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Medicare

Home/Medicare

3 Common Misconceptions about MIPS

Even though the largest healthcare fraud takedown in history occurred in July, 2017, QPP, MACRA, MIPS and APMs continue to dominate the compliance conversation. Confusion and discontent are present as providers and managers struggle to make decisions regarding their approach to regulations that will determine the amount of their future Medicare reimbursements. Results of a

Abbreviations 101: FQHC vs RHC

Over the last several decades, the number of Federally Qualified Health Centers (FQHC) and Rural Health Clinics (RHC) have been on the rise, due in part to the growing Medicare population and increasing reimbursement. Latest statistics show there are over 1200 FQHCs that meet grant requirements and over 4000 Medicare-certified RHCs in the US and

Compliance Program: What is the Value?

The value placed on a compliance program varies greatly with perspective and remains difficult to define. Obviously, the purpose of a compliance program is to prevent and deter wrongdoing. A strong program preempts problems. However, it is difficult to know what might happen in the future or what could have gone wrong in the past.

OIG WORKPLAN 2016

The Office of the Inspector General (OIG) is responsible for protecting the integrity of the programs in Health and Human Services against fraud, waste and abuse as well as recommending improvements to the system that would promote efficiency and efficacy within the limits of the health care laws.   Although OIG oversight includes programs such as

Are You Prepared for the HIPAA Phase 2 Audits?

After reviewing the HIPAA Privacy case investigations from 2009-2011, the Office of the Inspector General sent a strong message to the Office of Civil Rights in regard to the administration and enforcement of the HIPAA Privacy Rule. The OIG recommendation is clear in the September 2015 executive summary, “OCR Should Strengthen Its Oversight of Covered

Stark vs. Anti-Kickback: A Quick Comparison

The Federal Anti-Kickback Statute and the Stark Law are often confused because both laws deal with remuneration related to improper referrals. Large groups and multi-specialty practices must make an effort to manage referrals and ancillary services while adhering to these important regulations. It’s helpful to understand the fundamental distinctions between the two laws.   Anti-Kickback

Billing Care Plan Oversight Risks

Care Plan Oversight describes the physician or other healthcare professional’s supervision of patients in hospice, nursing facilities or those receiving care through home health agencies. CPO reimbursement covers initial certification, any re-certifications and care plan supervision. However, only physicians can bill for initial certification and re-certification and only one physician can bill per month. The

Are You Aware of the Whistleblower Provisions of the False Claim Act ?

The whistleblower provisions of the False Claims Act have lead to several newsworthy cases in recent years. Just a few days ago, the Justice Department announced that KMART Corporation (Kmart) will pay $1.4 Million to resolve False Claims Act allegations for knowingly providing coupons to Medicare beneficiaries to waive or reduce co-pays for purchasing more

Complying with Stark Law: Can you bill Medicare when treating your family members?

The treatment of family members falls under General Exclusions from Coverage under Medicare. No payment will be made for items or services for a family member when the charge is from an immediately related provider, any of their associates or their professional corporations. As part of Stark I in 1989, self-referrals for clinical laboratory services