compare its performance with that of other hospitals?
contains hospital-specific administrative claims data for a number of CMS-identified problem areas (e.g., specific DRGs, types of discharges); a hospital uses PEPPER data to compare its performance with that of other hospitals.
When an office based service is performed in a healthcare facility payment is affected by the use of?
Health Insurance Chapter 9
| Question | Answer |
|---|---|
| Which publication communicates new or changed policies and procedures that are being incorporated into a specific CMS manual? | program transmittal |
| When an office-based service is performed in a health care facility, payment is affected by the use of: | a site of service differential |
Which legislation allows employees to continue health care coverage beyond the benefit termination date by paying appropriate premiums?
The Consolidated Omnibus Budget Reconciliation Act of 1986 (COBRA) amended the Public Health Service Act, the Internal Revenue Code and the Employee Retirement Income Security Act (ERISA) to require employers with 20 or more employees to provide temporary continuation of group health coverage in certain situations …
Who does FECA cover?
Every civilian employee of the federal government, including employees of the executive, legislative, and judicial branches, is covered by FECA, as are several other groups, including federal jurors and Peace Corps volunteers. The FECA program is authorized in statute at 5 U.S.C. Sections 8101 et seq.
Which is considered Medicare abuse?
Medicare abuse includes practices that result in unnecessary costs to the Medicare program. Any activity that does not meet professionally recognized standards or provide patients with medically necessary services is considered abuse. Committing abuse is illegal and should be reported.
Which is another name for federal and state laws quizlet?
also called statutory law; laws passed by legislative bodies (e.g., federal Congress and state legislatures). also called statutory law; laws passed by legislative bodies (e.g., federal Congress and state legislatures). an order of the court that requires a witness to appear at a particular time and place to testify.
How does the Sunshine Act affect teaching hospitals?
The law also impacts teaching hospitals, including all hospitals that receive Indirect Medical Education (IME) funding, Graduate Medical Education (GME) funding and psychiatric hospital IME. CMS will compile a list of teaching hospitals each year and make it available to the public at least 90 days prior to the start of the next reporting year.
What was the physician payments Sunshine Act of 2010?
The Physician Payments Sunshine Act (PPSA)–also known as section 6002 of the Affordable Care Act (ACA) of 2010–requires medical product manufacturers to disclose to the Centers for Medicare and Medicaid Services (CMS) any payments or other transfers of value made to physicians or teaching hospitals. It also requires certain manufacturers and
What are the billing requirements for a teaching physician?
Billing Requirements for Teaching Physicians You must be identified as the teaching physician who involves residents in the care of your patients on claims. Claims must comply with requirements in the General Documentation Guidelines and E/M Documentation Guidelines sections.
How does Medicare pay for a teaching physician?
Medicare pays for services furnished in teaching settings through the Medicare Physician Fee Schedule