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You don't have to be a doctor or even in the health care business to commit health care fraud. A judge court just sentenced an Orchard Park, N.Y., gym owner to three years probation and 100 hours of community service for defrauding private insurers for fake fitness sessions -- including a couple allegedly attended by dead people.

Medicare will press ahead with a new bundled payment policy for lower extremity joint replacements next year, CMS announced in a final rule issued Nov. 16.
Three-quarters of the country's Medicare administrative contractors (MACs) have reported at least one ICD-10 claims-processing error, including a number of common procedures and services.
Come 2016, be prepared to adjust your billing protocol for transitional care management (TCM) services, reflected in codes 99495 and 99496.

The new U.S. budget is very bad for provider-based, off-campus facilities – and it was even worse before Congress revised it. But a top health care lawyer holds out hope it can be revised again in the facilities' favor.

 

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