The Federal Government Investigating COVID-19 Fraud

COVID-19 Fraud The federal government is broadening its multi-agency law enforcement effort to address pandemic-related fraud beyond Paycheck Protection Program (PPP) related cases to encompass alleged instances of healthcare-related COVID-19 fraud. The subjects and targets of these investigations and prosecutions include alleged bogus telemedicine encounters, falsifying COVID-19 vaccination cards, and the misuse of healthcare provider […]

Role of States in Exclusion of Ground Ambulances from NSA

Exclusion of Ground Ambulances from No Surprises Act The No Surprises Act (NSA) will prohibit most surprise bills, reducing out-of-pocket costs for emergency services and non-emergency services where the patient unintentionally sees an out-of-network provider. The recently enacted No Surprises Act (NSA) provides landmark protections against surprise billing in a wide range of settings but […]

Understanding Medicare TPE Audits

Medicare TPE audits: The Centers for Medicare & Medicaid Services (CMS) is resuming the Targeted Probe & Educate (TPE) audit, effective September 1, 2021. Based on data analysis of claims payment, CMS will identify areas with the greatest risk of inappropriate program payment. CMS’s Targeted Probe and Educate (TPE) program is designed to help providers […]

Medicare Coverage for Vagus Nerve Stimulation (VNS)

Vagus Nerve Stimulation (VNS) is a pulse generator, similar to a pacemaker, that is surgically implanted under the skin of the left chest and an electrical lead (wire) is connected from the generator to the left vagus nerve. Electrical signals are sent from the battery-powered generator to the vagus nerve via the lead. These signals […]

Basics of Provider-Based and Teaching Physician Services

Provider-Based Physician Services Providers may retain physicians on a full-time or part-time basis in, for example, the fields of pathology, psychiatry, anesthesiology, and radiology, and in many instances (especially in teaching hospitals) in other fields of medical specialization as well. Any one of these physicians may be engaged in a variety of activities including teaching, […]

Practice Management Guidelines to Improve Practice Collections

Receiving accurate insurance reimbursement for delivered services is always been a challenge for healthcare providers. Practice owners spend most of their time and energy on doing administrative tasks of medical billing to receive sufficient insurance reimbursements to cover overhead expenses and provide quality care. But often they make this task even harder by doing sloppy […]

Choosing Desired Medical Billing Company for Your Practice

Outsourcing your revenue cycle operations to a medical billing company is the right move toward securing the financial stability of your practice. However, choosing any medical billing company could cause more headaches than benefits. Medical Billers and Coders is a leading medical billing company providing complete medical billing and coding services. While interacting with our […]

2022 Revised Codes for Principal Care Management

In the Final Medicare Physician Fee Schedule (MPFS) for 2022 issued on November 2, 2021, the Centers for Medicare and Medicaid Services (CMS) added five new CPT codes in the categories of Chronic Care Management (CCM) and Principal Care Management (PCM) and increased reimbursement for already existing codes in the same categories. These codes are […]

Avoiding False Claim Billing for your Practice

Understanding False Claims Act As a healthcare practice, you can typically submit claims to Medicare or Medicaid. Your claims are bills for goods you provide and services you conduct for patients. These federal health insurance programs cover the costs associated with your services. The False Claim Act is a federal law that makes it a […]

Understanding Physician Self-Referral Law (Stark Law)

Physician Self-Referral Law (Stark Law) Basics The Physician Self-Referral Law, commonly referred to as the Stark law, prohibits physicians from referring patients to receive Designated Health Services (DHS) payable by Medicare or Medicaid from entities with which the physician or an immediate family member has a financial relationship unless an exception applies. Financial relationships include […]

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