Health Care Fraud News January 2015

Health care fraud is serious business. Stay clear of the path these providers chose. Chicago, IL- 10/2014: A dermatologist was convicted (3 counts of wire fraud and 3 counts of mail fraud) of defrauding Medicare and private payors by submitting false claims for more than 800 patients totaling over $2.6 million. The provider falsely documented hundreds of medical records to support medically unnecessary, cosmetic treatments for patients falsely diagnosed with actinic keratosis. The provider is awaiting sentencing in February 2015 but could face a maximum penalty of 20 years in prison and a $250,000 fine on each count, or an alternate fine totaling twice the gross fraud loss or twice the gai

Mississippi Medicaid Billing Boosters January 2015

PCP Bonus The federal Primary Care Physician program may have ended in 2014, but during 2014 the Mississippi DOM was granted authority by the Legislature to CONTINUE reimbursing eligible providers, as determined by the ACA, at 100 % of the Medicaid fee schedule. This bonus is available for qualifying physicians and non-physician practitioners. Effective 7/1/2015, reimbursement of primary care services provided by eligible providers will be at 100% of the fee schedule in effect as of January 1 of each year. To receive the bonus, providers who qualify must accurately “self-attest” by completing the 1/1/2015-6/30/2016 Self-Attestation Statement Form. Don’t delay! The deadline to submit the S

Medicare Billing Boosters January 2015

Value –Based Reimbursement HHS announced on January 26, 2015 that they have now set explicit goals to move toward a value-based reimbursement approach sooner than expected. They want to By the end of 2016: Tie 30% of fee-for-service Medicare payments to quality or value through alternative payment models, such as accountable care organizations or bundled payments and tie 85% of traditional Medicare payments to quality or value By the end of 2018: Tie 50% of fee-for-service Medicare payments to quality or value through alternative payment models, such as accountable care organizations or bundled payments and tie 90% traditional Medical payments to quality or value To read the announcement c

Hot Topics in Medical Billing for 2015

Let’s take a look at some of the 2015 hot topics in medical billing impacting health care providers. While some may be obstacles, others may become opportunities. Staying abreast of changes is now more important than ever- the financial health of your practice depends on it! ICD-10 Is On! ICD-10 is scheduled for implementation on October 1, 2015. Although history has proven that anything can happen, providers should not expect another delay such as we saw in 2014. If you haven’t already begun to review your coding, billing and documentation plans for ICD-10, you should make immediate plans to start! Did you receive training in 2014 but now need a refresher? Certainly any change is stre

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