Medicare, Medicaid & Private Payor Updates
EKRA: Laboratories, Treatment Homes and Clinical Treatment Centers Now Face Increased Enforcement and Penalties for Kickback Tainted Claims that are Reimbursed by Private Payors.(December 3, 2018): On October 24th, 2018, President Trump signed into law...
Home Health Providers Under the Microscope — The Review Choice Demonstration Project is Here(October 4, 2018): Last week, the Centers for Medicare & Medicaid Services...
Transcranial Magnetic Stimulation Claims Audits by Medicare MACs and UPICs are Underway. Are Your CPT 90868 Claims Compliant?(July 16, 2018): Do you provide Transcranial Magnetic Stimulation care...
Is Your Urogynecology, OB/GYN or Multidisciplinary Practice Prepared for a Medicare Biofeedback Claims Audit or a Pelvic Floor Therapy Claims Audit?(July 12, 2018): While no medical specialty has completely avoided the scrutiny...
CMS has Confirmed the Coverage of Personal Care Services by Medicare Advantage Plans Starting 2019.(June 26, 2018): The coverage of personal care services by Medicare has...
An Overview of Administrative Rheumatology Audits / Adverse Actions AND Civil / Criminal Enforcement Actions(May 20, 2018): It’s been a rough week for at least one Texas rheumatologist. ...
Expect an Increase in Audits of Chiropractic Services!(April 16, 2018): Chiropractors around the country are again finding their...
CBRs for Spinal Orthoses (CBR201803): What Do You Need to Know?(April 12, 2018): The Centers for Medicare & Medicaid Services (CMS) utilizes...
ZPIC Audits / UPIC Audits: The Impact of Transmittal 768 on the Medicare Appeals Process Timeline.(April 12, 2018): A big concern with the Medicare appeals process is the ghastly...
Medicare Advantage Plans May Soon Offer Personal Care Services(April 10, 2018): On April 2, the Centers for Medicare and Medicaid Services...
Read More Posts From This CategoryDental Audits & Compliance
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...
Dental Claims Audits are on the RiseBoth Medicaid and private payor dental claims audits are increasing around...
Dental Fraud: Dentist Faces 3,974 Years in Prison if Convicted!(November 30, 2017): Earlier this year, Attorney General Jeff Sessions announced...
Medicaid Dental Audits of IV Sedation Services(June 16, 2017): Under the Social Security Act, states are required to operate...
Delta Dental Audits are Ongoing Around the Country. Are You Prepared?(May 15, 2017): Over the last decade, both state and federal law enforcement...
Medicaid Dentist Eligibility Audits are Ongoing Around the Country(January 9, 2017): A recent report of the New York State agency that administers...
Dental Practice Audits are on the Rise — Protect your Interests!(October 11, 2016): More than 45 million children receive government-funded...
More Texas Medicaid Dental Audits Are Coming in 2017!(August 23, 2016): During 2014, the Texas Health Human Services Commission’s...
Exclusion Screening / OIG Screening and Background Checks in Dental Practices(March 31, 2016): Many of the dental practices around the country do not...
OIG Finds Significant Medicare Dental Overpayments Made to Hospitals(October 27, 2015): Late this summer, the Office of Inspector General for the U.S....
Dental Claims False Claims Act Liability(March 6, 2015): As we have seen in recent years, Medicaid audits resulting...
Read More Posts From This CategoryHome Health & Hospice
Is Your Urogynecology, OB/GYN or Multidisciplinary Practice Prepared for a Medicare Biofeedback Claims Audit or a Pelvic Floor Therapy Claims Audit?(July 12, 2018): While no medical specialty has completely avoided the scrutiny... [Read more of this review]
Seven Elements of a Payable Claim are an Essential Tool When Preparing for a ZPIC Audit(September 21, 2012): Each year, our attorneys and paralegals review and... [Read more of this review]
AdQIC: A Brief Refresher on the Role This Contractor Plays.(June 15, 2012): If you have ever been involved in a Medicare postpayment... [Read more of this review]
100 Involved in Health Care Fraud ArrestsUpdate (May 3): In total, 107 individuals were charged yesterday in connection... [Read more of this review]
Lose Your Appeal at Reconsideration? Consider an ALJ Hearing(June 18, 2011): As a review of the last several quarters of Medicare appeals... [Read more of this review]
The Medicare Administrative Appeal Process(March 25, 2011): Zone Program Integrity Contractors (ZPICs) have established... [Read more of this review]
Read More Posts From This CategoryRegulatory Issues | Privacy
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... [Read more of this review]
Maryland Limits on Opioid Prescriptions(June 30, 2017): In March 2016, the Centers for Disease Control and Prevention... [Read more of this review]
Cell Tower Ground Lease Renewals and Purchases(September 15, 2015): A landowner/ground lessor considering a renewal or easement... [Read more of this review]
OIG Proposes New Anti-Kickback Law Safe Harbors(November 10, 2014): The U.S. Department of Health and Human Services Office... [Read more of this review]
Peddling and Soliciting, Municipal Regulations These Issues Can be Complex. Is Your City Clear on These Points?(January 8, 2013): As a general rule cities can regulate hawking, canvassing,... [Read more of this review]
What is Civil Fraud?(Updated June 18, 2018): According to the Association of Certified Fraud... [Read more of this review]
Read More Posts From This Categorymake our blog #1 – vote for us
