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Dermatology Physicians / Practice to Pay $1.9 Million to Settle Overbilling Medicare for E&M Services

Abusers of the Medicare system can sometimes be intentional or not, but the stories that really get significant attention of the public are the ones that highlight healthcare personnel that intentionally over bill Medicare.

There are several types of abuse including falsifying claim forms adjusting the actual cost of services, Billing for services and supplies that […]

By |April 21st, 2016|Uncategorized|Comments Off on Dermatology Physicians / Practice to Pay $1.9 Million to Settle Overbilling Medicare for E&M Services

Calif State Medicaid Fraud Unit Recovers $795 Million in Judgements

California State Medicaid Fraud Control Unit: 2015 Onsite Review (OEI-09-15-00070) http://go.usa.gov/cpgj5 Why We Did This Study

OIG oversees all State Medicaid Fraud Control Units (MFCUs or Units). As part of this oversight, OIG conducts periodic reviews of all Units and prepares public reports based on these reviews. The reviews assess Unit performance in accordance […]

By |February 22nd, 2016|Medical Coding News and Recent Articles|Comments Off on Calif State Medicaid Fraud Unit Recovers $795 Million in Judgements

Effects of ICD-10 on Coding Production – Example from MGMA Community

Now that ICD-10 has been rolled out, medical coding companies are feeling its effects. The Medical Group Management Association (MGMA) and its affiliates are having to recreate their processes in order to account for the vast increase in the number and variety of codes. What was once a simple system with a mere 13,000 codes is […]

By |January 12th, 2016|ICD-10 Readiness|Comments Off on Effects of ICD-10 on Coding Production – Example from MGMA Community

$750,000 HIPAA SETTLEMENT CAUSES OCR TO UNDERSCORE NEED FOR ORGANIZATION WIDE RISK ANALYSIS

In a $750,000 HIPAA Settlement, the University of Washington Medicine (UWM) has agreed to settle charges that it potentially violated the Health Insurance Portability and Accountability Act of 1996 (HIPAA) Security Rule by failing to implement policies and procedures to prevent, detect, contain, and correct security violations.  UWM is an affiliated covered entity, which includes designated […]

By |December 18th, 2015|Uncategorized|Comments Off on $750,000 HIPAA SETTLEMENT CAUSES OCR TO UNDERSCORE NEED FOR ORGANIZATION WIDE RISK ANALYSIS

Keyboarding Injury? ICD-10’s Got That Covered

The much delayed launch of ICD-10 code implementation finally occurred on Oct        1st, 2015. The new International Classification of Diseases, Revision 10 inflates coding options by the thousands and requires more specificity than ever before.

Among the standards, the new injury codes expanded to include some pretty crazy ways people have been injured […]

By |November 19th, 2015|ICD-10 Readiness|Comments Off on Keyboarding Injury? ICD-10’s Got That Covered

Final 2016 Medicare Physician Fee Schedule Released

The MGMA reports that the final 2016 Medicare physician fee schedule has been released.

The Centers for Medicare & Medicaid Services (CMS) finalized the Medicare physician fee schedule (PFS) for 2016.

Key policies finalized in the 2016 payment rules include:

Finalizing the Home Health Value-Based Purchasing model.
Finalizing updates to the “Two-Midnight” rule.
Finalizing the End-Stage Renal Disease Quality Incentive […]

By |November 7th, 2015|Medical Coding and Billing, Medical Practice Revenue Optimization|Comments Off on Final 2016 Medicare Physician Fee Schedule Released

ICD-10 Aftershocks: The Challenges Every CFO Can Expect

If any individual in the C-suite will feel the effects of ICD-10 most prominently, it will be the hospital CFO. As reported in Becker’s Hospital Review, October 2015, in a article by Kelly Whittle, MS, Principal, ICD-1 0 Advisory and Whittle Advisors, LLC, the top 4 issues faced by hospital CFO will include.

Significant productivity loss […]

By |October 28th, 2015|ICD-10 Readiness, Medical Coding Best Practices|Comments Off on ICD-10 Aftershocks: The Challenges Every CFO Can Expect

Now there’s 70,000 Ways to Classify Ailments

Doctors, insurers and hospitals are preparing themselves for possible business disruptions on Oct. 1. This is when ICD-10 hits, a massive new set of codes meant to describe any illness or injury.

Under ICD-10, cardiologists will have over 800 codes for describing angioplasty. Dermatologists will have 8 different types of acne. Gastroenterologists who aren’t sure what’s causing […]

By |September 29th, 2015|ICD-10 Readiness, Medical Coding News and Recent Articles|Comments Off on Now there’s 70,000 Ways to Classify Ailments

Holdup at the doctor’s office? New billing codes could be why.

Starting October 1st, physicians and hospitals will have to be far more specific than ever before when diagnosing problems from visits.

Because of this change to the system, called ICD-10, patients should expect longer than usual times to be billed for their portion. This may even add waits to the doctor’s office when visiting.

To both physicians […]

Medicare Reimbursement Rates Get a Small Increase

California Medical Association (CMA ALERT) – The CMS announced that a 0.5% increase will be made for Medicare reimbursement rates, which are effective starting July 1, 2015 to December 31, 2015.

The increase to Medicare reimbursement rates is an effect of the Medicare Access and CHIP Reauthorization Act, signed in April 2015. CMS has released the […]