Part B Insider (Multispecialty) Coding Alert
Doctor Pays Fine for Wandering off PATH
Physician-presence rules in the teaching hospital setting are among the oldest compliance hot buttons around, but the feds haven't let up on investigating claims that sometimes go back a decade or more. In a recent settlement between the U.S. Department of Justice and a Philadelphia orthopedic surgeon, the doctor had to pay only single damages plus interest to resolve the case, not the astronomical fines the feds sometimes pursue. According to U.S. Attorney Patrick Meehan, Richard Rothman and his billing company, Reconstructive Orthopaedic Associates, will pay just more than $838,000, plus interest, to settle charges that he billed as the attending surgeon for procedures when he wasn't in the operating room long enough to satisfy Medicare reimbursement rules. Rothman countered that he "provided all of the services expected of a physician both as a matter of proper medical care and as required by all regulations relating to reimbursement," according to settlement documents. The claims at issue in the case dated back to 1993 through 1996. As part of the settlement, Rothman will enter into a five-year integrity agreement.
Part B Insider (Multispecialty) Coding Alert
- REIMBURSEMENT:
Know 'Hot Buttons' Before You Press Them
Stop! Are you dangling audit bait in the water? Certain codes are almost guaranteed to [...] - CODING:
If You're Downcoding on Purpose, You're Burning Cash
Many physicians are so beaten down by fraud probes and carrier audits that they're punishing [...] - Congress Pays for SARS, Smallpox
The $79 billion supplemental spending bill for fiscal year 2003 includes $2.23 billion for first [...] - COVERAGE:
PET Scans Now Covered for Thyroid Cancer and Cardiac Diseases
If your clinic performs positron emission tomography scans, you could be in for a big [...] - COVERAGE:
Don't Leap Past Basic Exams to Expensive Test
Soon you'll have a new diagnostic tool for arterial problems - but don't overuse it, [...] - TEACHING HOSPITALS:
Doctor Pays Fine for Wandering off PATH
Physician-presence rules in the teaching hospital setting are among the oldest compliance hot buttons around, [...] - DIAGNOSIS CODING:
CMN Doesn't Need to Justify Diagnosis Code, CMS Says
You may still be in the dark as to which ICD9 Codes to put on [...] - FRAUD & ABUSE:
Physician Deals With Hospitals Are Under Scrutiny
If your practice is working with a hospital, you may be in for scrutiny from [...] - CODING:
Don't Let the Bell Curve Fool You
If you're concerned that you may be downcoding, then it's important to have a certified [...] - HIPAA:
Lawsuit Aims to Slow HIPAA Juggernaut
Privacy advocates and other healthcare groups representing patients who charge that the Health Insurance Portability [...] - CODING:
New Codes Mean Changes for Billing Surgical Dressings, Defibrillators
Physicians and suppliers have a host of new "K" codes to get familiar with thanks [...] - INFUSION:
At Your Service, IV Providers Tell Medicare
Instead of paying per widget, the home-infusion industry wants Medicare to pay per diem for [...] - MODIFIERS:
Your Billing May Revolve Around Global Periods
If a patient comes back after surgery with a problem related to the diagnosis that [...] - COMPLIANCE:
Considering E-Mail Consultations? Read This First
The point-and-click era has patients clamoring for electronic access to their physicians, but before a [...] - MEDICAL REVIEW:
Bring Medical Review Into Greater Focus
Why is the insurance carrier picking on you? It may seem random, but there's usually [...] - FRAUD & ABUSE:
OIG Heats Up Griddle the Carriers Make You Dance On
You may be hearing frequently from carriers about some codes you bill often, but it [...] - DRUG REIMBURSEMENT:
CMS Invites Least Costly Alternative for Drugs
Medicare's new Single Drug Pricer doesn't mean that the Centers for Medicare & Medicaid Services [...] - PHYSICIAN NOTES:
CDC Sees HIV as Fertile Ground for Prevention
"Prevention efforts have stalled" on HIV, with 40,000 new infections now occurring annually in the [...] - ENROLLMENT:
Providers, Suppliers Face New Enrollment Standards
A wider range of Medicare providers could be subject to site visits to verify their [...]
