Reid Kiser is the founder and president of Kiser Healthcare Solutions, LLC presented the webinar “Understanding the Healthcare Quality Measurement Data Landscape: "Data is the New Oil” recently and a recording can now be found on our YouTube Channel. Reid returned to answer many commonly asked questions on our blog. Why is quality and quality
Do you know a physician in need of a vacation? Find a coverage solution with fee-for-time compensation arrangements Physicians report a high rate of burnout, so it’s especially important to overcome scheduling challenges and prioritize vacations. In other professions taking a much -needed break might be achieved by simply creating an e-mail autoresponder. However,
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
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
Medicare Advantage (MA) plans may be doing just what the name says- taking advantage of Medicare. It is highly unlikely that this was the intention in 2003 when MA plans were created by nongovernment entities using a capitated managed care reimbursement approach. The amount of Medicare reimbursement to the MA plan is fixed and calculated
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
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
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
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
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
