With the current healthcare environment many providers looked to alternative methods of treating patients and achieving outcomes this past year due to the pandemic. To meet the needs of their patients, and their financial obligations many providers implemented services that were not customary to their practice, or their billing departments. As is the case for any office that begins to provide something new there is always the potential for error in any aspect of the practice involved with the patient or claim. Therefore, I believe it is a great time to refresh providers on the procedures for reporting and returning Medicare overpayments as they are discovered moving forward.
As many of you are aware in 2016 the Centers for Medicare and Medicaid Services (CMS) published a final rue pursuant to Section 1128J(d) of the Social Security Act (the Act), as amended by the Affordable Care Act, that requires Medicare Parts A and B health care providers to report and return overpayments 60 days after the date an overpayment is identified, or the due date of any corresponding cost report, if applicable, whichever is later. If credible information indicates that an overpayment exists, the rule requires that a reasonably diligent inquiry must be performed.
Due to the increasing number of forms being required these days it is all too common for practices to get lost in the vast terminology, rules, and coding requirements that have to be followed as well. An area that practices have one of the most difficult times with is operationalizing the issuance of an ABN properly. I am frequently asked to consult for practices that ask who does which part, when, and with whom in regards to ABNs? In other instances, many practices I have worked with simply make the mistake that they can solve the complexities of trying to understand the nuances of how to properly utilize ABNs by deciding to issue ABNs to every Medicare patient for every service which is not a viable option either. The solution that many offices try that I just described is called issuing blanket ABNs, which in turn may cause Medicare to invalidate all issued ABNs from the practice, including those that may been appropriate which is why it is very important that blanket ABNs are never issued.
One thing in common with practices that issue ABNs in a proper manner is that they all have a process in place for identifying potential denied services prior to delivering them. To many practices this may sound easy, but to ensure that your practice is as effective as possible it will take some claims data analysis to ensure that your practice is capturing all potential opportunities for ABN issuance. The aim of this article will be to provide practices with 5 steps that will make ABN issuance easier.
This question is a redundant question, if it is my intellectual property, then by definition – I own it. True, but this question raises important issues that employers need to worry about – ownership of intellectual property. The general rule is that if your employees create intellectual property while they are working for you, the employer will own it. So, for example, if your office manager takes some pictures around the office and creates personal bios of your employees and puts that information on your website then you own that information. However, what if they created that information at night while they were not at work and technically you were not paying them? Well, now we are getting into a greyer area. So, my recommendation is to avoid this issue, by updating your HR manual to state that you own the intellectual property, and not your employees.
Whether you’ve been in practice for years or you’re just graduating, buying an existing dental practice can be a great way to quickly enter into an already established patient base without the pains of starting up from scratch. While it may seem like a daunting task, the right team can make the purchase transaction flow as smoothly as possible. Here’s a list of important things to consider when negotiating the purchase.
The healthcare industry is doing its level best to keep fax machine manufacturers in business. Because fax machines are considered to be HIPAA compliant, it’s easy to keep them humming along. Paying for expensive toner, electricity and the telephone line attached to the wall behind the machine is just the way we’ve always done it. But that telephone line should give you enough reason to consider your options.
AT&T built and owns the copper telephone network that provides the analog signal required for T1 lines, traditional telephones, fax machines, credit card machines, postage meters, alarms and elevators. That service is known as POTS – Plain Old Telephone Service. Maintaining that antiquated network is costly and inefficient for AT&T so they will retire POTS in the near future. All services will eventually run over fiber optic cables and your equipment may have to change to keep up. You may have received a letter telling you about this transition but probably ignored it or did not even open it thinking it was a solicitation. So, how does AT&T get your attention if you won’t read their letter? Check your phone bill!
Commercial leases are arguably the most one-sided contracts you could enter into while doing business. Most, if not all, commercial property owners and landlords will shift all of the liability of the premises onto the tenant. This includes maintenance, repair and replacement of structural components, roofs, wiring, plumbing, and even store fronts and sidewalks.
While a majority of the terms in a lease are “non-negotiable” there are a number that landlords can reasonably agree to change.
Healthcare fraud continues to be a significant priority for the U.S. Department of Justice. On February 24, 2021, the DOJ’s Criminal Division Fraud Section published its annual “Fraud Section Year in Review 2020.” While the Fraud Section has three separate enforcement units, the Health Care Fraud (HCF) Unit is responsible for all enforcement activities in the health care industry. The Unit’s focus is to protect against fraud and abuse in federal health care programs and recoup illicit gains.
During 2020, the HCF Unit operated 15 strike forces in 24 federal judicial districts throughout the U.S. The efforts of these strike forces led to charges against 167 individuals alleging $3.77 billion in fraudulent charges for health care paid for by federal and state programs. This should cause any health care provider to stand up and take notice. And enforcement in the health care industry is not likely to go away soon with so many schemes ripe for the government’s picking and generating recoupment on behalf of the federal health care programs.
Here are couple of the latest schemes that have landed pharmacies, pharmacists and other health care professionals squarely in the crosshairs of federal enforcement:
IV hydration therapy has many applications and purposes. In the most common cases, the purpose is for post-surgery recovery or wellness optimization. IV therapy businesses that want to offer a more concierge type of service by offering mobile or in-home services, need to be aware of Florida home health agency laws and regulations.
In most cases, the limited liability company, or LLC, is the preferred business structure for a wide variety of healthcare businesses. If you’re a licensed professional, you can also use the professional limited liability company, or PLLC for your healthcare practice or business. While generally these two entity types are the same, there’s a small difference to be aware of when organizing the company.
Health law is the federal, state, and local law, rules, regulations and other jurisprudence among providers, payers and vendors to the healthcare industry and its patient and delivery of health care services; all with an emphasis on operations, regulatory and transactional legal issues.