Apex Medical Group Pays $4.36 Million For Federal & State Health Care Fraud

May 07, 2012
A government investigation revealed that from at least 2001 through 2006 Apex Medical Group in Knoxville, TN submitted numerous false and fraudulent claims to government health programs, including Medicare and TennCare, for payment through a pattern of upcoding for various physician services.

Alert - CMS proposes one-year delay for ICD-10

Apr 09, 2012
Today, April 9, 2012, the Department of Health and Human Services (HHS) published a rule that proposes to delay ICD-10 one year from Oct. 2013 to Oct. 2014. The one-year delay of ICD-10 is in response to continued concerns from MGMA and others that adoption of the new code sets will prove extremely challenging to physician practices. In its most recent communication to HHS, MGMA called on the government to reconsider its ICD-10 implementation process

Meet the Top 10 Compliance Challenges - Part 2

Mar 26, 2012
This month, we conclude this two-part series with a look at the top five compliance risks, and some tips to ensure you meet these challenges effectively.

Three-day Window Extends to Non-diagnostic Services

Mar 26, 2012
CMS introduces a new modifier for hospital-owned physician practices.

Redefine Code Relationships for Orthopaedic Surgery in 2012

Mar 26, 2012
Changes in CPT® 2012 for orthopaedic surgery coding redefine the re- lationships between frequently reported arthroscopy codes and bring two new codes for treatment of Dupuytren’s contracture.

Congress and CMS Focus on Curbing Fraud and Abuse in Medicare and Medicaid

Feb 23, 2012
MGMA Connexion – February 2012



The top 10 government issues for practice executives to watch in 2012

By Allison Brennan, senior advocacy advisor, MGMA Government Affairs



The following is an excerpt:



#6. Continued emphasis on compliance



Congress and CMS continue to focus on curbing fraud, waste and abuse in public health programs, such as Medicare and Medicaid. Medicare recovers more than $7 for every $1 spent on fraud investigations, according to government data. Group practices should prepare for new compliance initiatives, such as Medicare enrollment revalidation requirements. Expect more upfront scrutiny instead of so-called “pay and chase” efforts from the government. During 2012, HHS may finalize long-awaited rules on new privacy requirements that stem from the 2009 Health Information Technology for Economic and Clinical Health Act. Additionally, the Recovery Audit Contractor program will focus more on Medicare Park B payments as auditors exhaust Medicare Part A opportunities. Reprinted with permission from the Medical Group Management Association, 104 Inverness Terrace East, Englewood, Colorado 80112. www.mgma.com. Copyright 2012.

CMS Issues Proposed Rules on Reporting Overpayments

Feb 16, 2012
The Centers for Medicare & Medicaid Services (CMS) issued a Proposed Rule instructing how providers should report and return overpayments under the Affordable Care Act (often called “Obamacare.”)

Will The ICD-10 Implementation Be Postponed?

Feb 15, 2012
CMS Administrator Marilyn Tavenner was a speaker at the American Medical Association's recent Advocacy Conference in Washingon, DC. When speaking to reporters following her presentation she said that CMS will "re-examine the timeframe" for ICD-10 implementation

The Outpatient Therapy Documentation/Claims Conundrum

Feb 10, 2012
Will the OIG be looking at you?, Lynn Berry, PT, CPC, discusses how current therapy documentation regarding therapy times and units often fall short of the rules outlined in Medicare guidelines.

Medical Technology is Making Humanism a Lost Art

Jan 31, 2012
In the Coding Edge article, Medical Technology is Making Humanism a Lost Art – New Health care regulations may help bring humanity back to medicine, Lynn Berry, PT, CPC describes new federal rules and regulations including the HCAHPS survey questions, the new rules for ACOs, and the new Value-Based Modifier (all of which contain measures of the patient experience) which are now recognized as key elements of successful patient treatment.