Infographic: Compare the Stark Law and Anti-Kickback Statute

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. Please view our helpful infographic.

DMEPOS Webinar

DMEPOS – CMS Compliance and Requirements Updates: Audio Version of the Webinar

Rachel V. Rose, JD, MBA, principal with Rachel V. Rose – Attorney at Law, P.L.L.C., Houston, TX presents this very timely subject for us. Durable medical equipment, prosthetics, orthotics and supplies (DMEPOS) includes an “entity or individual, including a physician or a Part A provider, which sells or rents Part B covered items to Medicare beneficiaries.” There are special payment rules associated with DMEPOS. DMEPOS products have to meet quality standards, DMEPOS suppliers need to be accepted by Medicare to participate (similar to providers), and are subject to fraud, waste, and abuse laws. The purpose of this webinar to provide an overview of participation and quality requirements, relay the latest compliance and requirements updates, and address False Claims Act cases involving DMEPOS companies.

What You Need to Know about The No Surprises Act

Catherine Short speaks with Rachel V. Rose, JD, MBA, principal with Rachel V. Rose – Attorney at Law, P.L.L.C., Houston, TX, on the topic of “The No Surprises Act – What You Need to Know.” Effective January 1, 2022, the No Surprises Act has implications for patients, providers, and insurance companies alike. The impetus behind the legislation, as well as the regulations, is to prevent patients from receiving bills for certain services that were performed or delivered by providers out of their plan’s network. The scope is limited and providers and plans alike need to take steps to understand the appeal process when a payment or claim is challenged. The purpose of this episode is to provide a brief overview of the evolution of the United States’ healthcare system and its relevance to the No Surprises Act. From there, the No Surprises Act and regulations will be explained, along with the appeal process. Finally, compliance tips will round out the show.

What you need to know about the No Surprises Act

Enacted in late 2020 as part of the Consolidated Appropriations Act of 2021 with an effective date of Jan. 1, 2022, the No Surprises Act (NSA) underscores its primary purpose is to protect patients from surprise medical bills when receiving certain services from – emergency services, non-emergency services from nonparticipating providers at participating facilities, and air ambulance service from nonparticipating providers. (86 Fed. Reg. 36872 (Jul. 13, 2021)).

AUC-Delayed but Not Gone

AUC – Delayed but not Gone: Audio Version of the Webinar

Melody W. Mulaik, MSHS, FAHRA, CRA, RCC, RCC-IR, CPC, CPC-H is the President of Revenue Cycle Coding Strategies LLC and our esteemed presenter. 2022 was scheduled to be the the official implementation date for AUC/CDS implementation but the 2022 Proposed Rule threw everyone a little curve ball. While a delay will occur it does not change the direction of the program or the need to prepare and test. As providers continue to either prepare their own practices or bridge the gap with imaging facilities, it is important that everyone be on the same page throughout the CMS implementation and remaining testing period.

Appropriate Use Criteria – Delayed but Not Gone

Catherine Short speaks with Melody Mulaik, President of Revenue Cycle Coding Strategies, a dynamic company that works with physician practices, healthcare systems, billing companies and other industry stakeholders to provide auditing, education and other collaborative consulting solutions to meet their coding and compliance needs. First Healthcare Compliance is a proud partner of Revenue Cycle Coding Strategies and our clients have enjoyed many webinars and previous podcasts by this team of experts. Melody joins us to address a current hot topic, “AUC – Delayed but not Gone.” 2022 was scheduled to be the official implementation date for AUC/CDS implementation but the 2022 Proposed Rule threw everyone a little curve ball. While a delay has occurred, it does not change the direction of the program or the need to prepare and test.  As providers continue to either prepare their own practices or bridge the gap with imaging facilities, it is important that everyone be on the same page throughout the CMS implementation and remaining testing period.

Waivers and Discounts Webinar

Waivers and Discounts: What are They and When do They Apply?

C.Trey Scott, Coordinating Attorney at Kennedy, Attorneys & Counselors at Law leads this webinar. Waivers and discounts are normal business activities that occur throughout the US daily as a way to reward customers or to assist when an invoice or bill may too expensive. However, in a healthcare context, the normal rules for waivers and discounts don’t apply. This presentation will highlight what waivers and discounts are, how they work, and when they are problematic/illegal.

E/M Coding Updates Podcast

E/M, CPT Code, & Documentation Updates for 2021 – CMS & AMA Come Together to Benefit Providers

Cindy Groux, CHBME/Board Member at HBMA and CEO, President and Owner of Health Care Practice Management, will address new CPT codes for 2021 to include prolonged services and clinical staff services, documentation changes to reduce the administrative burden, decreased needs for audits and how to promote coding consistency, and new rules for time billing.