Posted and filed under Compliance.

Targeted Probe and Educate (TPE) is Back

The tagline from the CMS Website is “When Medicare Claims are submitted accurately, everyone benefits.” First – TPE why do we even care?  Well, simple answer, it is a lovely little gift from CMS designed to help reduce claim denials and appeals through one-on-one help.  As we can attest thorough masses of audits of provider…

Read the full article

Posted and filed under Compliance, FWA.
Posted and filed under Compliance.

HIPAA & Human Error

Many of us have visited a doctor’s office. And in many circumstances our doctors visit includes a follow up correspondence of some sort. Whether it was a medical assistant contacting a patient to set up his/her next doctor’s visit, or in some cases a follow up notification from your doctor informing you of the results…

Read the full article

Posted and filed under Compliance.

The Role of State Boards of Dentistry (Part 2)

by guest contributor, Mark R. Brengelman, JD, MA Previous: The Role of State Boards of Dentistry (Part 1) This article provides another part into the perspective on the role of state boards of dentistry implementing the regulation of the practice of dentistry as a health care profession.  This article continues as a second part to…

Read the full article

Posted and filed under Compliance.

The Role of State Boards of Dentistry

by guest contributor, Mark R. Brengelman, JD, MA This article provides an initial perspective on the role of state boards of dentistry, which exist in each state and which regulate the practice of dentistry as a health care profession.  This article begins as a first part to this perspective (1 of 2 part series). Each…

Read the full article

Posted and filed under Compliance.

The Corporate Practice of Medicine

Recently, we were contacted by the Chief Financial Officer (CFO) of a medical group that provides primary care, urgent care and podiatric care to patients at several locations. The business operates as a corporate practice of medicine. The CFO had no prior healthcare experience. The Chief Operating Officer (COO) also had no prior healthcare experience….

Read the full article

Posted and filed under Compliance, Fraud, FWA, Healthcare.

Legal Violations Against Physical Therapists: Part II

It’s more than money when your license is on the line.  This week’s Fraud Spotlight features guest contributor Mark R. Brengelman, JD, MA. Be sure to tune into the column for more expert insights from our network of providers, investigators, and fraud experts. This article continues a multi-part series that will be covering the top ten violations…

Read the full article

Posted and filed under Compliance, Fraud, FWA, Healthcare.
Posted and filed under Compliance, Dental, Fraud, FWA.

Dental Fraud from a Different Perspective

This week’s Fraud Spotlight features guest contributor Mark R. Brengelman, JD, MA. Be sure to tune into the column next week for more examples of dental fraud from real cases! This article points out a unique aspect about dental fraud that has significant impacts on the dental office and the dentist who practices there –…

Read the full article

Posted and filed under Compliance, FWA, Healthcare, Payers.

MSP 101: A Brief Overview

Friend of Advize and healthcare payer expert Dino Kasdagly put together a helpful resource for healthcare professionals looking to quickly refresh their knowledge on Medicare as a Secondary Payer practices. Below you will find several popular instances in which Medicare benefits are secondary to Group Health Plan (GHP) benefits.  If the documented employer has more…

Read the full article