Recent Articles

How to Use the CMS Approved Audit Issues as Compliance Guidance for Your Medical Practice

August 06, 2010 13:39

  While it is impossible to pinpoint the exact areas that Recovery Audit Contractors (“RACs") will target when reviewing medical bills sent to Medicare, each regional RAC is required to post its current “issues under review” and disclose to the public the specific codes...

Is Your Medical Practice Complying with Medicare's Documentation Requirements?

July 28, 2010 11:07

  When submitting medical bills to Medicare, it is important to note that for a Medicare claim to be paid (and retained after an audit), certain requirements must be met. For instance, (1)   There must exist sufficient documentation it the provider’s records to verify that...

What Protection Do Medicare Providers Have When Being Audited by Recovery Audit Contractors?

July 26, 2010 10:41

  When implementing the Recovery Audit Contractor (“RAC”) program, Medicare incorporated a variety of limitations and requirements that RACs are required to abide by when conducting audits on Medicare providers. Most significantly, Medicare providers should be aware of the...

What Protections Do Medicare Providers Have When Being Audited by Recovery Audit Contractors?

July 26, 2010 10:41

  When implementing the Recovery Audit Contractor (“RAC”) program, Medicare incorporated a variety of limitations and requirements that RACs are required to abide by when conducting audits of Medicare providers. Most significantly, Medicare providers should be aware of the...

A Primer on the 1995 and 1997 Documentation Guidelines for Evaluation and Management Services

July 09, 2010 13:24

  After a recent post discussing preparation and maintenance of medical records, I received several requests for further information regarding the 1995 and 1997 Documentation Guidelines for Evaluation and Management (“E/M”) Services that I briefly discussed. The 1995 guidelines are...

AUDIT DEFENSE - PART I: Monitoring Your Practices Medical Records

July 06, 2010 13:00

“If it isn’t documented, it hasn’t been done.” This axiom is synonymous with the health care industry and is especially relevant when discussing audit defense. Whenever I sit down with a new audit defense client, my first three questions are always the same - “What...

Can Your Medical Practice Afford to Keep Treating Medicare Patients?

June 30, 2010 13:00

While Congress continues to tackle the difficult decision of when (not “if”) to implement a 21% cut in Medicare payments to physicians, medical practices are facing the equally difficult decision of whether they can afford to keep treating Medicare patients. On June 24, the House of...

U.S. Department of Justice Uses the False Claims Act to Recover $2.85 Million from New York City Ambulance Companies for Medicare Fraud.

June 21, 2010 18:27

On June 4, 2010 the U.S. Department of Justice announced the recovery of $2.85 million dollars from three New York City ambulance companies – SEZ Metro Corp., SEZ North Corp. and Big Apple Ambulance Service Inc. – to resolve false claims made to Medicare under the False Claims Act...

U.S. Department of Justice Uses the False Claims Act to Recover $2.85 Million from New York City Ambulance Companies for Medicare Fraud.

June 21, 2010 18:27

On June 4, 2010 the U.S. Department of Justice announced the recovery of $2.85 million dollars from three New York City ambulance companies – SEZ Metro Corp., SEZ North Corp. and Big Apple Ambulance Service Inc. – to resolve false claims made to Medicare under the False Claims Act...

What Must Health Care Practices Consider When Entering A Debt Collection Service Agreement?

February 16, 2010 01:45

When hiring a third party collection agency to recoup receivables due for unpaid health care services, there are a few key questions that health care practices must ask before entering a Debt Collection Service Agreement. 1. Will we need to disclose Protected Health Information (“PHI”)...