Blog

VA Proposal Would Expand Access to Care Via Telemedicine

Challenged by limited healthcare resources, the U.S. Department of Veterans Affairs has issued a proposal that would allow VA healthcare providers to serve patients across state lines via telehealth, regardless of where they are licensed to practice. For fiscal year 2016, VA healthcare providers had 2.17 million telehealth episodes serving more than 700,00 veterans, 45 […]

GAO: CMS Fraud Prevention Working

The days of “pay and chase” in the world of healthcare fraud are waning thanks to fraud prevention methods that the Centers for Medicare and Medicaid Services have put into place. A newly released report from the Government Accountability Office (GAO) finds that Fraud Prevention System (FPS), which analyzes fee-for-service claims to identify healthcare providers […]

Government Cracking Down on Genetic Testing Labs

As the use of genetic testing has grown in popularity, so too have the number of investigations into allegations that these labs may be paying kickbacks to physicians for ordering unnecessary tests. Most recently, two testing labs, Proove Biosciences in Irvine, Calif. and Dallas-based Next Health LLC, have been under investigation for doing just that. […]

CMS Issues Guidance on When a Hospital is a Hospital

Is your hospital really a hospital? Well, that depends on whether Medicare deems it so. Earlier this month, the Centers for Medicare & Medicaid Services issued clarifying guidance on what constitutes a hospital. Under these new guidelines, holding a state hospital license isn’t necessarily the end-all for receiving Medicare reimbursement. CMS says it will now […]

Joint Commission Issues Alert on Hand-off Communication

“What we have here is a failure to communicate” is a line from the 1967 film Cool Hand Luke. It’s also a problem in the world of healthcare when one provider hands over a patient’s care to another for continued care and treatment. Earlier this month, the Joint Commission issued a new Sentinel Event Alert […]

The FCA and the Use of Statistical Sampling

The U.S. Department of Justice late last month agreed to a $275,000 settlement in a False Claims Act case against a South Carolina-based company that operates elder care facilities. What’s significant about this case is that two years earlier, the DOJ rejected a significantly higher – $2.5 million – settlement. In the initial case, United […]

New vs. Established Patient Billing: Are You Doing It Properly?

It’s no secret that the Department of Health and Human Services Office of the Inspector General (HHS OIG) has been scrutinizing how Medicare pays providers for new and established patients. Such scrutiny has resulted in providers having to pay back millions for incorrectly billing for a new patient visit when the visit should have been […]

CMS Revamps Medicare Audit Strategy

Good news for some healthcare providers and not so good news for others. The Centers for Medicare & Medicaid has announced changes to its Medicare audit strategy in an effort to root out fraud and abuse. The new process is based on a pilot program that CMS introduced in 2014 in which the agency combined […]

Have Physicians Embraced the Use of End-of-Life Billing Codes?

It’s been about a year since the Centers for Medicare and Medicaid Services (CMS) approved payment for voluntary end-of-life counseling as part of its 2016 Medicare physician fee schedule. A recent article in Modern Healthcare suggests that many physicians are using the codes to have important end-of-life planning conversations with patients. The codes (99497 and […]

Proposed Opioid Bill Ensures Patient Privacy While Helping MDs Make Rx Decisions

An estimated one-in-three Americans had a prescription for opioids in 2015 and that number continues to grow. With that growth has come a startling increase in the number of overdose deaths. The National Center for Health Statistics reported that overdose deaths hit a record 19.9 per 100,000 population in the third quarter of 2016, up […]