Affordable Care Act Fraud Criminals Facing Tougher Sentences Due to the Affordable Care Act, criminals convicted of fraud now face tougher sentences and more jail time. Criminals will receive 20 to 50 percent longer sentences for crimes that involve more than $1 million in losses. “The government’s successes in prosecuting and winning health care fraud…
How are eye exam codes defined? CPT includes four codes that specifically describe eye exams: 92002: Medical exam and evaluation with initiation of diagnostic and treatment program; intermediate, new patient. 92004: Medical exam and evaluation with initiation of diagnostic and treatment program; comprehensive, new patient, one or more visits. 92012: Medical exam and evaluation with…
In May 2014, the Department of Health and Human Services, Office of Inspector General (OIG) published a proposed rule updating its regulations. The proposed rule will authorize civil monetary penalties for “failure to report and return a known overpayment,” among other issues. The rule has outlined the penalty for failure to report and return overpayments…
One of our Auditors, Mary Ireland, participated in the “Race for Hope” hosted by Canterbury Race Track in Shakopee, Minnesota on August 9th, 2015. The Canterbury Race Track, which is a horse racing track, hosts this event every year. Derby hats were made for the event and donated by various groups/stores and individuals, to raise…
On July 31st, 2014, the U.S. Department of Health and Human Services (HHS) issued a rule finalizing Oct.1, 2015 as the new compliance date for health care providers, health plans, and health care clearinghouses to transition to ICD-10, the tenth revision of the international Classification of Disease. ICD-10 will provide an enhancement platform for physician…
Our diet! Tooth decay results from the acid produced when sugar and oral bacteria in the mouth combine and feed off each other. Frequently consuming foods higher in acid content can lead to irreversible dental erosion. Dental erosion is the breakdown of the tooth’s structure; the outer layer called enamel. Dental enamel is the thin…
5. If your employer does not currently require ICD-10 proficiency they likely will in the very near future. As we all know, ICD-10 is quickly approaching and it’s being implemented on October 1st. This is the system that everyone is going to be required to use, which is why it’s so crucial that all healthcare…
How many physical examination elements can you extract from this documentation? VS: 124/80, Pulse: 74, Weight: 174 pounds CTA A&Ox3 No CCE Answer below: Answer: Six Constitutional – Vital Signs Respiratory – Clear to Auscultation (CTA) Psych – Alert and Oriented X 3 (A&Ox3). No CCE; (Clubbing, Cyanosis, Edema) Musculoskeletal (Clubbing) Cyanosis (Skin) Edema…
What are the 3 core health activities where a covered entity could disclose a patient’s PHI? Answer: The core health care activities of “Treatment,” “Payment,” and “Health Care Operations” are defined in the Privacy Rule at 45 CFR 164.501.