Posted and filed under Coding, Dental, Fraud, FWA.

Dental Fraud: Isolated or a Pattern?

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 some basics of dental misconduct – fraud.  A dentist who bills for services not performed is committing fraud.  For example, billing for the…

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Posted and filed under Coding, Healthcare.

Teaching Physician Guidelines

Billing and documentation guidelines are not the same in all 50 states. A statement such as, “I saw and evaluated the patient. I agree with the resident’s documentation,” may be acceptable in some states, but in other states, the Medicare Administrative Contractor (MAC) would consider this to be a generic attestation, and require the teaching…

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Posted and filed under Healthcare.

Understanding the Quality Payment Program

Andy Slavitt, the Acting Administrator of the Centers for Medicare and Medicaid Services (CMS), recently published a detailed blog post outlining the Quality Payment Program (QPP). QPP is slated to begin January 1, 2017. If you are unfamiliar with QPP, let’s back up a bit. In 2015, the Medicare Access and CHIP Reauthorization Act (MACRA) was signed into law…

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Posted and filed under Coding, FWA, Payers.

Vision vs. Medical Coverage Making You Bleary-Eyed?

Billing issues, to an extent, are expected in any physician or healthcare provider office. Most patients are in possession of both medical and vision benefits coverage, and this duality often causes confusion in ophthalmology offices. Certain procedures that are performed in an ophthalmology office should be billed as medical procedures, and do not apply to…

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Posted and filed under Careers, Medical Record Auditing.

Advantages to Utilizing an External Auditing Firm

External auditors, or auditors who work for external auditing firms, are often trained in a variety of specialties and have experience in auditing for many different payers, providers, and facilities. Hiring an external auditor is extremely advantageous because they are equipped with knowledge and experience that allows them to not only identify problems, but to…

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