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,…
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…
How would your staff react to an auditor or investigator?
Audits and investigations are stressful events either with or without prior notice. Medical staff should be prepared for an unannounced visit. First Healthcare Compliance provides a sample policy that assists…
Avoiding Overutilization vs. Patient Satisfaction: What’s a provider to do?
An increasingly important issue for many providers is the dilemma of providing care that is satisfactory to the patient while avoiding overutilization and its effect on reimbursement. Unfortunately, the patient’s…
Do Any of Your Medicare Patients Meet the Newly Approved Lung Cancer Screening Requirements With Low Dose Computed Tomography (LDCT)?
Lung cancer is the leading cause of cancer deaths in the United States and third in overall cancer incidence according to 2013 National Cancer Institute statistics. Fortunately, newly approved preventive…
Are You Familiar With the New CMS Payment Model?
The new CMS payment model ties reimbursement to value instead of volume. The focus is on developing a payment method based on quality and improvement of the delivery of care.…
Are You Aware of the New OSHA Reporting Requirements?
All employers under Federal OSHA jurisdiction are required to report any work-related fatality within 8 hours. As of January 1, 2015, all employers are also required to report any work…
$22 M of Potential Fraud, Waste and Abuse Discovered in 2012 Medicare Ophthalmology Claims
In 2012, approximately 49 million Medicare claims were related to screening, diagnosis or treatment of cataracts, wet acute macular degeneration and/or glaucoma. Medicare paid approximately $3.5 billion for these particular…
CMS Just Announced New Provider Enrollment Provisions
As of December 3, 2014, new safeguards have been added to the CMS provider enrollment policies. CMS continues to focus on prevention of Medicare fraud, waste and abuse as part…
Are You Billing for Home Care Visits?
Physician home visits are under scrutiny by CMS for any possible fraud. In 2012, Medicare paid home care service providers about $236 million. As the population of Medicare age recipients…