By
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…
By
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…
By
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…
By
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…
By
A quietly introduced rule change should relieve burden on teaching physicians.  How many weeks has it been since I have been critical of the Centers for Medicare & Medicaid Services (CMS)? Probably not too many. Usually it’s about unclear guidance or a missing document. In fact, I could point out…
By
Those investigating healthcare entities instructed to stick to statutes and regulations The U.S. Department of Justice (DOJ) has issued another memo likely to help healthcare providers avoid potentially unfair government investigations.  The Jan. 25 memo from Associate Attorney General Rachel Brand to the heads of all civil litigation components and U.S.…
By
Uncertainty persists amid the looming prospect of yet another federal government shutdown. The federal government is open for business after the House and Senate agreed on a continuing resolution to fund operations through Feb. 8, 2018 – when we presumably start all over again, ironically right after Groundhog Day. Are…
By
Bad advice tends to circulate regarding how to select the correct E&M codes.   At a recent oncology conference in California, the speaker before me erroneously declared that the level of medical decision-making always controls the selection of code for any evaluation and management (E&M) service. She confidently asserted that…
By
Costs of outpatient versus inpatient knee replacement a clear area of contention in wake of report.  Last week seemed to be a quiet time on the Medicare regulatory front. Perhaps the three-day government shutdown resulted in things ramping back up, however. For a while I thought I’d have nothing to…
By
Best practices are described for eliminating redundancies and easing workloads during the HEDIS season now underway.  Healthcare Effectiveness Data and Information Set (HEDIS) reviews are conducted by health plans and government payers every year from January to mid-May. With the official 2018 HEDIS review season now in full swing, this…