Called by some the “King of Nursing Homes” for his many low-income nursing home patients in northeast Illinois, Dr. Venkateswara Kuchipudi was recently convicted for referring patients to Sacred Heart Hospital in Chicago in exchange for kickbacks. Kuchipudi became the fifth physician and tenth defendant to be convicted for a massive Medicare and Medicaid fraud scheme that led to the … Continue Reading
Billing & Reimbursement
CMS Finally Makes Reasonable Changes to 60-Day Overpayment Rule
The Affordable Care Act (ACA) requires Medicare providers to return overpayments within 60 days of the date they are identified in order to avoid liability under the False Claims Act. Four years ago, CMS issued a proposed rule to implement this statutory requirement that would have placed a substantial burden on providers to identify and return overpayments within the 60-day … Continue Reading
Understanding Medicare Overpayments
By Todd Rodriguez on
Under the federal Affordable Care Act, physicians and other providers have only 60 days to refund overpayments to the Medicare program before they face potential liability under the False Claims Act. In addition, if CMS or the Medicare Area Contractor (MAC) identifies an overpayment, physicians have a limited period of time to respond or reply to the overpayment demand before … Continue Reading
Offering Discounts (or Waivers) of Coinsurance/Copayments to Patients as an Out-of-Network Provider
By Edward J. Cyran on
Commercial payors are actively looking for ways to reduce payments to out-of-network providers. One area of focus is discounts and waivers of patient copayments and deductibles by out-of-network providers. In the eyes of these payors, coinsurance/copayments are essential to incentivizing patients to use in-network providers, and discounts on (or waivers of) coinsurance/copayments by out-of-network providers often result in higher costs … Continue Reading
New Study Suggests Defensive Medicine May Be Effective in Reducing Malpractice Liability
By Edward J. Cyran on
A new study in the BMJ suggests that the more services a physician provides to his or her patients, the less likely the physician is to be sued for malpractice. The study examined the use of resources by attending physicians in several Florida acute care hospitals during a ten-year period from 2000-2009, in relation to the number of malpractice claims … Continue Reading
The Switch to ICD-10
By Edward J. Cyran on
The long-anticipated implementation of ICD-10 coding finally began this past Thursday, October 1, 2015. As of that date, government and commercial payors ceased to accept claims under the old coding system (ICD-9). The transition has been five years in the making due to a government delay in 2012.
The new system has five times the codes of the prior system, … Continue Reading
First Court Decision on the Medicare/Medicaid 60-day Overpayment Rule
By Edward J. Cyran on
You may have heard some years ago that the Affordable Care Act established a “60-day overpayment rule” that requires a provider to report and return any overpayment from a federal health care program (such as Medicare or Medicaid) within 60 days of “the date on which the overpayment was identified” by the provider (for certain institutional providers, the overpayment must … Continue Reading
Expanded Authority for CMS to Deny Enrollment and Revoke Medicare Billing Privileges
By Edward J. Cyran on
You may have heard that CMS recently expanded its authority to deny enrollment and revoke the Medicare billing privileges of providers and suppliers. The new changes could affect any physician, group practice or other Medicare provider or supplier. As the changes are wide reaching, all Medicare providers and suppliers, and anyone providing support services for such providers or suppliers (such … Continue Reading
CMS Prepares for Physician Fee Schedule Cut
By Todd Rodriguez on
Posted in Billing & Reimbursement, Medicare
As of today’s date, Congress has not yet fixed or even patched the expected 21% cut to the Medicare Physician Fee Schedule. A eNews alert sent out today by the Centers for Medicare and Medicaid Services notifies physicians of the following:
“The negative update of 21% under current law for the Medicare Physician Fee Schedule is scheduled to take … Continue Reading
Pennsylvania Senate Bill would Limit Retroactive Denials
By Todd Rodriguez on
Posted in Billing & Reimbursement, Pennsylvania Law
These days, more often than not, physicians and up on the short end of the stick when it comes to new health care legislation. However, last month a bill was introduced by Senator David Argall which, if passed, would give physicians and other healthcare providers important protection against retroactive insurance denials. Specifically, Senate Bill No. 554 would limit the period … Continue Reading