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
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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. …
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Understanding Medicare Overpayments
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…
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Offering Discounts (or Waivers) of Coinsurance/Copayments to Patients as an Out-of-Network Provider
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…
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New Study Suggests Defensive Medicine May Be Effective in Reducing Malpractice Liability
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. …
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The Switch to ICD-10
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…
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First Court Decision on the Medicare/Medicaid 60-day Overpayment Rule
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…
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Expanded Authority for CMS to Deny Enrollment and Revoke Medicare Billing Privileges
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,…
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CMS Prepares for Physician Fee Schedule Cut
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…
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Pennsylvania Senate Bill would Limit Retroactive Denials
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…
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