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

ComplyTrack Changes

Catch the Latest ComplyTrack Wave -- What's New in 5.0 This Week

This week’s changes focused mostly on the Contract and Relationship Manager.

Some new fields were added

In Manage Representatives, a new field was added to record the effective date for each permission and review. We also added a field to record the representative’s birthday.

In the contract sub-agreement, a new field was added to record description and notes.

In the contract, we added a field to record the Owner.

Health Care Compliance Update: June 2008

Health Care Compliance Update: June 2008

Hot Topics
• Recovery Audit Contractors
• Medicaid Enforcement
• OIG’s revised self-disclosure requirements
• Electronic medical records/Health information technology
• Quality of care
• Hospital acquired conditions or “Never events”

Health Care Compliance Letter
Volume 11-10, May 13, 2008

Fraud and Abuse

More MAC J1 LCD's added to MediRegs

MAC J1 LCDS for CA, Guam, HI, NV, American Samoa and North Marianna Islands

Attention American Samoa, California , Guam, Hawaii, Nevada and North Marianna Islands LCD users.....MAC J1 LCD's are here!!
Attention American Samoa, California , Guam, Hawaii, Nevada and North Marianna Islands LCD users…..MAC J1 LCD’s have been posted on the MediRegs Regulation and Reimbursement Suite site as of today (6/16/08). Please see your state library or the LCD library to view the new MAC J1 LCD’s today!


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