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Billing Care Plan Oversight Risks

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

Are You Aware of the Whistleblower Provisions of the False Claim Act ?

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

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 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

LEIE: Do You Know About the List of Excluded Individuals and Entities?

The Exclusions Statute is one of five major federal fraud and abuse laws. Exclusion is an administrative remedy that is in the form of a penalty imposed on a provider. You may have never heard of it or have only recently become aware of it, but Congress first mandated exclusion of practitioners convicted of program

Are your mobile devices HIPAA compliant?

As the world of healthcare evolves, more and more healthcare providers are turning to mobile devices in their practice. If you are a covered entity, you are responsible for complying with HIPAA regulations for securing private patient information, including when using mobile devices. Here are some guidelines to ensure security while using mobile devices: Before

Do You Risk Violating HIPAA on Social Media?

As technology continues to evolve, so does social media, with more and more platforms arising for people to communicate – anytime, anyplace to anyone. The increase in social media presence in healthcare creates greater vulnerability toward breaches of patient confidentiality. Here are some tips to avoid violating HIPAA with social media: Do not talk about

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

How do you fire a patient?

Obviously, no one wants to terminate a patient, but sometimes it is reasonable and in the best interest of both parties.  There are circumstances when it may be within the rights of the provider and appropriate to terminate a patient. Some examples include a patient who: -No-shows or cancels appointments frequently or repeatedly -Does not

Are you trying to prevent medical identity theft?

Medical identity theft continues to be major problem in the US with approximately 2.32 million adults or close family members falling victim in 2014. According to the Fifth Annual Study on Medical Identity Theft by the Ponemon Institute, medical identity theft is on the rise with a 21.7% increase since last year.