Search for: "Physicians Auditing "
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15 Aug 2013, 12:45 am
Affinity Health Plan, Inc. [read post]
11 Aug 2013, 4:48 pm
Physicians who treat for pain management physicians are clinicians. [read post]
7 Aug 2013, 8:06 am
If you need help developing a compliance plan or reviewing and refining your existing audit defense strategies in light of the final rule, please contact an experienced healthcare attorney at 248-544-0888. [read post]
6 Aug 2013, 10:24 am
If adopted, the bill would prohibit, for example, a physician ordering advanced imaging services for a Medicare beneficiary if the services are performed in the ordering physician’s offices. [read post]
6 Aug 2013, 7:41 am
In his case, the fact that the physician names listed on the superbills were not the patients' referring physicians was one of the facts that shifted this case from a billing error case to a fraud case.Posted by Tracy Green, an attorney specializing in representing and defending health care professionals in health care fraud, Medicare fraud and Medi-Cal fraud allegations, audits, investigations and charges. [read post]
6 Aug 2013, 6:30 am
If the employer notices a continuing pattern of large reserve adjustments on the claim files right before or when the claim closes, a claim file audit should be completed. [read post]
5 Aug 2013, 11:31 am
Businesses and workers concerned that the definition of “full-time” employment as 30 hours per week in the “pay-or-play” penalties of the Patient Protection and Affordable Care Act (commonly referred to by the public as “Obamacare”) is hurting American workers may want to share their input on recently introduced legislation that would raise the number of hours an employee must work to qualify as “full-time” for purposes of the pay-or-pay… [read post]
1 Aug 2013, 2:40 pm
As always, providers should maintain excellent documentation regarding the physician's rationale for the services provided and the rational for how the provider arrived at the billing status. [read post]
31 Jul 2013, 8:51 am
“[N]ot only should an insurer audit and challenge the reasonableness of bills submitted by health care providers, but the providers should expect no less. [read post]
29 Jul 2013, 2:26 pm
If you need assistance in defending a Medicare audit, or if you need help creating an effective compliance plan for your practice, please contact an experienced health care attorney at 248-544-0888. [read post]
23 Jul 2013, 6:18 am
Internal audits allegedly revealed widespread upcoding, i.e., physician coding of patient encounters at levels higher than evidenced in the corresponding medical records. [read post]
8 Jul 2013, 10:47 am
Physicians or other health care providers now have even more to worry about when a Medicare or other federal program audit reveals overpayments – repayment demands from commercial insurers and self-insured health plans, who are secondary payers. [read post]
26 Jun 2013, 2:48 am
One area of controversy in the report involves the GAO’s criticism of TJC’s accreditation program for having less focus on imaging quality and physician qualifications than the other two accrediting organizations, assertions the TJC strongly contested. [read post]
24 Jun 2013, 8:55 am
About 10% of all spinal fusions paid for by Medicare in 2011 were not necessary, either because there was no medical basis for them or because doctors did not follow standards of care by exploring non-surgical treatments, according to a USA TODAY analysis of data from Medicare program audits. [read post]
23 Jun 2013, 2:00 am
“Quality Measurements, Payment, and the Law: Disincentives to Physician-Patient Discussions of End-of-Life Care” is the title of a new article by Missouri health lawyer Harvey M. [read post]
21 Jun 2013, 2:43 pm
The revised statute also mandates that the Commission retain separate physician and dental directors who must ensure any investigative findings based on the necessity or quality of care be reviewed by a qualified expert. [read post]
20 Jun 2013, 12:41 pm
If you need assistance defending a Medicare audit or need help creating a compliance plan to address pain management risk areas, please contact an experienced healthcare attorney at 248-544-0888. [read post]
14 Jun 2013, 12:53 pm
The Resolution Agreement shows how efforts to respond to press or media reports, patient or other complaints, physician or employee disputes, high profile accidents, or other events that may involve communications not typically run by privacy officers can create big exposures. [read post]
14 Jun 2013, 11:45 am
Obstruction Allegations During Audit. [read post]
10 Jun 2013, 7:57 pm
The policy also applies to non-physician practitioners, including nurse practitioners, physician assistants, and certified nurse specialists. [read post]
