The ABCs of Medicare and Medicaid Audits

by Steve Adams, CPC, CPC-H, CPC-I, PCS, FCS, COA   Just when you thought participating with Medicare and Medicaid couldn’t get any more difficult they roll out their enforcement arm(s) to help recoup potential overpayments and reduce waste in the system. This article will simply introduce you to the major players and offer you some links to their web sites so that you can become...

Prolonged Services

By Steve Adams, CPC, CPC-H, CPC-I   The CPT definition of prolonged care varies from that of the Centers for Medicare & Medicaid Services (CMS). Since 2009, CPT recognizes the total duration spent by a physician on a given date, even if the time spent by the physician on that date is not continuous; the time involves both face-to-face time and unit/floor time. CMS only attributes...

HEALTHHEALTHCARE PROVIDERS RISK FCA LIAB...

by Scott R. Grubman[i], Rogers & Hardin, LLP Healthcare providers are at risk of potential liability through a lesser-known provision of the False Claims Act (“FCA”).  Providers who receive too much money from Medicare or Medicaid, even if through no fault of their own, are at risk of substantial FCA liability, as well as civil penalties and exclusion. Given the increased...

The Affordable Care Act & Qui Tam W...

by Jay Brownstein and Kevin Little Controlling healthcare costs is essential to the economic security of the United States. Total healthcare spending in the U.S., already an astronomical $3 trillion dollars in 2013, is expected to grow almost 6% annually through 2022.1  Spiraling healthcare costs is an obvious problem on many levels, including the fact that, through Medicare, the...

ICD-9 coding for Pain Control

by Steve Adams Effective October 1, 2006, ICD-9-CM category 338 was created for pain. With the creation of the new codes in this section, guidelines related to these codes were also added to the ICD-9-CM Official Guidelines for Coding and Reporting – effective November 15, 2006 A review of these guidelines (section I. C. 6) is important for correct code assignment. Several...

Sounds Crazy but… Distributing Free Pres...

by Bob Healy Consumers, Medical Practices, Health Systems and Pharmacies Can Benefit Think about it. When was the last time that you went to a doctor or hospital and they gave you something for free? What would you think if they provided you with an opportunity to reduce your healthcare costs? Chances are you’d have a pretty positive feeling about them. Medical practices and health...

Primer on Whistleblowing in Healthcare

What are whistleblower lawsuits? Whistleblower lawsuits and settlements are on the rise and in the news. From January 2009 through September 2013, the federal government recovered $17 billion in false claims alone.  Of course, most healthcare providers are honest and work diligently to improve the health of their patients and contribute to the lawful operation of a healthcare...

HIPAA and the Feds: Be “Proactive” not “...

By: Brian L Tuttle, CHP, CHA, CPHIT, CBRA, CCNA, CISSP One sure fire way to get your business or practice audited and in big financial (if not criminal) trouble is to take a reactive instead of a proactive approach. What do I mean by this? Let’s take for example a situation I encountered earlier in the year. A practice had a breach of private health information occur (called in...

Financial Ramifications for Physician Pr...

by Kevin S. Little, JD Absent from the noisy political rhetoric for and against The Patient Protection and Affordable Care Act (ACA),[1]popularly known as “Obamacare,” is analysis of the potential financial impact of the ACA’s significantly high deductibles upon physician practices.  In a third-party payer system where consumers are inclined to think that if covered by insurance...

Still Getting Ready for ICD-10-CM

by Steve Adams, MCS, CPC, CPC-H, CPC-I The go live date with the International Classification of Diseases, 10th Edition Procedure Coding and Clinical Modification (ICD-10CM) in offices, hospitals, and medical centers across America is October 1, 2014 Even though almost every other country in the world has been using the latest version of the International Statistical Classification of...

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