Creating compliant good faith estimates for self-pay and uninsured patients means more than just handing patients a form with a number on it. You must also master the timing of the estimates you distribute—and if you don’t, the government could fine your practice. Why? Because the estimate needs to give the patient enough time to […]
No medical practice wants to be the target of a False Claims Act (FCA) accusation. Penalties for violating the FCA include fines of up to $11,000 per claim, attorney costs, exclusion from Medicare, and having to pay back triple the damages that the government incurs. But if you want to avoid FCA accusations, your best […]
When the HIPAA privacy laws first went into effect, medical practices were vigilant—but that hasn’t necessarily been the case recently. Some practices have relaxed their HIPAA compliance, and that’s a mistake. The government is still coming after violators, and has imposed more than $133 million in HIPAA settlements and penalties as of Sept. 30, 2022. […]
Is your practice reporting advance care planning (ACP) properly? If you’re like the majority of practices that the OIG recently audited, you’re probably documenting these incorrectly, which could mean you’ll need to pay money back to Medicare. Here’s why: A recent OIG audit revealed that out of 691 ACP services they reviewed, 466 didn’t comply […]
The Employee Retirement Income Security Act (ERISA) governs how your practice must communicate to your employees about such topics as your health insurance plan and your retirement benefits. If your practice doesn’t abide by the law, you could face massive civil and criminal penalties, so it’s essential to stay on top of the requirements. One […]
One audit type that’s always looming over medical practices involves Recovery Audit Contractors (RACs). These organizations are appointed by each MAC to uncover, confirm, and take back reimbursements Medicare made in error. Because they get paid a percentage of what they recover from medical practices, RACs are sometimes referred to as Medicare’s “bounty hunters.” Recovery […]
Medical practices can get paid more for Medical Advantage claims by accurately reporting patient risk—but the main way insurers evaluate risk is through your diagnosis codes. And if your practice isn’t performing ICD-10-CM self-audits, you could be underrepresenting your risk and shorting your practice significant income without even knowing it. Background: Risk adjustment is a […]
Medical practices have had a few years to comply with the HIPAA privacy and security rules, which means you’ve gotten a handle on issues like giving patients access to medical records in a timely manner and keeping their private information secure. But one area that you may not have mastered yet involves the Information Blocking […]
As many medical practices are aware, Durable Medical Equipment (DME) fraud is running rampant, and you could be pulled into a case even if you didn’t knowingly violate the Stark law or Anti-Kickback Statute. Why? Because a DME supplier who violates these laws could present your provider’s DME prescriptions as evidence to shift liability away from […]
As part of the Centers for Medicare & Medicaid Services (CMS), Medicaid auditors are eager to come after potential instances of fraud or abuse that could cost you a fortune in fines, penalties and exclusions if you aren’t careful. Check out several areas that Medicaid auditors are targeting, and find out how you can stay […]
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