Tag Archives: compliance
Compliance: Curb Upcoding Mistakes Or Risk OIG Scrutiny
Posted on 08. Jun, 2010 by Editor.
Practice size does not matter when dealing with compliance — even solo practitioners have to stay on the straight and narrow.
Even small dermatology practices have to stay compliant with government regulations — and although this sounds like a simple fact, it’s one that many Part B providers may overlook.
Ensuring physician practice compliance can be a complex path, and many practices think of it is something that large hospitals should focus on — after all, those are the entities that get all of the media exposure when they violate compliance rules. But every practice is responsible for compliance, no matter how big or small.
Doctors Take Note
In some cases, small practices think compliance rules don’t affect them — but also don’t realize they’re at risk of being noncompliant.
Example: “I met with a solo practitioner a few years ago
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Radiology Billing Checklist: Rules for Additional Tests without Treating Physician’s Order
Posted on 22. Oct, 2009 by .
Keep these additional test rules at your fingertips if your want to keep auditors out of your hair.
The Office of Inspector General and Recovery Audit Contractors are out to audit non-compliant ultrasound claims, so knowing the rules is more important than ever. And we’ve got a link and a handy checklist to keep you out of trouble.
If you’re wondering when a radiologist can bill for a test without the treating physician’s order, we’ve got the link where CMS answers your question, plus a handy checklist.
CMS explains when a radiologist can bill for a test without the treating physician’s order in the Medicare Benefit Policy Manual, Chapter 15, Section 80.6.
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The Truth About Self-Audits
Posted on 17. Sep, 2009 by .
And one crucial step you should never miss.
How many ticking time bombs are waiting in your medical records?
If you don’t audit your charts regularly, you’ll never know. But even the most thorough set of audits could come to nothing if your staffers believe they’ll lose their jobs if you uncover a problem in an audit.
Reality: “Internal audits (or those conducted by the practice using an outside resource) are the main thing that will protect providers,” says Stephanie Fiedler, CPC, ACS-EM with Loeb & Troper, LLP, in New York City. “Auditing is a method of determining which providers need education related to documentation and proper code selection,” she says.
In fact, a large percentage of the audit focuses on the doctor’s documentation, not how the coders and their managers are doing their jobs.
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Boost HIT Security with This HIPAA Checklist
Posted on 24. Apr, 2009 by .
The scenario: A patient in your financial planner’s office gets too good a look at the planner’s computer screen, which includes other patients’ information. How do you prevent future leaks like this?
The resolution: Use this checklist to help you catch HIPAA violations and track problem areas in your medical office. For each item listed, check whether you observed the activity, the number of occurrences, and any pertinent comments.
• Staff discusses confidential information in public areas.
• Conversations with patient or family regarding confidential information are held in public areas.
• Overhead and intercom announcements include confidential information.
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Safeguard Your Computer System Against Internet Attacks
Posted on 21. Apr, 2009 by .
Send e-mail scams to the recycling bin with these tips.
Think the employees at your practice or facility know how to stop an Internet scam in its tracks? Think again. You must educate your staff members on how to react to even the simplest virus or hoax, or risk leaking your patients’ PHI to hackers and identity thieves.
Strategy: Distribute a “Do’s & Don’ts” tip sheet similar to the one below to all your regular e-mail or Web users. Tell them to refer to the sheet each time they spot a suspicious e-mail or are contacted by companies claiming to need personal data, advises Elisabeth Derwin, an information technology specialist with Bennet Health System in San Francisco.
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OIG Slaps Radiology Practice With Record $2 Million Penalty
Posted on 06. Apr, 2009 by .
Think it’s okay to provide diagnostic tests without physician orders? One Las Vegas radiology practice is paying dearly for making that mistake, among others.
The physician-owned practice will pay $2 million to resolve allegations that it submitted false claims to Medicare, the OIG announced in a March 25 press release.
WEBINAR: Keep your RPA billing squeaky clean.
The settlement–one of the largest ever negotiated under the OIG’s Civil Monetary Penalties authority–will resolve the following allegations against the radiology practice:
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Set Up Your Red Flags Plan With These 6 Tips
Posted on 01. Apr, 2009 by .
Ensure your practice is ready by May 1 with a top-notch plan.
You’ve got less than two months to implement your Red Flags Rule program, but don’t stress too much.
Take a look at these tips, courtesy of Barbara Colburn, director of operations for a medium-sized billing service in Wisconsin, and president of Total Health Care Solutions, a healthcare consulting firm, and set up your program with ease.
1. Identify what the program is and who is affected. Your plan should outline why the practice members need to know about the Red Flags Rule and name all of the covered entities (offsite facilities, labs, clinics, etc.)
2. Identify “red flags.” Make a list letting your staff know what they should be looking for regarding identity theft. For instance, they’ll want to be on the lookout for potentially forged documents or an identification document with a photo, name, or age that doesn’t appear to match the information on their insurance card.
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Sneak a Peek at the RACs
Posted on 23. Mar, 2009 by .
With the Recovery Audit Contractor (RAC) program back in business, you can’t miss the chance to learn all there is to know about the RAC contractors and their habits. That’s why a new CMS transmittal may well be the most interesting reading material you’ve come across in a long while, reports Part B Insider.
CMS transmittal 148, dated March 6, offers updated advice on communication with RACs, points of contact, and an overview of the entire RAC process.
The transmittal offers some insight into the RAC exclusion program, noting …
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Is Big Pharma’s Gravy Train Running Dry?
Posted on 20. Mar, 2009 by .
Do perks from pharmaceutical and medical device companies influence your doctor’s MDM?
Legislators worry about just that, reports The Wall Street Journal. Congress is kicking around a bill that would require companies and doctors to disclose consultant and speaking gigs. Big Pharma largely supports the bill because it would override the “patchwork” of new state laws regulating relationships between drug companies and clinicians.
Massachusetts, for example, has just implemented a law that limits free meals for doctors, and requires public disclosure of … More from The Boston Globe …
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Stark Snag = False Claims Liability?
Posted on 27. Feb, 2009 by .
Physician practices looking to steer clear of anti-kickback, Stark, and even false claims liability should take a close look at a recent decision from the 3rd U.S. Circuit Court of Appeals involving a ‘safe harbor’ arrangement between an anesthesiology group and a hospital.
Some lessons learned from the case …
Don’t rely on the hospital for contract revisions that keep you in the safe harbor: A 1992 contract between the anesthesiology group and the hospital was an issue. While the original agreement had been in a safe harbor, it didn’t cover pain management services the anesthesiologists later added.
The Stark violation surfaced in a whistle-blower’s false claims complaint: The connection between Stark and FCA is “probably something that’s here to stay,” an attorney tells American Medical News … More …
2009 Audio Update with Stark attorney Wayne Miller.
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