Medicare, Medicaid & Private Payor Updates
What is the CMS Preclusion List? What is the Difference Between an Exclusion and a Preclusion Action? How Can You Appeal a CMS Preclusion Action?(October 8, 2019): On April 16th, 2018, the Department of Health & Human Services...
Medicare, Medicaid and CHIP Enrollment Revocation and Denial Authorities Have Expanded. What Steps are You Taking to Reduce Your Level of Risk?Big Changes to CMS Form 855 are on the Horizon (September 18, 2019): On September...
Genetic Testing Fraud Prosecutions are on the Rise Around the Country. Are Your Genetic Testing Practices Compliant?(August 13, 2019): Over the last year, a number of genetic testing fraud investigations...
OIG’s Renewed Interest in Orthotic Audits and Investigations: What Your DME Company Needs to Know(February 8, 2019): A series of recent reports out of the Department of Health...
Read More Posts From This CategoryDental Audits & Compliance
SIU Dental Audit Reviews by DentaQuest, Delta Dental and Cigna Can Ultimately Lead to Criminal Prosecution and Imprisonment. Are Your Dental Office’s Medical Necessity, Documentation, Coding and Billing Practices Compliant?(October 16, 2019): A Federal District Court Judge recently sentenced a Murfreesboro,...
The Dangers of Billing Payors for the Services of a Non-Credentialed Dentist / Non-Participating Dentist(August 17, 2019): Over the last year, we have seen a significant increase in...
Aetna’s SIU is Actively Auditing Dental Claims. Are Your Dental Services Compliant with Applicable Regulatory and Contractual Requirements?(January 3, 2019): Slowly but surely, the percentage of adults and children with...
Mobile Dentistry in Texas – An Overview of Regulatory Risk Areas to be Considered(December 7, 2018): Each state sets their own licensure requirements, rules and...
UPIC Dental Audits (Such as Qlarant Dental Audits) Have Been Initiated. Is Your Practice Ready for its Medicare Dental Claims or Medicaid Dental Claims to be Audited?(July 3, 2018): While a number of Medicare Advantage Plans now offer supplemental...
Read More Posts From This CategoryHome Health & Hospice
OIG Has Identified Common Errors by High-Risk Home Health Agencies. Does Your Home Health Agency Have These Documentation Problems?(September 30, 2019): On September 5, 2019, the Department of Health & Human... [Read more of this review]
Home Health Agency Alert: The Review Choice Demonstration Project start dates for Ohio, Texas, North Carolina and Florida are Around the Corner!(August 7, 2019): This article further updates our articles of February 19th and... [Read more of this review]
Home Health Agency Alert: The Review Choice Demonstration Project is Moving Forward in Illinois Effective June 1, 2019(April 9, 2019): This article updates our article of February 19 on the lifting... [Read more of this review]
CMS has Ended its Moratorium on New Home Health Agencies in Texas, Illinois, Michigan and Florida. Unfortunately, the Lifting of the Moratorium Isn’t Necessarily a Good Thing for Existing Home Health Agencies.(February 19, 2019): CMS has now ended, at least for the current time, the moratorium... [Read more of this review]
Read More Posts From This CategoryRegulatory Issues | Privacy | Other
A Civil Investigative Demand Issued to You or Your Medical Practice is Serious Business. Understand Your Level of Risk Before Responding to the Government’s Investigation(September 17, 2019): The False Claims Act (31 U.S.C. §§ 3729-3733) is the primary... [Read more of this review]
Recent Changes to DOJ’s “Justice Manual” Addressing De-Facto Regulations and Agency Guidance Documents(December 27, 2018): On November 16, 2017, Attorney General Jeff Sessions issued... [Read more of this review]
Is ePHI Encryption Required? The Failure to Properly Protect ePHI Can be Quite Costly(June 27, 2018): Violations of the Health Insurance Portability and Accountability... [Read more of this review]
Sexual Harassment: Cases Against Texas Physicians in 2017(January 26, 2018): From Churches to Congress, sexual harassment and assault charges... [Read more of this review]
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