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Justice Department steps up use of the False Claims Act to prosecute health care fraud

11/03/2014

The department implemented a new procedure so that all new whistleblower cases accusing providers of violating the False Claims Act, which are filed with the department’s civil division, now will be shared with its criminal division as soon as the cases are filed to determine whether a parallel criminal investigation should be opened.

Recovery auditors collected $3.65 billion in overpayments in fiscal year 2013

11/03/2014

by: Marla Durben Hirsch

Recovery auditors collected $3.65 billion in overpayments in fiscal year 2013 and $102 million in underpayments, according to CMS’ latest report.

2013 data show denials up with lower-level new patient office visit E/M codes

10/27/2014

by: Roy Edroso

Watch out: Our latest Medicare data shows us that E/M denials have been going up — not so much for the high-level codes practices normally worry about, but for the lower ones, especially for new patients.

OIG proposes to clarify, increase anti-kickback safe harbor protections

10/27/2014

by: Marla Durben Hirsch

You soon may be able to offer patients transportation to your offices for appointments and receive payments from hospitals with fewer compliance risks, now that HHS’ Office of Inspector General (OIG) has proposed a new rule updating the anti-kickback statute and civil money penalty (CMP) law.

Base 7th character on treatment stage, not whether provider is new

10/27/2014

by: Laura Evans

Select the “active” treatment seventh character on ICD-10 injury codes based on whether the patient is undergoing active treatment for the injury — not whether the provider is seeing the patient for the first time, according to the latest update to ICD-10 coding rules.

Busier practices with more procedures best bets for hiring medical scribes

10/27/2014

by: Roy Edroso

If you’re thinking of hiring medical scribes, don’t just jump in — analyze the cost of the time your providers spend entering information into the electronic health record (EHR) against the cost of the service to see whether you can afford it.

Provider roadmap: Next steps to achieve stage 1, stage 2 meaningful use

10/27/2014

by: Scott Kraft

If you were unable to attest to even stage 1 of meaningful use before the Oct. 3 deadline, you face a 1% penalty to 2015 payments unless you claim a hardship exception.

PECOS questions answered: How to set up surrogates, handle signatures and more

10/20/2014

by: Scott Kraft

Ensure proper provider enrollment with answers to common questions, provided by enrollment and credentialing expert David Zetter, president of Zetter Healthcare Management Consultants, Mechanicsburg, Pa., and a member of CMS’ Provider Enrollment, Chain and Ownership System (PECOS) power users group.

Build a communication plan to be the trusted adviser to your patient population

10/20/2014

by: Richard Scott

The unfolding Ebola scare provides a valuable lesson for physician practices: Keep your patient communication practices sharp so you remain the go-to source for patients during times of need.

CCI 20.3 introduces new daily limits for established patient visits in MUE list

10/20/2014

by: Julia Kyles

You will have a clearer path to reporting certain E/M visits twice in one day, thanks to the latest set of daily utilization edits, which went into effect Oct. 1.

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