Six Financial Arrangements Successfully Pass OIG Scrutiny

In six recently released advisory opinions, the Office of Inspector General (OIG) gave clearance to several programs and financial arrangements, finding that sufficient safeguards had been put in place to prevent violations of the Social Security Act and the anti-kickback statute.  The OIG announced that the following arrangements would not be subject to civil monetary penalties or sanctions:

Retired LCDs Pose a New Problem for Clinical Laboratories

The retirement of a LCD is considered by many to be a blessing rather than a problem because while a LCD is active, claims denials are automatic if the requirements of the LCD are not met. This forces the provider to obtain an advance beneficiary notice (ABN). Further, laboratories must maintain a database of LCD edits and update them when LCDs change or new ones are issued. Many think this all goes away when a LCD is retired. Think again!

Medical Associations Challenge FTC's Interpretation Of "Red Flag" Rules

American Medical News Article on FTC Red Flag Rules

Amy Sorrel of AMNews wrote a recent article discussing the Red Flag Rules and the delayed enforcement: "New Federal Trade Commission regulations to combat identity theft have taken physicians and the health care industry by surprise and prompted the agency to delay enforcement from Nov. 1 to May 1, 2009."

False Statement Within Claim Does Not Result In Liability Under FCA

Effect of Untrue Certification of Compliance in Annual Cost Report

A provider's certification of compliance with Medicare statutes and regulations as stated in an annual cost report does not render all claims submitted for reimbursement by that provider false under the False Claims Act (FCA) if that statement is not true.

The 2009 CPT Update Has Been Released!

The January 1, 2009, CPT annual update has been released by the AMA. To avoid denied claims for improper coding beginning January 1st, all providers must implement this annual update over the next two months - not an easy thing to accomplish for any staff! To help, we've compiled the following summary to give you a sample of the larger procedural services that are changing.

Can you define "child" for coding purposes?

Recently a customer asked us what the definition of “child” is for coding purposes. Our own research on this topic has proven inconclusive so we wanted to put this out there to others in the field for consideration and feedback.

Let’s start by considering a general definition for child. When you think of the word "child" as a general term what is the true definition? Next, is there a specific catch-all definition for child or does it truly differ for a specific code or payment system?

FTC Delays Identity Theft Prevention Program Compliance Deadline

New Red Flag Compliance Deadline - May 1, 2009!

Just this afternoon, the FTC announced that it would delay the deadline to comply with the new Red Flag Rules from November 1, 2008 to May 1, 2009.  The delay is to due to the confusion and uncertainty created in certain industries over whether the rules apply to them.  "Many entities also noted that because they generally are not required to comply with FTC rules in other contexts, they had not followed or even been aware of the rulemaking, and therefore learned of the requirements of

Reimbursement Integrated Library- July 2008

Reimbursement Integrated Library

Dennis Barry’s Reimbursement Advisor

Each month, Dennis Barry’s Reimbursement Advisor includes two or three articles the offer practical
analysis on specific aspects of healthcare provider reimbursement. The
newsletter is particularly helpful in explaining some of the more complex areas
of Medicare reimbursement and regulation. A good example of this is the lead
story in the July 2008 issue on Medicare bad debt. The article explains how a


Subscribe to RSS - blogs