Are you a Meaningful User of the Future?

Since the Electronic Health Records (EHR) incentive program known as Meaningful Use began in 2011, the healthcare community has felt its impact and attempted to meet the increasing obligations. A new language has been created with an alphabet soup of acronyms. Physicians voice concerns that complying with Meaningful Use competes with attention on patients and

$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

Have You Reviewed the OIG 2015 Workplan?

The 2015 Workplan of the Office of the Inspector General highlights important areas for providers including medical necessity of services billed, payment review, exclusions, and incentive payments. Determination of the medical necessity of services billed is a primary focus of the Workplan. As stated in the Social Security Act, Medicare will not pay for items

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

Improper Payments for Evaluation & Management Services Cost Medicare Billions in 2010

According to the Office of the Inspector General’s report for 2010, Evaluation and Management services accounted for 30% of Medicare Part B payments, a total cost of $32.3 billion.  However, 55% of these 370 million claims were coded incorrectly and/or lacked appropriate documentation.  These claims correlated to $6.7 billion in improper Medicare payments. 26% of

What The Medicare Claims Data Could Mean To Your Practice

The recently released information on physicians’ billing practices with Medicare has sparked some interesting discussion on the data analysis.  In 2012, 880,000 healthcare providers billed Medicare for $77B. A rheumatologist listed as a “Medicare Top Biller” describes the potential for the public to misconstrue the data without knowing all of the factors involved in billing