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Every patient receiving an ICD for primary prevention will be required to have an encounter for shared decision-making using an evidence-based decision tool. The Centers for Medicare & Medicaid Services (CMS) has released a final decision memo on changes to the national coverage determination (NCD) for implantable cardioverters defibrillators (ICDs).…
The whole world of opt-out physicians and practitioners creates compliance issues, particularly for coding, billing, and reimbursement Physicians and certain practitioners can elect to opt out of the Medicare program. An affidavit must be filed with a Medicare Administrative Contractor (MAC) first. There is then a two-year process, with the…
The CERT study gives one the opportunity to identify potential errors the same way that the auditors do. With nearly a million physicians in this country, how do auditing organizations determine who to audit? As of 2011, a total of 100 percent of Medicare fee-for-service claims started being passed through…
A recent False Claims Act case highlighted a range of perils. Scripps Hospital recently paid $1.5 million to resolve a False Claims Act (FCA) case. There are several lessons to be learned from the complaint and settlement.   First, when an FCA case is first announced or settled, people typically turn to…
The court ruled that the whistleblower’s complaint lacked credible allegations that any false claims were submitted to Medicare. Last week, a federal Judge in the Middle District of Florida dismissed a lawsuit against electronic health record (EHR) giant Epic Systems. An EHR is a digital version, or database, of a…
An analysis of your peer-to-peer process might lead to your abandoning the program. The peer-to-peer (P2P) process is a particularly abhorrent chore for physicians. These phone conversations are generally offered by commercial and managed insurance plans when their clinical case manager or medical director does not feel that inpatient status…
With the purchase of Aetna, CVS hopes to steer patients enrolled in Aetna’s insurance plans from hospital outpatient clinics and go directly to clinics located inside the CVS retail outlets. Regulations impacting hospitals that acquire their drugs through the 340B drug discount program took effect Jan. 1. The program allows…
A look ahead to the unification of healthcare and how patients access their information. It has been announced that Apple is expanding its HealthKit application to make it possible for a person to view their own health records on their mobile devices. According to Apple, it is strange that people…