• Waiting for the Medicare therapy cap exceptions process to expire once again at the end of 2010? Good news: It may hang on for another two years. In mid-Sept 2009, Sen. Max Baucus (D-Mont.) released a summary of legislation that…

Check out this succinct ‘million dollar statement’ to cinch documentation requirements. Are your cardiology or specialty practice’s evaluation and management services garnering fair Medicare payment – or are they a ticket to potential reimbursement recoupments and worse? The answer can lie in…

Plus: You’ll face a 10-day payment delay from MACs as they update their claims systems to reflect changes. Good news: Despite Centers for Medicare and Medicaid Services’ (CMS) plans to downgrade your 2010 conversion factor by 21.29 percent, the government stepped…

The case stirs debate over the ethics of auditors turning complainants. Genesys Health System recently paid close to $670,000 to settle a False Claims Act lawsuit initiated by an internal auditor who blew the whistle on alleged upcoding of cardiology evaluation…

Modifier AI will denote the primary physician of record, now that consult coding is a thing of the past. Center for Medicare and Medicaid Services (CMS) will no longer reimburse you for consultations effective Jan. 1, 2010, but your physicians will…

Keep incident to billing and assistant supervision issues separate. If you’ve been concentrating on how to bill incident-to services, you may have overlooked one tricky area: supervision rules for outpatient physical therapists. Medicare incident-to rules require that a physician billing incident-to must…

Medicare doesn’t consider locum tenens an appropriate billing scenario for an uncredentialed physician. Myth: Tired of waiting for your new physician’s Medicare credentialing to process? You can just report the new doctor’s service under an existing physician’s ID number and append…

This New York cardiologist spent time under the OIG’s microscope, only to learn he was billing properly. Turns out the old saying is true: If you haven’t done anything wrong, an Office of the Inspector General (OIG) audit is nothing to…

Marquez bought $55M worth cars, horses, and diamonds. On Jan 5, 2010, Ihosvany Marquez, of Miami-Dade County, was indicted on charges of conspiring to commit Medicare fraud on a scale rarely seen before. Another defendant in the same case – Michel De…

Find out what the OIG views as signs of illegal “swapping” arrangements. When reports of pharma kickbacks involving nursing homes hit the media, you know it’s time for your facility to review how it’s doing business with pharmacy and other ancillary…