Search Results for: private overpayment

Prior Authorization Audits for Certain ASC Services in 2026 - Featured Image - Liles Parker

Prior Authorization Demonstration Audits for Certain ASC Services Start in January 2026

Medicare, Medicaid & Private Payor Updates /

(December 09, 2025): The Government Accountability Office (GAO) has long expressed concerns regarding the fraud, waste and abuse risks inherent in the Medicare program. In fact, GAO first designated Medicare as a “High Risk” program due to its size, complexity and susceptibility to improper payments.[1] Throughout 2025, Medicare providers and suppliers were subjected to significant […]

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Hospice Audit and Investigative Actions are Expected to Rise in 2024 - November 2023

Hospice Audit and Investigative Actions are Expected to Rise in 2024

Featured, Home Health & Hospice /

(November 20, 2023): Medicare, Medicaid, and most private insurance plans cover hospice care and related services. To be eligible for hospice care,[1] a patient must be certified as terminally ill and have a life expectancy of six months or less.  In recent years, the hospice industry has exponentially grown, and the number of Federal, State

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AI in medical billing- Liles Parker - October 2023

AI in Medical Billing: A Benefit or a Compliance Risk?

Regulatory Issues | Privacy | Other /

(October 10, 2023): In terms of revenues and expenses, health care providers and suppliers have repeatedly faced two unfortunate realities: (1) Reimbursement rates are shrinking, and (2) they are constantly being saddled with additional unfunded mandates (for example, HIPAA compliance, OSHA requirements, compliance obligations, etc. Coupled with ordinary practice expenses, many health care providers are

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Texas HHSC-OIG is Ramping-Up its Investigations of Medicaid Pediatric Telemedicine Claims

Medicare, Medicaid & Private Payor Updates /

(June 27, 2023): In the State of Texas, Medicaid plays a significant role in providing healthcare services to a large portion of the population. With more than 5.9 million[1] Texans (approximately 18.9% of the current population[2]) enrolled in Medicaid, it is an essential program for qualifying low-income citizens. In Texas, Medicaid costs taxpayers over $40

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2023 Webinars

TAHCH Webinar Updates on Vaccine and Mask Mandates Tuesday, January 4, 2023 1 p.m. EST / Noon CST / 10:00 a.m. PST Duration: 60 Minutes Jennifer Papapanagiotou JD, MS, BS Heidi Kocher JD, CHC, MBA, BS COVID vaccine and mask mandates have come, been amended, been removed for some occupations or sites and left in

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Civil Investigative Demands (CIDs) & Collateral Enforcement Risks: A Review

Regulatory Issues | Privacy | Other /

(October 12, 2022): The False Claims Act is the primary civil enforcement tool utilized by our government today. In Fiscal Year (FY) 2021, the U.S. Department of Justice (DOJ) won or negotiated over $5.6 billion in False Claims Act (FCA)[1] settlements and judgments. Of that amount, more than $5 billion [2] resulted from matters involving

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Enforcement Efforts Targeting Aquatic Therapy Providers and CPT Code 97113 Claims

Medicare, Medicaid & Private Payor Updates /

(October 3, 2022): Aquatic therapy is a common method of rehabilitation and maintenance for several types of injuries and conditions, and the practice is widely accepted by Medicare, Medicaid and many private payors. Historically, both payors and law enforcement have routinely audited aquatic therapy claims. The Centers for Medicare and Medicaid Services (CMS) initially suspended

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Incident To Billing Practices are Under Law Enforcement’s Microscope. Are Your Incident To Billing Practices Compliant?

Medicare, Medicaid & Private Payor Updates /

(September 20, 2022): In the Medicare billing context, the term “Incident To” refers to the fact that under certain circumstances, the services of non-physician, mid-level practitioners (such as Nurse Practitioners (NPs) and Physician Assistants (PAs)) are “. . . furnished as an integral, although incidental, part of the physician’s personal professional services in the course

Incident To Billing Practices are Under Law Enforcement’s Microscope. Are Your Incident To Billing Practices Compliant? Read More »

laws regulation changes affect billing agreement - Liles Parker

Ever-Changing Federal and State Laws and Regulations are Transforming Third-Party Billing Contracts

Regulatory Issues | Privacy | Other /

(July 28, 2022): The business side of medicine has changed considerably over the last decade. Health care laws, regulations, and administrative policies are constantly evolving. A number of these changes have impacted health care practices, billing companies, and the third-party billing contracts executed between these parties. From its earliest beginnings, the majority of third-party billing

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