http://trishakolens.posterous.com/springhill-group-medical-how-to-prevent-medic Over the years, Medicare has been proactive in its efforts to bring awareness to Medicare fraud, a national problem that costs the program millions of dollars each year. The Medicare program relies heavily on a number of sources to assist them in the detection and prevention of Medicare fraud including professionals of the healthcare industry. Overview of Medicare Fraud Medicare fraud generally refers to willfully and knowingly billing medical claims in an attempt to defraud the Medicare program for money. Anyone found guilty of Medicare fraud is subject to exclusion from participation in the Medicare program in addition to fines and possibly imprisonment. Most Medicare fraud occurs in these areas: • Billing for DME • Billing for physicians services • Billing for institutional services such as nursing homes, hospitals, hospice, etc. Be Aware of Common Schemes There are four popular Medicare fraud schemes. 1. Medical Equipment Never Provided The most common area of Medicare fraud is billing for Durable Medical Equipment (DME). DME refers to any medical equipment necessary for a patient’s medical or physical condition. It includes wheelchairs, hospital beds, and other equipment of that nature. The provider will bill Medicare for equipment that the patient never received. Mobility scooters have been particularly popular for Medicare fraud schemes. 2. Services Never Performed In this instance, the provider bills for tests, treatment or procedures never performed. This can be added to the list of tests a patient has actually received and never be noticed. A provider may also falsify diagnosis codes in order to add on unnecessary tests or services. 3. Upcoding Charges Misrepresenting a level of service or procedure performed in order to charge more or receive a higher reimbursement rate is considered upcoding. Upcoding also occurs when a service performed is not covered by Medicare but the provider bills a covered service in its place. 4. Unbundling Charges Some services are considered all inclusive. Unbundling is billing for procedures separately that are normally billed as a single charge. For example, a provider bills for two unilateral screening mammograms, instead of billing for 1 bilateral screening mammogram. Medicare Fraud Indicators There are certain indicators that are common in the detection of Medicare fraud. Is your practice: • Routinely waiving copayments and deductibles for Medicare patients without checking for their ability to pay? • Charging higher rates to Medicare patients compared to other persons for similar services? • Missing treatment documentation such as physician or nurses notes? What to Do If I Suspect Fraud? It is your responsibility as a representative of the healthcare industry to be aware of and report any fraudulent activity suspected. If you would like to report suspected Medicare fraud, contact the Department of Health and Human Services or the Office of Inspector General for further assistance. http://springhillmedgroup.com/
Video: 2011 HEAT Provider Compliance Training – Overview of Centers for Medicare and Medicaid Services
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Upcoming Deadlines Chiropractors Need to Know
As DC’s we have a “special” status in the Medicare system; we are neither full-fledged physicians (like MD’s) but we are also more than practitioners (like PT’s). To quote the Medicare Benefit Policy Manual “The opt out law does not define “physician” to include chiropractors; therefore, they may not opt out of Medicare and provide services under private contract.” (Ch 15, Section 40.4). Basically, this means you
CAHs Can Include Capital Lease Equipment Costs in Medicare EHR Incentive Payments
In July, the Centers for Medicare & Medicaid Services (CMS) changed its position on the inclusion of assets acquired through capital leases in the assets eligible for the Medicare EHR Incentive Payment. In a revision to a previous series of frequently asked questions, CMS states it will allow assets acquired through a capital lease to be included in the cost of eligible electronic health record (EHR) assets. However, this revision does not apply to operating leases, which are still excluded from assets eligible for the EHR incentive payment. The cost of an operating lease may continue to be included on the cost report as reimbursable cost.
Maine Writer: Medicare for All
Non-profit Health Care Administrator and Registered Nurse. B.S. with a major in Nursing and Masters in Health Services Administration. I grew up in Baltimore (Dundalk), Maryland. http://davidrcrews2.blogspot.com/ Therefore, I continue to root for the Baltimore Orioles despite protests from my Boston Red Sox neighbors. My husband of 40 years is retired Navy, and I was a Navy Wife for thirteen years (my husband Richard retired after 23 years). We love living in Maine in the summertime, but we’re always preparing for another winter. If you would like to comment on any of my blogs please send me an e-mail firstname.lastname@example.org. I publish all comments, uncensored, relevant to the content of the blog. I look forward to hearing from you. If you are interested in my list server Friends-L please contact me at email@example.com and put list server in the subject line. I hope to hear from you.
Medicare Reimbursement: Medicare Payment Methods for Providers, Medicare Advantage Plans, and Medicare Part D Drug Plans
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National Provider Call: New Medicare Preventive Services
The Centers for Medicare & Medicaid Services (CMS) will be holding a National Provider Call on Wednesday, August 15 from 2-3:30 p.m. EST. On the call, CMS experts will provide an overview of the new preventative services covered by Medicare, when to perform them, who can perform each service, who is eligible and how to code and bill for each service.
Supporting Every Provider in Delivering Better, More Coordinated, Patient
We want to make sure that healthcare providers interested in forming ACOs have the opportunity to do so. That’s why we created the Advance Payment Model—to provide entities such as rural and physician-owned organizations that hope to become ACOs in the Medicare Shared Savings Program with the support they need to invest in staff and in health information technology. They will repay Medicare through savings they achieve.
Premier Launches New Collaborative to Support ACO Preparation
In a press release announcing the new collaborative, Robert Gerberry, associate general counsel of Summa Health System, Akron, Oh., said in a statement that “Premier provided resources that helped us with a successful Shared Savings Program application. Through Premier,” Gerberry said,” we had direct access to representatives from the Centers for Medicare & Medicaid Services for application questions, opportunities to speak with other healthcare organizations going through the same process, and exceptional consulting expertise as we drafted our application.” Gerberry led the preparation of the MSSP application for the NewHealth Collaborative, an ACO launched by Summa and a group of northeast Ohio physicians.