A Florida orthopedic office has agreed to pay $4.4 million in medicare fraud claims. This recoupment is for all the things we frequently uncover as outside auditors: “incident to” billing errors, modifier misuse, bundled services billed in global periods, and lack of medical necessity documented. Compliance services such as MyMeducator.com staff e-learning programs, external chart audits, and outside compliance specialists like HMCExperts.com would have uncovered these ...Continue Reading → Share
MOHS services targeted for audit in 2019. Dermatologists are high on the DOJ and CMS investigations this year as they worked to recover more than $2.5 billion in Medicare fraud cases. Compliance services such as MyMeducator.com staff e-learning programs, external chart audits, and outside compliance specialists like HMCExperts.com have helped many providers avoid these costly mistakes.
The US Department of Justice (DOJ) and the Centers for ...Continue Reading → Share
2018 HEALTHCARE TAKEDOWN
By the numbers
601 Defendants charged, including:
165 Medical Professionals
$2.5 billion in Losses
587 Exclusions Issued
58 Federal Districts
30 Fraud Control Units
350 OID Agents
2018 healthcare fraud settlements exceed $2 billion dollars for the 9th consecutive year. Compliance services such as MyMeducator.com staff e-learning programs, external chart audits, and outside compliance specialists like HMCExperts.com Continue Reading → Share
Alzheimer’s disease is typically first noticed in the form of memory problems, although the condition is typically quite advanced by that stage. In order to catch it earlier, scientists have developed a video game that assesses players’ spatial navigation skills.
Called Sea Hero Quest, the game can be played on smartphones or tablets, and was developed in a partnership between Germany’s Deutsche Telekom, France’s CNRS research group, and Britain’s ...Continue Reading → Share
By Richard Scott (Belinda Holmes as Contributor)
in May 1, 2017 Part B News: Patient Encounters
Focus more on the preventive aspects of the “Welcome to Medicare” visit instead of the physical exam components and you may steer your practice to more success with this oft-denied service.
Practices endured a 17% denial rate for G0402 (Initial preventive physical examination; face-to-face visit, services limited to new beneficiary during the first 12 months of Medicare enrollment) in 2015, the latest year of available Medicare claims data. The ...Continue Reading → Share
Medicare Employs Sophisticated Data Analytics to Catch $1.5 Billion in Fraud
The latest in Medicare and Medicaid fraud prevention? A collaboration between the Centers for Medicare & Medicaid Services (CMS), predictive analytic technology, and big data that has contributed to more than $1 billion in savings in 2014 and 2015.
The Fraud Prevention System (FPS) is a proactive strategy that analyzes payment requests submitted by providers. By looking at 4.5 million Medicare claims made on a daily basis, it aims to prevent ...Continue Reading → Share
Attest to 2016 Program Requirements by February 28, 2017
The Centers for Medicare & Medicaid Services Registration and Attestation System is now open. Providers participating in the Medicare EHR Incentive Program must attest to the 2016 program requirements by February 28, 2017 at 11:59 p.m. ET in order to avoid a 2018 payment adjustment. The EHR reporting period was any continuous 90 days between January 1 and December 31, 2016.
If you are participating in the ...Continue Reading → Share
by Belinda Holmes, BS, CPC, CCP-P
AMA & CMS Highlights on ICD-10 Implementation
“ICD-10 implementation is set to begin on Oct. 1, and it is imperative that physician practices take steps beforehand to be ready,” Dr. Steven Stack, AMA’s president, said in a statement. The Medicare claims processing systems will not have the capability to accept ICD-9 codes for dates of services after Sept. 30, 2015, nor will they be able to accept claims for both ICD-9 and ICD-10 codes.
In July, with ...Continue Reading → Share
by Owen Dahl
August 5, 2015
Medical practices will soon face a major change in the way they do business. The deadline for implementation of ICD-10 is days away. This is just one of the many regulatory changes practices must comply with, to stay current in the policy landscape. Instead of dreading “change,” how about thinking about it in a different way? You are not changing, your practice is “transitioning” to a new way of doing things.
You may think this is ...Continue Reading → Share
by Robert Pear
September 13, 2015
“We will have to be very much more specific,” said Dr. Pardeep Kumar, an internist in practice with his wife in Terre Haute, Ind. Credit James Brosher for The New York Times
TERRE HAUTE, Ind. — The nation’s health care providers are under orders to start using a new system of medical codes to describe illnesses and injuries in more detail than ever before. The codes will cover common ailments: Did a diabetic also have kidney ...Continue Reading → Share