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    Whether you’re provider, medical coder, practice, practice manager, or auditor, you need to be knowledgeable of federal regulations that relate to fraud, abuse, and compliance. Stay in the know: The five most important Federal fraud and abuse laws that apply to physicians are the False Claims   Read more..
    Posted on 24 Jul, 2018
    Learn the Ins and Outs of Healthcare Fraud, Abuse, and Compliance
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    The Office of Inspector General (OIG) plays an important role in negotiating, developing, and enforcing corporate integrity agreements (CIAs). As a condition of settlement in a variety of civil and false claim cases, OIG will require an organization to incorporate a CIA in exchange for   Read more..
    Posted on 17 Jul, 2018
    Understanding the Ins and Outs of Corporate Integrity Agreements
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    What is a compliance plan? A compliance plan is a collection of steps that a provider, organization, or practice establishes to ensure adherence to federal and state regulations. OIG developed voluntary compliance program guidance in an effort to help organizations with their compliance programs. Resources   Read more..
    Posted on 13 Jul, 2018
    How to Write an Effective and Powerful Compliance Plan
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    Medicine codes for both therapeutic and diagnostic services include injections, physical medicine, and rehabilitation services. These are some of the most difficult services to audit and, as a result, some of the most frequently audited in the medicine section of CPT®. Injections and infusions Injections and   Read more..
    Posted on 10 Jul, 2018
    How to Overcome Challenges in Medicine Auditing
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    Doctors deal with interruptions every day. They need to call a patient back. The coding department asks them for clarification on a patient charge. Clinicians and staff come in to talk to them. Although the intention is there, the physician may not document the information   Read more..
    Posted on 3 Jul, 2018
    Connect the Documentation Dots to Revenue Outcomes
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    Coding is integral to claim submission. To prepare and submit a claim for reimbursement, you need documentation of all services and procedures performed and the reason, providing a diagnosis for each to demonstrate medical necessity. Medical practices use a superbill, also called an encounter form,   Read more..
    Posted on 27 Jun, 2018
    Staking Your Claim
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    In 2003, Medicare established their Fee for Service (FFS) Recovery Audit Program as part of the Medicare Prescription Drug, Improvement, and Modernization Act. Recovery Auditors held a three-year-long demonstration project across six states, between 2005 and 2008, to determine the potential for identifying improper reimbursement   Read more..
    Posted on 21 Jun, 2018
    What You Need to Know About Recovery Audit Contractors (RACs)
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    Medicare pays telehealth services under the Medicare fee-for-service program, with a larger payment made to the consulting physician or practitioner (at the distant site) than the payment made to the facility at the site where the patient is located. According to a MedPAC report, from 2014-2016   Read more..
    Posted on 5 Jun, 2018
    Ace Medicare Telehealth Reimbursement Basics—Part I
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    Like all CPT® codes, E/M codes are universal and used by Medicare, Medicaid, and most other payers for processing claims for a physician’s professional services. You should also use E/M service codes for billing facility services on an outpatient basis. Because evaluation and management services are   Read more..
    Posted on 17 May, 2018
    How to Nail Down Levels of E/M Services & Secure Optimal Reimbursement
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    Providers should not let the EMR code for them. If it does, the providers need to override the system and only use it as a guide. The EMR is not equipped to understand nuances of medical-decision making that only a provider could determine. Say yes   Read more..
    Posted on 19 Apr, 2018
    10 Tips for Keeping Compliance Issues at Bay

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