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…
The clock was about to strike midnight, and Scott Newman was desperately feeding pages into a scanner, trying to prevent thousands of dollars in prescription payments from turning into a pumpkin. As the owner of Newman Family Pharmacy, an independent drugstore in Chesapeake, Virginia, he was responding to an audit ordered by a pharmacy benefit…
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…
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…
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…
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….
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…
Over the past few weeks, we have been engaging with clients on a variety of topics, the most recent being the discussion of “code rotation.” Some have asked what we mean when we discuss this term of art. We had often heard this term used by our retired OIG agents and thought it was an…
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 –…
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…