In recent years, we have seen an emerging number of physicians and health care providers transitioning to concierge, direct-to-consumer practices. Many providers no longer want to deal with the hassles of billing insurance,...more
Getting in to see your doctor is not always as easy as picking up the phone. Often, there is a several-week-long wait for an opening, and the doctor your insurer covered last year may no longer be in-network this year. That...more
Helpful hints -
OIG Updates Health Care Fraud Self-Disclosure Protocol (“SDP”) -
On November 8, 2021, the OIG issued an updated SDP to providers, which included clarifications of existing guidance and increased the minimum...more
11/16/2021
/ Centers for Medicare & Medicaid Services (CMS) ,
Disproportionate Share Adjustments ,
Employer Mandates ,
Health Insurance Portability and Accountability Act (HIPAA) ,
Healthcare ,
Healthcare Fraud ,
Medicaid ,
Medicare ,
OIG ,
Outpatient Prospective Payment System (OPPS) ,
Physician Fee Schedule ,
Self-Disclosure Requirements ,
Vaccinations
With the increased audit activity we are seeing among the alphabet soup of Medicare contractors— RACs, ZPICs, SMRCs, CERTs, etc.—now appears to be a good time for a refresher on the Medicare claims appeals process. Due to...more