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Update: CMS’s Proposed Changes to the Physician Fee Schedule for 2019

Following up on our September 4th, 2018 post “MGMA Opposes Proposal to Consolidate E/M Codes”, The Coding Network has been actively tracking the status of the sweeping changes to the Physician Fee Schedule for 2019 proposed by the Centers for Medicare & Medicaid Services. The complete language of CMS’s proposed rule can be found online at https://www.regulations.gov/document?D=CMS-2018-0076-0621.  According […]

By |October 17th, 2018|Medical Coding News and Recent Articles|Comments Off on Update: CMS’s Proposed Changes to the Physician Fee Schedule for 2019

Stuart Doctor Charged in Twenty-Six Count Federal Health Care Fraud Indictment

A specialist has been accused of submitting social insurance misrepresentation out of her training in Stuart, Florida. The U.S. Lawyer for the Southern District of Florida, Shimon R. Richmond, Special Agent in Charge, U.S. Division of Health and Human Services, Office of Inspector General (HHS-OIG), Miami Regional Office, Robert F. Lasky, Special Agent in Charge, […]

By |October 16th, 2018|Medical Coding News and Recent Articles|Comments Off on Stuart Doctor Charged in Twenty-Six Count Federal Health Care Fraud Indictment

Medicaid and Medicare Telehealth Payments Fails to Meet Medicare Requirements

OIG reviewed 191,118 Medicare paid distant-site telehealth claims, totaling $13.8 million, that did not have corresponding originating-site claims. The watchdog agency then reviewed provider supporting documentation to determine whether the services met Medicare’s requirements for reimbursement. 31% of the telehealth claims did not. Specifically:

24% were unallowable because the beneficiaries received services at nonrural originating […]

By |October 12th, 2018|Medical Coding News and Recent Articles|Comments Off on Medicaid and Medicare Telehealth Payments Fails to Meet Medicare Requirements

Batesville Lady Blamed for Overbilling Medicaid for Preferred Family Health

A previous charging assistant at Preferred Family Health has been captured on doubt of Medicaid extortion. Vicki Chisam, 65, of Batesville is blamed for purposely putting forth false expressions to the Arkansas Medicaid Program from January 2015 to Nov. 9, 2015 in the interest of the facility. The excessive charges, as indicated by Attorney General […]

By |October 10th, 2018|Medical Coding News and Recent Articles|Comments Off on Batesville Lady Blamed for Overbilling Medicaid for Preferred Family Health

Southeastern Connecticut Doctor Settles under the False Claims Act for Nearly 100K

John H. Durham, United States Attorney for the District of Connecticut, today declared that HELAR CAMPOS, MD, a doctor with a training in New London and Norwich, has gone into a common settlement with the administration in which he will pay $99,912 to determine charges that he abused the False Claims Act.

Read the Full Story […]

By |October 4th, 2018|Medical Coding News and Recent Articles|Comments Off on Southeastern Connecticut Doctor Settles under the False Claims Act for Nearly 100K

VCU Agrees to Settle For $4 Million

Virginia Commonwealth University Health System Authority (VCU), which works VCU Medical Center and related human services offices in Richmond, consented to pay $3,994,151 to settle claims for charging excessive charges paid by Medicare, Tricare, and the Federal Employees Health Benefits Plan (FEHB) for administrations rendered to patients.

Read The Full Story Here!

By |October 3rd, 2018|Medical Coding News and Recent Articles|Comments Off on VCU Agrees to Settle For $4 Million

$65M False Claims Act Lawsuit Shows Need To Improve Coding & CDI Compliance

In August, Ontario, Calif.- based Prime Healthcare Services paid $65 million to settle assertions it disregarded the False Claims Act by conceding patients who just required outpatient mind and participating in upcoding.

Read The Full Story Here!

By |September 19th, 2018|Medical Coding News and Recent Articles|Comments Off on $65M False Claims Act Lawsuit Shows Need To Improve Coding & CDI Compliance

AMA Releases 335 Coding Changes For 2019

The American Medical Association has released the 2019 Current Procedural Terminology code set.

The code set was released Aug. 31, and the AMA announced the release Sept. 5.

Six things to know:

1. The new code set consists of 335 code changes.

2. Code changes include three new remote patient monitoring codes, as well as two new interprofessional internet […]

By |September 14th, 2018|Medical Coding News and Recent Articles|Comments Off on AMA Releases 335 Coding Changes For 2019

Detroit Podiatrist Goes To Prison for Health Care Fraud

A Detroit-territory podiatrist was condemned to 28 months in jail today for his investment in a $1 million plan including podiatry benefits that were charged to Medicare however were never rendered.

Read The Full Story Here!

By |September 13th, 2018|Medical Coding News and Recent Articles|Comments Off on Detroit Podiatrist Goes To Prison for Health Care Fraud

AMA Releases 335 Coding Changes For 2019

The American Medical Association has released the 2019 Current Procedural Terminology code set.

The code set was released Aug. 31, and the AMA announced the release Sept. 5.

Six things to know:

1. The new code set consists of 335 code changes.

2. Code changes include three new remote patient monitoring codes, as well as two new interprofessional internet […]

By |September 7th, 2018|Medical Coding News and Recent Articles|Comments Off on AMA Releases 335 Coding Changes For 2019