"Nationwide Healthcare Lawyers"
(January 9th, 2015) Health care providers increasingly complain that the Recovery Audit Program creates numerous administrative and financial burdens for those participating in the federal Medicare program. Providers continue to advocate for numerous changes to the program, especially those that will reduce their burden when dealing with Recovery Audit Contractors (RACs). In response to these […]
CMS Implements RAC Program Improvements Read More »
(August 12, 2014): Texas Medicaid dental fraud has been an ongoing concern of both federal and state law enforcement agencies. As set out in an August 2014 report titled “Texas did Not Ensure that the Prior Authorization Process was Used to Determine the Medical Necessity of Orthodontic Services,” the U.S. Department of Health and Human
Texas Medicaid Dental Fraud: Is the State Partly to Blame? Read More »
(July 18, 2014): Over the last decade, Compliance Programs have become an essential part of the way large and mid-sized health care providers conduct business. In recent years, small health care providers have followed suit, and Compliance Program development, review and implementation has become a priority if the provider intends on staying within the four
Health Care Compliance Program Development, Review & Implementation Read More »
GAP Analyses are routinely used in practically every industry to assist an organization in identifying whether corrective actions are needed in order to bring an entity to an acceptable level of legal and professional compliance. Our health care clients have consistently found that a GAP Analysis of their practices can be an invaluable compliance tool.
How to Conduct a GAP Analysis of Your Health Care Practice Read More »
(February 11, 2014): Has a Zone Program Integrity Contractor (ZPIC) denied your home health claims? If you believe that these denials are unwarranted, your home health agency (HHA) may challenge the denials through Medicare’s administrative appeals process. Medicare’s appeals process provides five levels of appeal. The first four levels of appeal are before different administrative
Medicare ALJ Appeals of Denied Home Health Claims Read More »
(December 4, 2013): Generally, Medicare does not cover hospital outpatient dental services. Under the general exclusion provisions of the Social Security Act, items and services in connection with the care, treatment, filling, removal, or replacement of teeth or structures directly supporting the teeth (e.g., preparation of the mouth for dentures or removal of diseased teeth
Hospital Outpatient Dental Services are Being Audited Read More »
(October 16, 2013): Healthcare providers should be on guard – a new type of whistleblower may be an individual you would least expect. Recently, the Department of Justice (DOJ) entered into a multi-million dollar settlement agreement with a Florida-based healthcare provider based on claims that the provider submitted false claims to various Federal and State
Should You be Concerned About a Consultant Qui Tam? Read More »
(October 3, 2013): The HIPAA Omnibus Rule (Omnibus Rule) is well over 100 pages long. When considered in the context of existing HIPAA and HITECH, health care providers are often it difficult to apply the provisions of the Omnibus Rule to privacy situations that are commonly arising in a physician’s practice. One such situation is
Complying with an Individual’s Request to Restrict the Submission of PHI to Insurance Read More »
(August 26, 2013): Medicare compliance challenges have increased (rather than decreased) with the passage of the Affordable Care Act and the implementation of Electronic Medicare Records (EMR) systems by physicians and other health care providers around the country. Late last week, Robert W. Liles, Managing Partner at Liles Parker, had the privilege of serving as a
Liles Parker Attorney Presented at the West Virginia Physician Summit Read More »
(August 15, 2013): Over the last few months, Strategic Health Solutions, LLC, a Supplemental Medical Review Contractor, appears to have significantly stepped up its post-payment audits of physicians and non-physician practitioners billing high level Evaluation and Management (E/M) codes. Strategic Health Solutions’ current audit push appears to be focused on E/M services provided to established
Strategic Health Solutions has Initiated an E/M Claims Audit of 99214 and 99215 Read More »
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