http://www.codingnetwork.com/blog/ The Coding Network Blog en service@codingnetwork.com Copyright 2012 2012-05-07T17:14:10+00:00 http://www.codingnetwork.com/blog/post/doctor-indicted-of-insurance-billing-and-medicare-fraud-for-falsifying-diag/ http://www.codingnetwork.com/blog/post/doctor-indicted-of-insurance-billing-and-medicare-fraud-for-falsifying-diag/#When:16:14:10Z A federal grand jury in Birmingham, AL indicted a physician for fraud totaling about $1.3 million for billing Blue Cross Blue Shield and Medicare for non-reimbursable cosmetic skin treatments. The 96-count indictment filed in U.S. District Court charges DIANA K. McCUTCHEON, 54, with committing health care fraud and wire fraud through her 2 medical clinics in Alabama. Medical Coding and Billing, Medical Coding Audits and Compliance 2012-05-07T16:14:10+00:00 http://www.codingnetwork.com/blog/post/apex-medical-group-pays-4.36-million-for-federal-state-health-care-fraud/ http://www.codingnetwork.com/blog/post/apex-medical-group-pays-4.36-million-for-federal-state-health-care-fraud/#When:16:12:52Z 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. Medical Coding News and Recent Articles, Medical Coding Audits and Compliance 2012-05-07T16:12:52+00:00 http://www.codingnetwork.com/blog/post/mgma-launches-rac-watch-increased-rac-audit-activity/ http://www.codingnetwork.com/blog/post/mgma-launches-rac-watch-increased-rac-audit-activity/#When:15:55:09Z Medicare Recovery Audit Contractors (RACs) are tasked with identifying and recouping overpayments and refunding underpayments. In fiscal year 2011, RACs identified $939.3 million in improper payments, and this year they are on track to nearly double that number based on activity in the first quarter. To help gather information — and provide you with valuable resources — The MGMA created a way for you to share your perspectives through RAC WATCH, a new outreach initiative outlined below. Medical Coding Audits and Compliance 2012-05-07T15:55:09+00:00 http://www.codingnetwork.com/blog/post/alert-cms-proposes-one-year-delay-for-icd-10/ http://www.codingnetwork.com/blog/post/alert-cms-proposes-one-year-delay-for-icd-10/#When:04:01:33Z 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 Medical Coding News and Recent Articles, Medical Coding and Billing 2012-04-10T04:01:33+00:00 http://www.codingnetwork.com/blog/post/meet-the-top-10-compliance-challenges-part-2/ http://www.codingnetwork.com/blog/post/meet-the-top-10-compliance-challenges-part-2/#When:16:00:35Z 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. Medical Coding News and Recent Articles, Medical Coding Audits and Compliance 2012-03-26T16:00:35+00:00 http://www.codingnetwork.com/blog/post/three-day-window-extends-to-non-diagnostic-services/ http://www.codingnetwork.com/blog/post/three-day-window-extends-to-non-diagnostic-services/#When:15:54:18Z CMS introduces a new modifier for hospital-owned physician practices. Medical Coding News and Recent Articles, Medical Coding and Billing 2012-03-26T15:54:18+00:00 http://www.codingnetwork.com/blog/post/redefine-code-relationships-for-orthopaedic-surgery-in-2012/ http://www.codingnetwork.com/blog/post/redefine-code-relationships-for-orthopaedic-surgery-in-2012/#When:15:44:05Z 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. Medical Coding News and Recent Articles, Medical Coding and Billing 2012-03-26T15:44:05+00:00 http://www.codingnetwork.com/blog/post/congress-and-cms-focus-on-curbing-fraud-and-abuse-in-medicare-and-medicaid/ http://www.codingnetwork.com/blog/post/congress-and-cms-focus-on-curbing-fraud-and-abuse-in-medicare-and-medicaid/#When:05:01:37Z 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. Medical Coding News and Recent Articles, Medical Coding and Billing 2012-02-24T05:01:37+00:00 http://www.codingnetwork.com/blog/post/cms-issues-proposed-rules-on-reporting-overpayments/ http://www.codingnetwork.com/blog/post/cms-issues-proposed-rules-on-reporting-overpayments/#When:19:43:53Z 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.”) Medical Coding News and Recent Articles, Medical Coding and Billing 2012-02-16T19:43:53+00:00 http://www.codingnetwork.com/blog/post/will-the-icd-10-implementation-be-postponed/ http://www.codingnetwork.com/blog/post/will-the-icd-10-implementation-be-postponed/#When:16:33:51Z 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 Medical Coding News and Recent Articles, Medical Coding and Billing 2012-02-15T16:33:51+00:00