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About Christian Roule

Christian works as the Site Administrator and Content Copywriter for The Coding Network. He is a published author and a member of the IT Team.

Whistleblower Sharing in Settlement from Prime Healthcare

By |August 20th, 2018|

A San Diego whistleblower will receive $17. 2 mil with the settlement of a 7-year-old false statements|lawsuit against Prime Healthcare Care regarding overbilling for Medicare services at California hospitals.

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Prime Healthcare Services To Settle False Claims Act Allegations

By |August 17th, 2018|

Prime care Services, Inc., Prime care Foundation, Inc., and Prime care Management, Inc. (collectively Prime), and Prime’s Founder and Chief exective officer, Dr. Prem Reddy, have united to pay the u. s. $65 million to settle allegations that fourteen Prime hospitals in Calif. wittingly submitted false claims to health care by admitting patients World Health Organization needed solely more cost effective, patient care and by asking for costlier patient diagnoses than the patients had (a apply called “up-coding”), the Justice proclaimed these days. below the settlement agreement, Dr. Reddy pays $3,250,000 and Prime pays $61,750,000.

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Proposed 2019 E&M Overhaul Impact Analysis

By |August 16th, 2018|

You don’t have to be a coder to realize what the financial impact of proposed changes from the Centers for Medicare & Medicaid Services (CMS) will be, or to see that there will be winners and losers. Using 2016 data (since data from last year hasn’t yet been released), in the aggregate, winners would have […]

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Owner of Ambulance Company Pleads Guilty To Health Care Fraud

By |August 15th, 2018|

The owner and managers of Arrow-Med Ambulance, Inc. plead guilty in connection with claims of fraud to Medicare and Medicaid. The accusation was of them using ambulances for medically unnecessary transports.

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eClinicalWorks Fined For Failing To Comply With DOJ Settlement Agreement

By |August 7th, 2018|

The Inspector General of the Department of Health and Human Services fined eClinicalWorks $132K for violating a 2017 agreement which had required them to report patient safety issues with its EHR in a timely manner.

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OIG Estimates Medicare Improper Payments at $3.7 million

By |August 6th, 2018|

The Office of Inspector General (OIG) reviewed 191,118 Medicare paid distant-site telehealth claims, totaling $13.8 million, that lacked corresponding originating-site claims. The watchdog agency then reviewed provider supporting documentation of these claims to determine if the services met Medicare’s requirements for reimbursement. 31% of the telehealth claims did not.

Now is the time to fully understand Medicare telehealth claim requirements and nail down its coding, and […]

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Medicare Cuts For Academic Hospitals

By |August 3rd, 2018|

Scholastic and country healing centers will probably observe a cut in Medicare subsidizing if the CMS concludes a proposition to diminish repayment for more-complex patients, as indicated by a Moody’s Investors Service examination discharged Monday.

Under the CMS’ recently proposed installment structure, the organization needs to level installments for a few charging codes instead of paying […]

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Evaluation & Management Coding Handbook 2018

By |August 1st, 2018|

According to CMS, Evaluation and management (E/M) codes are the most frequently reported—and the most audited. In a study referred to by CMS, the OIG noted that 42% of claims for E/M services were incorrectly coded. Medicare reports a 65-70% error rate for codes 99215, 99223, and 99233. Upcoding and the misuse of modifier 25 are problematic. Widespread issues include the inherent […]

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Georgia Emergency Physicians Sue Anthem Over ER Policy

By |July 30th, 2018|

The MAG (Medical Association of Georgia), alongside the American College of Emergency Physicians, sued Anthem for payment denial of some emergency department services.

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Southwest Orthopaedics Physicians to Pay Settlement

By |July 25th, 2018|

9 specialists from Southwest Orthopaedics (based in OKC) agreed to pay $670,000 to settle civil claims stemming from allegations they submitted false claims.

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