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Am I Double-Billing This Radiology Procedure?
Question: A patient suffered a blow to the head and displayed symptoms of dizziness, sleepiness, slurred speech, and confusion. To check for internal injuries and aneurysm, the attending doctor ordered a CT scan (70460), which revealed no evidence of serious…
Continue reading...Can a provider pay patients for referrals?
5. October 2009
Question: I know that there are restrictions on gifts that providers who receive Medicare or Medicaid payments can give other doctors for referrals, and they cannot pay them for such referrals. But are providers restricted from paying their…
Continue reading...What Are the Compliance Guidelines for New Patient Freebies?
28. September 2009
Question: What kind of gift can a provider give new patients? Can the provider advertise an iPod for every new braces patient, for example? Answer: If the patient is not a Medicare or Medicaid beneficiary, you don’t…
Continue reading...What Ambulance Services Are Excluded From SNF Consolidated Billing?
21. September 2009
Question: So the OIG has advised CMS to audit SOME ambulance services for Part A SNF residents, which are incorrectly billed to Part B. What ambulance services are excluded…
Continue reading...Should We Try a DIY Annual Report for Our CIA?
14. September 2009
Question: Our practice was under OIG scrutiny, and long story short, we’re now under a five-year corporate integrity agreement (CIA). We’re required to submit an annual report to the OIG to outline our compliance activities, but aren’t sure how to…
Continue reading...CMP Does Not Require Exclusion from Medicare
8. September 2009
Question: We believe the government is about to impose a civil monetary penalty (CMP) on our health care organization. Is it possible that we might still be allowed to participate in the Medicare program? Or does a CMP always go…
Continue reading...Do I Have To Be Concerned With EMTALA Compliance?
1. September 2009
Question: A patient comes to our medical office, presenting with inner ear pain and dizziness. He cannot pay his copay. Do we have to see this patient under EMTALA? Answer: If a patient cannot pay, a physician practice doesn’t have…
Continue reading...How Do I Calculate Fair Market Value for Stark?
25. August 2009
Question: I work for a health care provider that owns the office building. The owners want to rent a bit of empty office space in the building to another provider. Since referrals between the two are possible, we want to…
Continue reading...Stay a Step Ahead of the RACs With 2 Strategies
29. July 2009
Question: We think we’ve found a billing system error at our SNF that may have led to some incorrectly coded claims. With the stepped-up MAC and RAC audits going on out there, what do we do? Answer: Giving your claims…
Continue reading...Does ‘The Consultant Told Me to Do It’ Hold Up in Court?
2. June 2009
Snake charming? No, thank you. Texas hospital pays nearly $10 million for inflated outlier charges If your health system has increased charges to potentially increase outlier reimbursement, you’d better have the documentation…
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26. October 2009
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