Search Results for: private overpayment

Hospital Outpatient Dental Services are Being Audited

Dental Audits & Compliance /

(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 […]

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Should You be Concerned About a Consultant Qui Tam?

Medicare, Medicaid & Private Payor Updates /

(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

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Complying with an Individual’s Request to Restrict the Submission of PHI to Insurance

Medicare, Medicaid & Private Payor Updates /

(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

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Liles Parker Attorney Presented at the West Virginia Physician Summit

Firm News /

(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

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Strategic Health Solutions has Initiated an E/M Claims Audit of 99214 and 99215

Medicare, Medicaid & Private Payor Updates /

(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

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Medicare Dental Audits are Being Conducted by ZPICs. Is Your Specialty Dental Practice Ready?

Dental Audits & Compliance /

(January 18, 2013): Specialty dental practices around the country are receiving audit letters from “Zone Program Integrity Contractors” (ZPICs), contractors working for the Centers for Medicare and Medicaid Services (CMS). This latest audit focus by ZPICs is rather surprising in light of the fact that very few dental procedures qualify for Medicare coverage and payment.

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The Recovery Audit Contractor Program Continues to Expand its Medicare Footprint

Medicare, Medicaid & Private Payor Updates /

(November 26, 2012): The Medicare Fee-for-Service (FFS) program consists of numerous payment systems, with a complex network of contractors that process more than one billion claims submitted by more than one million healthcare providers each year.[1] Medicare providers include hospitals, physicians, skilled nursing facilities, labs, ambulance companies, and durable medical equipment, prosthetics, orthotics, and supplies

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Healthcare Data Mining Audits: Impact on Medicare Providers and Suppliers

Medicare, Medicaid & Private Payor Updates /

(June 27, 2012): Healthcare data mining has become quite routine. For instance, in a recent case involving a Missouri psychologist, the provider was indicted and arrested on two counts of healthcare fraud and forgery. At the heart of this case was the fact that the psychologist allegedly submitted claims to Medicare and Medicaid that were

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Texas Medicaid Dental Claims Are Under Audit Scrutiny

Dental Audits & Compliance /

(April 23, 2012): Texas dentists, orthodontists and oral surgeons are under considerable scrutiny by the government, and most practices don’t even realize it. This article examines several one of the current tools being used by the government to calculate the alleged amount of “damages” (improper claims) paid to dental providers by the State under Medicaid.

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Conducting a Gap Analysis / Mock Audit: An Essential Compliance Tool for Your Practice

Medicare, Medicaid & Private Payor Updates /

(November 15, 2011): Understandably, health care providers have grown weary of government audits, malpractice issues, peer reviews and private payor assessments. In an effort to reduce their potential liability, many providers are now regularly utilizing Gap Analyses / Mock Audits to test their preparedness for audit. In doing so, they have been able to identify

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