Audit Zone

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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 clients in preparing the front office. Here are some recommendations to ensure that proper steps are taken: Immediately contact your supervisor, manager and/or Compliance Officer

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 perceived satisfaction may not be a result of receiving the best quality of care and in some cases may be due to inappropriate or wasteful

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 service for annual lung cancer screening is available for Medicare beneficiaries meeting certain eligibility criteria. This increased availability and accessibility to screening should ultimately affect

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. The increasing ability to share information amongst providers, consumers and others, necessitates the dual function of “best possible” decision making and maintaining patient privacy. HHS

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 -related inpatient hospitalization, amputations or loss of any eye within 24 hours. Reporting is currently available on the OSHA’s toll free number 1-800-321-OSHA or through

$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 services. Review of the data using 4 National Coverage Requirements found $14 million in potentially inappropriate payments and according to 2 Local Coverage Requirements an

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 of their comprehensive program integrity plan. Reportedly, 25,000 providers have already been excluded from participation and may no longer be able to re-enroll. Use of

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 increases it seems likely that the need for home care services will also increase. There are many benefits to providing home care services such as

What Should You Do After Discovering a Billing Error?

Just correct the problem and you will be compliant? No, but this is the first step in the right direction. According to the HHS in “A Roadmap for New Physicians – Avoiding Medicare and Medicaid Fraud and Abuse,” the following steps should be taken: Immediately cease filing the problematic bills Seek knowledgeable legal counsel Determine

Are You Aware of the Updated CMS Timeline for Meaningful Use?

Recent CMS modification allows more flexibility in certified EHR technology for 2014. Participation by providers will likely increase as will the ability to meet objectives such as e-prescribing, reporting quality measures and checking lists of drug interactions and drug allergies. Eligible providers can use the 2011 Edition CEHRT or a combination of 2011 and 2014