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Articles Posted in Payer Reimbursement

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Concierge Medicine Practices: Medicare Compliance Risks

Increasingly, our healthcare and business law firm’s clients are interested in opening concierge medicine practices.  Little Health Law’s last blog post provided an overview of what concierge medicine is with references to compliance risks.  This post outlines those very serious compliance risks for practices that treat Medicare patients and are…

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What to do if Your Medicare Privileges are “Deactivated”

There are numerous adverse actions that can be taken against a provider’s Medicare ordering and referring or billing privileges.  In general, however, deactivation is not considered such an “adverse action” that will reflect on the providers PECOS; however, it does “stop” your ability to use your Medicare privileges.  If you…

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AseraCare Settlement with DOJ A Win for Hospice Providers Under Federal False Claims Act

In a landmark federal False Claims Act case closely watched for many years by hospice administrators, other healthcare providers and legal experts, last week the Department of Justice (DOJ) entered a joint dismissal in settlement of the case against AseraCare Inc., a national hospice provider company.  The settlement marks an…

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Fraud and Abuse Update: Billing Schemes and Medicare Fraud and the OIG’s National Health Care Fraud Takedown

In our Georgia business and healthcare law firm, we have noticed that cases involving Medicare fraud and billing compliance issues are published on virtually a daily basis, underscoring the critical need that physicians, nurses and other care providers and billing professionals exercise caution and vigilance in billing Medicare or other…

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CMS Announces Numerous Rule Changes

In early August, the Centers for Medicare & Medicaid Services (CMS) published an updated set of guidelines stating that hospitals will now be required to annually publish a list of charges online. CMS announced that the change in guidelines will “help improve access to hospital price information” and “give patients…

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DOXIMITY STUDY SHOWS UPTICK IN PHYSICIAN DEMAND AND COMP IN 2017

Earlier this month, Doximity released a new study that provides a national review of physician compensation information and job trends, as the strong trend of physician employment by hospital systems continues.  Doximity, formed in 2011, is “the largest community of healthcare professionals in the country,” according to its website. More…

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Fraud and Abuse Update: HHS Issues Health Care Fraud and Abuse 2016 Report

The United States Department of Health and Human Resources (HHS) and the United States Department of Justice (DOJ) recently issued a joint annual report for 2016 (the Report) providing details about the federal fraud and abuse program and, in particular, annual financial recoveries.  Fraud and abuse law enforcement efforts continued…

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HHS Complains of Court Order to Fix Medicare Appeals Backlog

The US Department of Health & Human Services (HHS) says that it cannot meet the requirements of a federal court order to reduce the horrible backlog of Medicare appeals cases that for many years has plagued the United States and adversely impacted the ability of health care providers to be…

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Physician Credentialing

Overview Credentialing is used to evaluate physicians for different purposes and is required of almost all physicians. It is utilized by hospitals when evaluating physicians for medical staff positions and hospital privileges and when enrolling in health insurance plans as a participating provider. Unfortunately, this process has not been streamlined and…

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General Accounting Office Issues Findings Regarding Medicare Appeals Backlog

Earlier this month, the United States General Accounting Office (GAO) issued its monthly anticipated report (the Report) to Congress about the status of the Medicare Appeals backlog.  The Report states on the first page, “Opportunities Remain to Improve Appeals Process,” which is a gross understatement and will likely be received…

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