Part B Insider (Multispecialty) Coding Alert
Look Twice at These 5 JV Warning Signs
You should take notice if your joint venture exhibits any of the following five elements, which the OIG views as particularly problematic: 2. You don't operate the business yourself, nor do you commit "substantial financial, capital, or human resources to the venture." 4. You and the other entity both benefit financially from the venture. That is, your partner "takes its share in the form of payments under the various contracts with [you]," and you get extra money from the business you wouldn't receive otherwise, the April 23 OIG bulletin explains. 5. The amount of money you make from the venture depends on the "value or volume of business" you generate. There should be "no hint" that distribution of profits is tied to referrals or production volume, insists Joan Dentler, principal and CEO of ProNet HealthCare Strategies in Austin, Texas. This list is making people squirm because it "reflects a lot of current arrangements," says attorney Linda Baumann with Reed Smith in Washington.
1. You expanded into a line of business that depends on your own referrals to survive.
3. The entity you've joined forces with is a would-be competitor. Warning: This has "kickbacks" written all over it.
Part B Insider (Multispecialty) Coding Alert
- DIAGNOSIS CODING:
Be Very Virtuous When Submitting V Codes - REIMBURSEMENT:
MedPAC Stands by Physician Pay Raise Recommendation - CORRECT CODING INITIATIVE:
CMS Reverses CCI Edits for TEE
When the doors of reimbursement close on a procedure you perform regularly, don't despair. Sometimes [...] - DIAGNOSIS CODING:
When Can V Codes Stand Alone?
How long after you remove a tumor can it serve as the primary diagnosis for [...] - TELEMEDICINE:
Telemedicine, Regular Medicine Both Have Same Result
What's the difference between counseling someone on managing her diabetes via video and in person? [...] - FRAUD & ABUSE:
OIG May Dislocate Your Joint Venture
Durable medical equipment companies won a starring role in the HHS Office of Inspector General's [...] - COVERAGE:
CMS Plans to Reach Out for Tech Advice
If you think you're having a hard time keeping up with the galloping advances in [...] - LMRPS:
Carriers Unveil Spate of Draft LMRPs
Need summer beach reading? Your carrier may have just the thing. Carriers are putting out [...] - INCIDENT-TO BILLING:
Ask Your Local Carrier About Incident-To Requirements
How far away from a physician can nonphysician practitioners stray before incident-to billing goes away? [...] - CODING:
Are You Using Modifier -59 Correctly? Quick Test Will Say for Sure
If you're slapping modifier -59 on your claims like there's no tomorrow, doomsday could in [...] - COMPLIANCE:
Drugmaker Guidance Could Have Wide Reach to Physicians
If you're accepting free services or payments as an inducement to prescribe a particular drug, [...] - DIAGNOSIS CODING:
CDC Readies New ICD-9 Codes
Starting in October, you could have a whole new way to look at Pap smear [...] - Physicians Still Lag on HIPAA, Survey Says
The compliance deadline for the HIPAAprivacy rule has come and gone - but physicians still [...] - E-CONSULTS:
ACP Seeks to Put 'E' in Medicare - DOCTOR'S NOTES:
Physician Payment Reforms Could Be on the Way
Don't panic! That's the message one prominent Washington law firm is sending physicians. At press [...] - Look Twice at These 5 JV Warning Signs
You should take notice if your joint venture exhibits any of the following five elements, [...] - UPCODING:
E/M Upcoding Leads to $1.36 Million Payout
Here's one more reason to be sure your evaluation and management coding practices are up [...] - COMPLIANCE:
'Set-In-Advance' Stark Setback Buys Physicians Time
Teaching hospitals and medical foundations bracing for a potential paperwork nightmare July 7 received a [...] - Montana Blues Sings Apologetic Song
One carrier took April Fools' Day a little too far this year, it now admits. [...]
